The definition for premature ejaculation in terms of time varies from 30 seconds up to 4 minutes.¹ Therefore the best definition is an inability to control ejaculation sufficiently to permit both partners to enjoy sexual intercourse. Premature ejaculation may be classified as 'lifelong' (primary) or 'acquired' (secondary):²

• Lifelong premature ejaculation is characterised by onset from the first sexual experience and remains a problem during life. Ejaculation occurs too fast before vaginal penetration or less than 1-2 minutes after penetration.
• Acquired premature ejaculation is characterised by a gradual or sudden onset with ejaculation being normal before onset of the problem. Time to ejaculation is short, but not usually as fast as in lifelong premature ejaculation.

Epidemiology

• The prevalence of premature ejaculation varies according to definition and is difficult to assess in view of many men not wanting to seek help or even discuss the problem.
• One random survey of in the United States found that about 30% of men had ejaculated prematurely in the past year.³

Risk factors⁴

• Premature ejaculation may be anxiety related. It is therefore more common in young men and early in a relationship. In these situations, the problem usually resolves with time.
• Iatrogenic causes include amfetamine, cocaine and dopaminergic drugs. Although effective for the treatment of premature ejaculation in some men, sildenafil may also be a cause of premature ejaculation in others.⁵
• Urological causes, e.g. prostatitis.
• Neurological causes, e.g. multiple sclerosis, peripheral neuropathies.

Management

• General advice:
  • More frequent sex (or masturbation): premature ejaculation is more likely if there is a longer gap between sexual intercourse.
  • Using a condom to decrease sensation.
  • Sex with the woman on top reduces the likelihood of premature ejaculation.
  • Squeeze and stop-go techniques: stimulating the penis almost to the point of ejaculation and then stopping. These techniques are often effective but may take a few months to produce any benefit and relapse is common.
  • Short-term success rates of 50-60% have been reported with behavioural strategies but pharmacological treatment has been shown to be more effective and improvements achieved with behavioural strategies are generally not maintained long-term.²
• Drug therapy:
  • SSRI antidepressants are the most commonly used, but relapse may occur after stopping the medication.⁶ Paroxetine, clomipramine, sertraline and fluoxetine have all been shown to be effective.⁷
  • Sildenafil is an effective alternative, especially in older men and when associated with erectile dysfunction.⁸
  • Anaesthetic creams may be effective.⁹
• Psycho-sexual therapy:
  • Includes assessment, behavioural and educational methods, psychotherapy in terms of the relationship, and sexual timetables.¹⁰

Complications

Premature ejaculation may have a significant adverse effect on both self-confidence and the relationship.¹¹

Document references

1. Bandolier; Premature ejaculation treatments reviewed. October 2004.
2. Guidelines on Male Sexual Dysfunction: Erectile dysfunction and premature ejaculation, European Association of Urology (2009)
3. Laumann EO, Paik A, Rosen RC; Sexual dysfunction in the United States: prevalence and predictors. JAMA. 1999 Feb 10;281(6):537-44. [abstract]
4. Piediferro G, Colpi EM, Castiglioni F, et al; Premature ejaculation. 1. Definition and etiology. Arch Ital Urol Androl. 2004 Dec;76(4):181-7. [abstract]
5. Chia S; Management of premature ejaculation -- a comparison of treatment outcome in patients with and without erectile dysfunction. Int J Androl. 2002 Oct;25(5):301-5. [abstract]
6. Piediferro G, Colpi EM, Castiglioni F, et al; Premature ejaculation. 3. Therapy. Arch Ital Urol Androl. 2004 Dec;76(4):192-8. [abstract]
7. Waldinger MD, Zwinderman AH, Schweitzer DH, et al; Relevance of methodological design for the interpretation of efficacy of drug treatment of premature ejaculation: a systematic review and meta-analysis. Int J Impot Res. 2004 Aug;16(4):369-81. [abstract]
8. Abdel-Hamid IA, El Naggar EA, El Gilany AH; Assessment of as needed use of pharmacotherapy and the pause-squeeze technique in premature ejaculation. Int J Impot Res. 2001 Feb;13(1):41-5. [abstract]
9. Busato W, Galindo CC; Topical anaesthetic use for treating premature ejaculation: a double-blind, randomized, placebo-controlled study. BJU Int. 2004 May;93(7):1018-21. [abstract]
10. Jannini EA, Simonelli C, Lenzi A; Sexological approach to ejaculatory dysfunction. Int J Androl. 2002 Dec;25(6):317-23. [abstract]
11. Symonds T, Roblin D, Hart K, et al; How does premature ejaculation impact a man s life? J Sex Marital Ther. 2003 Oct-Dec;29(5):361-70. [abstract]

Internet and further reading

• Bandolier; Erectile dysfunction and premature ejaculation.
• Relate; Help with relationship and psychosexual problems.

Acknowledgements