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Premature Ejaculation

Premature Ejaculation involves a persistent or recurrent pattern of ejaculation during partnered sexual activity within one minute of vaginal penetration and before the individual wishes it.  On average, most men engage in sex for a period of 3 to 6 minutes before achieving orgasm.  A problem with Early Ejaculation is assumed if a man is unable to exercise control over ejaculation for a period of longer than one minute (or if the man ejaculates just before commencing sex).

Sexual functioning can be effected by many factors including alcohol or other drug use, medical issues (e.g., medical procedures or medication) and personal factors such as tiredness and stress.  Hence, some men may experience short periods of Premature Ejaculation influenced by these factors and which resolve in their own time.  Therefore, Early Ejaculation is only considered to be a psychological problem if it persists for a minimum of 6 months and is experienced on all or almost all occasions of sexual activity (i.e., more than 75% of the time).  Early Ejaculation is only considered a psychological problem if it causes the couple or one individual significant distress, as some couples may not be bothered by a relatively short period of sex.

Some general guidelines have been proposed to describe the level of severity for this problem.  Mild Premature Ejaculation is considered if ejaculation occurs within 30 seconds to 1 minute of sexual intercourse.  Moderate Premature Ejaculation is considered if ejaculation occurs within15-30 seconds of sex commencing and Severe Premature Ejaculation is considered if ejaculation occurs prior to intercourse or within 15 seconds of commencing sex.

Like many other psychological conditions, Early Ejaculation can result in Mild, Moderate or Severe levels of emotional distress depending on the individual and couple concerned.  Early Ejaculation can sometimes effect a man’s self-esteem or cause anxiety about sex and sometimes may also cause personal distress for the man’s partner that in turn creates problems in the relationship.  Early Ejaculation may also effect men regardless of sexual orientation.  Other factors include whether the problem is lifelong or acquired.  If the problem has been present since the individual became sexually active it is considered lifelong.  If the problem commenced after some months or years of normal sexual functioning it is considered acquired.  The condition may also be situational or generalised.  If situational, the problem only occurs with certain types of stimulation, situations or partners.  If generalised, the problem is not limited to specific types of stimulation, occurs in different situations and/or with different partners.

What causes Premature Ejaculation?

Early Ejaculation can be caused either by psychological or physical factors or a combination of both.  A good place to start if you suspect you are experiencing Early Ejaculation is to speak with your GP or a sexual health physician firstly to determine if there is a physical basis for the problem.  Many men who experience Early Ejaculation report that their sense of poor control over the problem leads to apprehension or anxiety about sex with their partner/future partners.  An important fact for men and couples to consider is that many men would like to engage in sex for longer periods of time before ejaculating, however this is not necessarily evidence of Premature Ejaculation as a psychological problem.  On average men typically engage in sex for between 3 to 6 minutes before ejaculation.  An individual may desire to engage in sex for longer periods of time than average but be unable to do so, however despite this desire the individual would not be considered to suffer Premature Ejaculation if he was able to engage in intercourse for an average length of time.  Some men also experience variations in how much control they have over ejaculation over time and this is also considered perfectly normal (i.e., some men may able to exercise control for 5 minutes or longer some days and only 1 minute at other times).

Physical causes of Premature Ejaculation:

Genetics play a role in lifelong Premature Ejaculation.  Some men are unable to engage in sex for average periods (i.e., 3-6 minutes) as they are ‘biologically programmed’ to come more quickly, this is the case particularly for men with lifelong Premature Ejaculation.  Medical issues including Hyperthyroidism, Prostatitis or drug withdrawal may play a role in acquired Premature Ejaculation (i.e., for men who typically have been able to have sex for a normal length of time previously).  Onset might be sudden or may be slowly more noticeable over time, but medical management of these illnesses then resolves acquired Premature Ejaculation.  Premature Ejaculation is not diagnosed as a psychological condition if it occurs in the context of illicit substance use, as in these instances the problem usually resolves itself when the drug is no longer used.

Psychological counselling may still be important even if the cause of Premature Ejaculation is physical or medical.  Physical causes of Premature Ejaculation can create anxiety, which in turn can make the problem worse.  A psychologist will be able to provide you with information and support to manage the effects of Premature Ejaculation on your relationship and ensure each of you can still enjoy a fulfilling sex life.

Psychological causes of Premature Ejaculation:

Relationship factors can play a role in Premature Ejaculation and involve such issues as discrepancies in desire for sexual activity or recurrent arguments and relationship problems.  Other influences include individual factors such as poor body image or a history of sexual or emotional abuse.  Cultural or religious influences may also affect sexual functioning – for example religiously based values and attitudes toward sexuality or certain activities can influence a person’s ability to experience sexual pleasure.

Some men have particular concerns that their partner will feel unsatisfied if they come too quickly, or they may feel like they’ve ‘failed’ in some important way.  These sorts of worries can create anxiety or stress which in turn makes Early Ejaculation more likely.  If the problem persists once any medical basis for Premature Ejaculation has been treated or ruled out, it is important at that point to speak with a psychologist who specialises in this area to effectively manage any concerns the man has about his performance and its possible impact on his partner.

How common is Premature Ejaculation?

Approximately 1% to 3% of men experience this problem at some stage in their lives.  Some studies have found that 20% to 30% of men report that they wish they could engage in sex for longer periods of time before ejaculation, however in most of these cases individuals are capable of engaging in sex for a ‘normal’ or average length of time (i.e., 3 to 6 minutes) and hence Premature Ejaculation is not diagnosed in these instances.

What are the steps in treatment for Premature Ejaculation?

Medication is typically the preferred treatment option for lifelong Early Ejaculation.  An approved treatment is Dapoxetine (Priligy) and others that may be useful include Prozac, Zoloft and Aropax taken as a single dose a few hours before sexual activity (daily use of these anti-depressants may also prove useful).  A Topical Anaesthetic that ‘numbs’ the area around the end and shaft of the penis may also be useful, although these should not be used on a long-term basis.

Medication may also prove useful for acquired Early Ejaculation, however it’s also important for men or couples to seek counselling on this problem.  Psychotherapy can help alleviate the anxiety, fears or worries that often accompany this condition and which may often result in worsening the problem.  Counselling will generally aim to explore what expectations for sex each partner has and how the couple can maintain intimacy and enjoy a fulfilling sex life even if this problem can’t be fully resolved.  Various techniques will be explored that the man/couple can implement to lengthen the time between commencing sex and ejaculation (such as increasing regularity of masturbation between occasions of sex or the use of masturbation some hours before sex).

Disclaimer:  The information covered on this website is for educational purposes only.  A diagnosis of any psychiatric or medical condition must only be made by a medical or mental health specialist.  Diagnosing a psychiatric concern is a complex process that involves formal training, do not ‘diagnose’ yourself.  If you have concerns that a particular disorder or condition applies to you, please speak with your General Practitioner for further assessment and medical/psychological care.

Individual counselling appointments are 50 minutes long.
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