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Premature Ejaculation

Premature ejaculation (PE) is believed by many urological practitioners and sexual health experts to be the most common sexual disorder among men. Studies show that between 20-30 percent of men between the ages of 18 and 59 have experienced ejaculating prematurely for some portion of their lives. Despite this high prevalence very few men seek treatment. The good news is that there are several treatments. Seeking your treatment from a board certified urologist is advised.

The definition of ejaculation is when a man reaches sexual climax and semen is ejected from his penis. Premature ejaculation is:

  • Ejaculation occurs before the man wishes it to occur.
  • Ejaculation occurs too quickly to sexually satisfy his partner.

How does ejaculation work?

Ejaculation is a primitive, yet complex reflex which involves:


  • Hypothalamus, amygdala, thalamus
  • Pons - Nucleus Paragigantocellularis

Spinal cord

  • Sacral reflex level S1
  • S1-3


  • Sympathetic nerves – pelvic plexus L1
  • Sensory nerves
  • Pudendal nerve

What Causes Premature Ejaculation?

Most men have experienced premature ejaculation at one time or another. As an example, almost all men have had some type of premature ejaculation if it has been a long time since they have had sex. Premature ejaculation is only a problem when it becomes a persistent condition, and more so, if it is a problem for the man with PE, or their partner.

There have been several clinical studies performed specific to physiology mechanisms. These include serotonin receptors, a genetic disposition, hyperarousal, excitable ejaculatory reflex, elevated penile sensitivity, and nerve conduction atypicalities. PE may also be caused by prostatitis, or a drug side effect.

What are the Treatments?

Behavior therapy

This targets your ability to recognize when you are about ready to ejaculate, and how to take steps to delay it.

  • Biofeedback—electrical feedback that helps you learn to control the muscles that cause ejaculation.
  • Start and stop method—stopping sexual stimulation for 30 seconds when nearing climax, then resuming.
  • Squeeze method—same as start and stop method, but includes gently squeezing the base of penis before the 30-second stop period.
  • Sexual positions—trying different sexual positions that may allow greater control over the muscles that cause ejaculation.

Psychological counseling

Counseling may be offered for an individual or for a couple. It is aimed at identifying and treating:

  • Fears or guilt which have resulted in PE
  • Interpersonal problems with your partner that may contribute to the condition


In some cases, a doctor may prescribe a desensitizing cream such as lidocaine and prilocaine . It can be applied to the penis to lessen sexual stimulation. In other cases, a doctor may prescribe a serotonin reuptake inhibitor (SSRI) therapy (e.g. sertraline, paroxetine, fluoxetine, citalopram, or dapoxetine); or alternatively, use of an agent with SSRI-like effect.

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