Causes of Premature Ejaculation
There is no one clear cause for premature ejaculation. It may happen only in certain sexual situations or if it has been a long time since the last ejaculation. It may occur with a new partner. Anxiety, guilt, or depression can be psychological contributors in some cases. Medical issues such as hormones or prescription side effects should also be considered. With time and experience, most men learn to appropriately delay ejaculation on their own.
Diagnosis of Premature Ejaculation
Give us a call if you believe you are suffering from premature ejaculation. Your medical and sexual history will be discussed and we will perform a physical exam. Lab tests may be done in order to rule out any other underlying health factors that could be causing erectile dysfunction.
Treatment of PE
Treatment of premature ejaculation involves psychological, pharmacological, sexology and behavioural approaches. Even though there may not be a psychological cause of the PE, any man having this condition may develop a secondary performance anxiety that can benefit from psychological help. When considering treatment, consideration should be given to the man’s expectations of how long he should last as well as other factors such as the state of the relationship. Sometimes communication between the couple and simple adjustment of the couple’s sexual technique is adequate therapy.
The classic behavioural exercise is the stop start technique which involves repetitive stimulation of the penis each time stopping short of the point of ejaculatory inevitability allowing the arousal to temporarily subside. Over time this repetitive stimulation pushes back the point of ejaculation though it does require persistence and commitment over some months. The stop start technique can be carried out in 3 stages involving use of a dry hand, lubricated hand and finally penetration.
Another ejaculation delaying technique is the squeeze technique where the tip of the penis is firmly squeezed for about 10-15 seconds just before penetration.
Medication: The use of an anaesthetic spray combined with a condom may delay ejaculation. Stud Spray™ is available without a prescription from a pharmacy but must not be used without a condom. Pelvic floor exercises are said to improve erection quality and improve control of ejaculation. The only approved medication for the treatment of PE is dapoxetine (Priligy™). This medication is a short acting SSRI anti-depressant medication that is taken as a single dose between 1 and 3 hours before planned sexual activity. SSRI medication can be used off label on a daily basis though the medication must be taken daily without interruption for up to 1-2 years. If the PE occurs secondary to ED, then use of PDE5i may help both conditions.
Sex therapy and counselling can help PE even if the cause is physiological as the inevitable secondary psychological component can be treated which can help improve the outcome.
Mindfulness exercises may help treat performance anxiety, erectile dysfunction and premature ejaculation. This involves putting aside a 15-20 minute session about 2 or 3 times a week but not at a time when stressed or tired. Using yoga type relaxing breathing techniques during mindfulness exercises can be helpful. The idea is to create an erotic focus not just in the genital region but other pleasurable areas of the body. These exercises can be done on ones own or together with a partner. These exercises begin with clearing one’s mind of everyday life hassles and stressors. The genitals can be touched but are not necessarily the focus of the exercise though the stop start exercise for PE can be incorporated into this routine. Please view the separate document on mindfulness excercises.