Premature ejaculation (PE) is the most common sexual dysfunction in men under 40. And it’s a problem that affects both the man and his partner.

Most men experience occasional PE, particularly after a long period of sexual abstinence or when a relationship is new. It's when it happens more than half the time or when it causes a cycle of ‘anxiety interfering with arousal’ that the problem needs attention, say health professionals.

In most cases, it is important the man’s partner is involved in the diagnosis and treatment. Finding out about PE can be a help for your relationship.

What is premature ejaculation?

Premature ejaculation is defined as a situation when a man ejaculates before either he or his partner would want him to. No time limit is specified, since PE is a problem only when it causes distress to one or both partners. It may be helpful to know, though, that the average time a man can sustain intercourse is less than three minutes.

For a diagnosis of PE doctors are looking for the following:

• the problem occurs repeatedly
• one or both partners are distressed by the situation - sexual satisfaction and the couple’s interpersonal relationship are affected
• there is no single outside influence causing the problem, such as withdrawal from opioid-containing medicines.

Premature ejaculation may also be associated with erectile dysfunction (impotence) because ongoing worry can interfere with the ability to become aroused and maintain an erection.

The effects of PE

Premature ejaculation can cause a range of problems for a man and his partner:

• sexual frustration
• sometimes failure to achieve pregnancy (if PE occurs before penetration)
• anxiety 
• depression and lowered self-esteem
• relationship problems.
  

Any or all of these problems can put a couple off even considering sexual interaction, further compounding the problem.

What causes PE?

Premature ejaculation is not thought to indicate any underlying physical condition or disease.

While many people believe PE is mainly psychological, some suggest the men who experience it may have a more sensitive genital nerve supply than most men. Others believe there may be a relationship between PE and the levels of the feel-good hormone serotonin in the brain.

Primary PE
This is PE that has existed since the man’s first sexual intercourse. It is thought this may be caused by early conditioning or trauma.

Secondary PE
When the man was previously able to achieve longer periods of intercourse, this is called secondary PE and may be caused by stress and anxiety, depression or poor communication with his partner.

Treatments for PE

Treatment for PE is most often provided by a sex therapist, a psychologist or a psychiatrist. Much of the management of PE focuses on helping the man to address the cause that underlies the problem. “Treatments centre around developing sexual power and confidence,” says clinical psychologist and director of SexTherapy NZ, Robyn Salisbury. Some suggested self-help techniques can also be worthwhile trying.

Increased foreplay: Couples may use foreplay to help the man’s partner reach a state of high arousal before intercourse. This can result in ejaculation being more closely timed to the partner’s orgasm.

Masturbation: Through practice, the man can get to know his own responses to stimulation and build his confidence.

Pause, engage: During sex, the man can withdraw if necessary and take a minute or two to relax, before continuing. Repeating this several times can prolong intercourse.

There are other, often suggested techniques Robyn Salisbury does not recommend as they fail to address the underlying cause of the problem. Rather than improve the situation, she asserts the following techniques may put couples off attempting to have sex altogether:

• the man thinks of something boring
• the man firmly squeezes the tip of the penis for 20 seconds after withdrawal to prevent PE, then waits 30 seconds before continuing
• the man wears one or two condoms (or uses a local anaesthetic cream) to reduce the sensitivity and make intercourse last longer.

Medication for PE

Where medication is a preferred option, your GP may be able to prescribe drug treatment using dapoxetine (Priligy) or types of antidepressants known as an SSRI (selective serotonin re-uptake inhibitor). These drugs have the effect of delaying ejaculation in some men, so a trial may quickly determine whether these work for you or not.

If you or your partner are suffering because of PE, talk to your GP in the first instance. He or she can refer you to the right person for help and treatment.

Original material provided by everybody and reviewed by psychologist Robyn Salisbury from Sex Therapy NZ, June 2009. Robyn recommends the book New Male Sexuality by Bernie Zilbergeld for valuable insights into the condition.