Premature ejaculation is uncontrolled ejaculation either before or shortly after sexual penetration. It happens with minimal sexual stimulation and before the person wishes. It may result in unsatisfactory sex for both partners. This can increase the anxiety that may add to the problem. It is one of the most common forms of male sexual dysfunction. It has probably affected every man at some point in his life.
Most cases of premature ejaculation do not have a clear cause. With sexual experience and age, men often learn to delay orgasm. Premature ejaculation may occur with a new partner. It may happen only in certain sexual situations or if it has been a long time since the last ejaculation. Psychological factors such as anxiety, guilt, or depression can also cause it. In some cases, it may be related to a medical cause such as hormonal problems, injury, or a side effect of certain medicines.
The main symptom is an uncontrolled ejaculation either before or shortly after intercourse begins. Ejaculation occurs before the person wishes it, with minimal sexual stimulation.
Premature ejaculation can be lifelong or acquired. With lifelong premature ejaculation, the patient has experienced premature ejaculation since first beginning coitus. With acquired premature ejaculation, the patient previously had successful coital relationships and only now has developed premature ejaculation.
Patient characteristics in lifelong premature ejaculation can include the following:
- Psychological difficulties
- Deep anxiety about sex that relates to 1 or more traumatic experiences encountered during development
In patients with lifelong premature ejaculation, inquire about the following:
- Previous psychological difficulties
- Early sexual experiences
- Family relationships during childhood and adolescence
- Peer relationships
- Work or school
- General attitude toward sex
- Context of the event (eg, marital versus nonmarital)
- Sexual attitude and response of the female partner
- Nonsexual aspects of the current relationship
- level of involvement of the sexual partner in treatment
Clues from these and similar questions usually point toward causative factors that may be addressed specifically with therapy.
Patient characteristics in cases of acquired premature ejaculation can include the following:
- Erectile dysfunction
- Performance anxiety
- Psychotropic drug use