Premature ejaculation

The time it takes for a man to ejaculate can vary widely. On average, men ejaculate five to six minutes after penetration, though this can range from one or two minutes to as much as eight minutes. There is no standard rule. However, the differing expectations can cause confusion, uncertainty, and frustration. Premature ejaculation (PE) is defined as ejaculating within a minute after penetration without being able to delay it. 

Symptoms of premature ejaculation include: 

• Ejaculating before or within one minute after vaginal penetration. 
• Inability to delay ejaculation. 
• Experiencing significant negative effects, such as stress, frustration, or avoidance of sexual intimacy. 

There is no exact data on how common premature ejaculation is, as it is often a taboo topic. Estimates suggest that between 3% and 30% of men experience PE. Unfortunately, fewer than 10% seek help, which is a missed opportunity as it can have a major impact on a couple’s sex life. Discussing it, whether with your partner or a doctor, is a good first step. 

While once thought to be purely psychological, premature ejaculation is now understood to involve a combination of factors. Fear and frustration can contribute to the problem, creating a vicious cycle that is difficult to break. Physical causes may include abnormalities in the neurotransmitter serotonin, which affects nerve signals, or thyroid hormone imbalances. However, significant studies on the physical causes are still lacking. 

Possible causes include: 

• Prostate infections 
• Thyroid disorders 
• Side effects of medications 
• Diabetes 
• Genital hypersensitivity 
• Being overweight 
• Genetic factors 
• Emotional issues 
• Stress 

Regardless of the cause, the pressure to perform can lead to tension that, in itself, triggers premature ejaculation. 

There are two main types of premature ejaculation: primary (men who have always experienced premature ejaculation) and secondary (men who developed the issue after previously having normal ejaculation). 

Premature ejaculation is identified when ejaculation occurs in less than a minute during vaginal, anal, oral sex, or self-stimulation, without control over the timing. While not dangerous, it is considered a condition that can affect quality of life. 

If medical causes are ruled out, you can try techniques to regain control over ejaculation. These include the start-stop technique and the squeeze technique. 

• Start-stop technique: This involves recognising body signals to pause stimulation just before reaching the orgasmic reflex, allowing the excitement to subside. Repeating this process helps you gain better control over time. 
• Squeeze technique: With this method, you squeeze the penis just below the glans with your thumb and index finger right before ejaculation to interrupt the reflex. 

Breathing techniques can also help control arousal levels. Try to accept the situation to reduce frustration, as tension can worsen the problem. 

There are three approaches to using medication for premature ejaculation: 

• Inhibiting ejaculation 
• Preventing the penis from becoming flaccid immediately after ejaculation 
• Numbing the head of the penis to reduce sensitivity 
• Dapoxetine is a selective serotonin reuptake inhibitor (SSRI) used for delaying ejaculation. 
• Other SSRIs, such as paroxetine or sertraline, can also help. While they are primarily prescribed for depression and anxiety, they may be used to extend the time to ejaculation without having those conditions. 

Medication to prevent the penis from softening after ejaculation 

Options include devices that maintain an erection after orgasm, intracavernous injections, or oral medications like sildenafil, tadalafil, or apomorphine. 

Products to numb the penis 

For those who prefer not to take oral medication, lidocaine gel or cream can numb the penis. Apply it ten minutes before sex and remove it afterward to avoid numbing your partner. 

Behavioural or cognitive therapy may be beneficial, especially for secondary PE, where psychological factors play a significant role. Sex therapy, relationship counselling, and psychoeducation can help address the underlying issues. 

Consulting a urologist may be necessary. A urologist can perform a physical exam or tests to rule out conditions such as thyroid disease or prostate issues. 

Addressing factors like obesity and stress can help. Recommendations include: 

• Regular exercise, such as walking, yoga, or meditation 
• Avoiding an overloaded schedule to ensure rest and relaxation 
• Staying well-hydrated for overall health 
• Eating a balanced diet rich in fruits and vegetables, and avoiding fatty, processed foods 

Albert Schweitzer Hospital (s.a.), Ejaculation too soon (premature ejaculation), consulted on 18 May 2019, at https://www.asz.nl/bekkenbodemcentrum/aandoeningen/seksuele-problemen/te-snel-klaarkomen–premature-ejaculatie-/ 

Nederlands Huisartsen Genootschap (2015), I’m coming too soon (man), consulted on 18 May 2019, on https://www.thuisarts.nl/snel-klaarkomen/ik-kom-te-snel-klaar-man

Hond, Drs. H. de (z.j.), Early ejaculation, causes and treatment, consulted on 18 May 2019, on https://www.andros.nl/erectieproblemen/vroegtijdig-klaarkomen/

Hoogland, A. (2016), Ejaculatio praecox: premature ejaculation, consulted on 18 May 2019, at https://www.gezondheidsnet.nl/erectieproblemen/ejaculatio-praecox-vroegtijdige-zaadlozing Melod (2010), Dealing with premature ejaculation, consulted on 18 May 2019, at https://mens-en-

gezondheid.infonu.nl/seksualiteit/32313-behandelen-premature-ejaculatie-voortijdig-klaarkomen.html Dutch Care Institute (z.j.) Dapoxetine, consulted on 18 May 2019, at https://www.farmacotherapeutischkompas.nl/bladeren/preparaatteksten/d/dapoxetine

Nederlands Huisartsen Genootschap (s.a.), NHG-Standard sexual complaints (first revision), consulted on 18 May 2019, at https://www.nhg.org/?tmp-no-mobile=1&q=node/1772.