Dr. M.J. Bazos, MD Patient Handout


About Your Diagnosis
Premature ejaculation (PE) is a relatively common disorder seen primarily in heterosexuals. It occurs in about 25% to 40% of men at different points in their sexual life. It is characterized by an inability to maintain an erection during sexual intercourse for a long enough time to satisfy the individual. Because the problem does involve such an intimate part of a relationship, premature ejaculation can lead to social isolation and psychological distress. If, however, the man’s partner does not complain about the premature ejaculation, it is unlikely that the man will seek professional help about this problem.

Living With Your Diagnosis
In most instances, the ejaculation comes less than a minute after entering the vagina. Rarely, ejaculation can occur either immediately before or immediately after vaginal entry. However, in either case, the ejaculation occurs before the individual or his partner would desire it. One should not, however, be preoccupied with the length of time. The real deciding factor in diagnosing premature ejaculation is that both the patient and his partner are dissatisfied with this aspect of their sexual functioning. It is also important to keep in mind that most men ejaculate prematurely, but generally not all the time as do individuals with this disorder. In assessing the individual with premature ejaculation, the following questions should be asked:
• Why is the patient seeking therapy now?
• What is the couple’s length of sexual experience?
• Are there any other emotional aspects that might be affecting their sexual behavior?
• Are their expectations for sexual intercourse reasonable?
• Is the man desperate about losing his partner because of rapid ejaculation?
• Does sexual activity occur under secretive conditions where the couple might be interrupted?
• Does the sexual partner have some form of sexual disorder, such as an unusual amount of pain during sexual activity or a decreased interest in sex? The answers to these questions will allow the individual evaluating the man with premature ejaculation to determine whether this condition is acquired or lifelong, and also to determine what other psychosocial factors need to be addressed to help treat the condition. Usually, men who have premature ejaculation are able to delay an orgasm during masturbation but not during sexual intercourse. To be considered abnormal, premature ejaculation must cause distress for the patient or difficulties with a relationship, and must not be related to any drugs the patient may be taking. In particular, withdrawal from some narcotics causes premature ejaculation. There are different types of premature ejaculation. PE is classified according to the onset, whether it is lifelong or acquired later, and by context, whether it is generalized or just situational. PE can be caused by a psychological condition or by a combination of factors. As young males become more sexually experienced with age, the majority learn how to delay orgasm. However, some men continue to have premature ejaculation, and they are the ones who may seek help for this disorder. In lifelong premature ejaculation, the problem begins with the first sexual intercourse and continues throughout all the patient’s relationships until treatment is sought. When premature ejaculation occurs after there has been a period of normal sexual functioning, it is usually because of a decreased frequency of sexual activity or intense performance anxiety with a new partner. Some men who have stopped regular use of alcohol may have premature ejaculation because they relied on their drinking to delay organism, instead of learning from experience how to do so.

The treatment of premature ejaculation can involve a range of therapy, from simply reassuring the patient and providing him with realistic expectations about sexual activity, to the use of medications. In particular, the use of clomipramine in a dose of 25–50 mg has been shown, in some cases, to increase the time before ejaculation by an average of 250%. In addition, other serotonin drugs, such as Zoloft, Paxil, and Prozac, may also be of some benefit. In general, those individuals who respond to clomipramine or other medications will have a reoccurrence of the disorder if the medication is
stopped. Much attention has been focused on the so-called squeeze technique for the treatment of premature ejaculation. In this technique, the male will focus his attention on the sensations he is obtaining through his penis during intercourse, and then he will signal his partner to stop moving or to apply a firm squeeze to the penis in an attempt to interrupt ejaculation. This obviously requires excellent communication between an individual and his partner, which probably improves functioning as well. It is important to remember that in premature ejaculation, as with any sexual dysfunction, the primary concern is not what is “normal sexual behavior” but what sexual difficulties are adversely affecting the pleasure and enjoyment of both partners involved. It is those conditions that merit treatment.

The DOs
If you have premature ejaculation, it is important to create an appropriate atmosphere for sexual activity. Fear of interruption and clandestine (secret) sexual activity increase chances of premature ejaculation. You should also communicate with your partner to allow for both of you to express your feelings and expectations regarding sex. Together you might develop techniques (e.g., squeeze technique) that may prolong an erection. Most important, try to relax. Anxiety (especially performance anxiety) only makes this condition worse.

The DON’Ts
Because your ejaculation may be rapid and unpredictable, avoid such risky “birth control” methods as withdrawal before ejaculation. Do not feel embarrassed to discuss this condition with your physician.

When to Call Your Doctor
You should call your physician if you are unable to achieve an erection, if you have a bloody or foulsmelling discharge, pain on intercourse, or significant depression secondary to premature ejaculation.