Premature Ejaculation Treatment in Delhi, India

Premature ejaculation (PE) is a common sexual complaint, with as many as 1 out of 3 people reporting it at some time. This condition occurs when a man ejaculates sooner during sexual intercourse than he or his partner would like.

Premature ejaculation isn't usually a cause for concern if it happens infrequently. However, it becomes a diagnosable condition if a man always or nearly always ejaculates within 1 to 3 minutes of penetration, is unable to delay ejaculation during sex most of the time, and feels distressed and frustrated about it. This distress can lead to avoiding sexual intimacy. Fortunately, premature ejaculation is treatable. Understanding and addressing the underlying causes, which can be psychological or biological, is crucial for effective management and treatment of this condition.

Premature Ejaculation can be classified into two types:

1. Lifelong (Primary) PE: This type occurs from the first sexual experience.
2. Acquired (Secondary) PE: This type develops after having had previous sexual experiences without PE.

There are many possible causes of premature ejaculation, including:

• Psychological causes: These are the most common causes of PE. They can include stress, anxiety, performance anxiety, depression, guilt, relationship problems, a history of sexual abuse, etc.
• Biological causes: These causes are less common than psychological causes. They can include abnormal hormone levels, such as low serotonin levels, a medical condition such as thyroid problems or diabetes, or certain neurological conditions.
• Behavioural causes: These causes can include substance abuse, such as smoking or drug use, or a lack of sexual experience.

The primary symptom of premature ejaculation (PE) is the inability to delay ejaculation for a sufficient period of time during sexual activity, resulting in ejaculation occurring sooner than desired. This can happen before or shortly after penetration. Here are the key symptoms associated with PE:

• Ejaculation with Minimal Stimulation: Ejaculation occurs with minimal sexual stimulation, often within one to three minutes of penetration.
• Lack of Control: Inability to delay ejaculation during most sexual encounters.
• Distress: Feelings of frustration, distress, or embarrassment about the lack of control over ejaculation.
• Relationship Issues: Strain in relationships due to dissatisfaction with sexual performance.

Diagnosing premature ejaculation (PE) involves a thoughtful and thorough approach by a doctor, including both conversation and examination to get a complete picture of the issue.

Initial Discussion

When a patient comes in for a diagnosis, the doctor begins with a detailed discussion. They ask about the patient's sexual history, delving into how frequently PE occurs, how long it has been an issue, and whether there have been any noticeable changes over time. The doctor also inquires about overall health, exploring any existing medical conditions and reviewing all medications the patient is taking. Emotional well-being is another critical area of focus; the doctor will ask about stress levels, relationship satisfaction, and any other factors that might be affecting sexual performance.

Physical Exam

Following this discussion, the doctor conducts a physical exam. This usually starts with a genital check to look for any abnormalities and may include an examination of the prostate gland to identify potential issues. The doctor also assesses the patient's overall health during this exam.

Additional Tests

Sometimes, additional tests might be needed:

• Blood Tests: To check for hormone imbalances that could be contributing to PE.
• Urine Tests: To rule out underlying infections.

Treating premature ejaculation (PE) involves a variety of approaches, often tailored to the underlying causes and the severity of the condition. The treatment can be a combination of behavioural techniques, therapy, medication, and lifestyle changes.

Behavioural Techniques

• Stop-Start Method: This technique involves stimulating the penis until the patient feels about to ejaculate, then stopping the stimulation for about 30 seconds. This process is repeated multiple times before allowing ejaculation to occur.
• Squeeze Technique: Similar to the stop-start method, this involves stopping stimulation and then gently squeezing the penis for several seconds until the urge to ejaculate passes. This can help increase control over ejaculation.

Therapy

• Psychological Counselling: Working with a therapist can help address any psychological factors contributing to PE, such as anxiety, stress, or relationship issues. Cognitive-behavioural therapy (CBT) is particularly effective.
• Couples Therapy: If relationship issues are contributing to PE, couples therapy can help improve communication and intimacy between partners, reducing performance anxiety.

Medication

• Topical Anaesthetics: Creams or sprays containing a numbing agent like lidocaine or prilocaine can be applied to the penis to reduce sensation and delay ejaculation.
• Oral Medications: Certain antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) like sertraline, paroxetine, or fluoxetine, can be prescribed to delay ejaculation. These medications may take a few weeks to become effective.
• Pain Relievers: Some pain relievers, such as tramadol, have been found to delay ejaculation as a side effect. However, these are typically prescribed if other treatments are not effective.

Lifestyle Changes

• Exercise: Regular physical activity can improve overall health, reduce stress, and enhance sexual performance. Kegel exercises, which strengthen the pelvic floor muscles, can be particularly helpful for improving control over ejaculation.
• Healthy Diet: A balanced diet can improve overall health and reduce factors that contribute to PE. Reducing alcohol and avoiding recreational drugs can also make a significant difference.

Addressing Underlying Health Issues

• Treating Prostate Issues: If prostatitis or other prostate conditions are contributing to PE, treating these conditions can help alleviate symptoms.
• Managing Hormonal Imbalances: If hormone levels are found to be abnormal, appropriate treatment to balance these hormones can improve PE.

Communication and Education

• Educating Both Partners: Understanding that PE is a common issue and learning about techniques to manage it can reduce anxiety and improve sexual satisfaction.
• Open Communication: Encouraging open and honest communication between partners about sexual needs and concerns can help reduce performance pressure and anxiety.

By combining these approaches, individuals can effectively manage premature ejaculation, improve sexual satisfaction, and enhance overall quality of life. It's important for patients to work closely with their healthcare providers to develop a treatment plan that is tailored to their specific needs.

Premature ejaculation (PE) can lead to several complications that may impact a man's psychological well-being, relationship satisfaction, and overall quality of life. Understanding these complications is essential for seeking appropriate treatment and support. Here are some of the potential complications associated with PE:

1. Emotional and Psychological Stress

PE can cause significant emotional distress, leading to feelings of embarrassment, frustration, and inadequacy. These negative emotions can contribute to anxiety and depression, further exacerbating the problem.

2. Relationship Issues

The strain of dealing with PE can affect intimate relationships, causing tension and dissatisfaction between partners. This can lead to a decrease in sexual intimacy and overall relationship harmony.

3. Reduced Sexual Satisfaction

Men with PE and their partners may experience reduced sexual satisfaction. The inability to control ejaculation can make sexual experiences less enjoyable and fulfilling.

4. Low Self-Esteem

Persistent PE can negatively impact a man's self-esteem and body image. The constant worry about premature ejaculation can lead to a lack of confidence in sexual situations.

5. Avoidance of Sexual Intimacy

Due to the fear of premature ejaculation, some men may avoid sexual encounters altogether, which can further strain relationships and lead to a lack of intimacy.

Preventing premature ejaculation involves adopting various strategies and lifestyle changes that can help improve control and delay ejaculation. Here are some effective prevention methods:

• Practice Relaxation Techniques: Deep breathing, meditation, and mindfulness can reduce anxiety and improve sexual performance.
• Engage in Regular Physical Exercise: Enhances overall health, reduces stress, and improves sexual stamina. Pelvic floor exercises like Kegels can be particularly beneficial.
• Maintain a Healthy Diet and Lifestyle: Balanced nutrition, reduced alcohol consumption, quitting smoking, and avoiding recreational drugs can positively impact sexual health.
• Initiate Open Communication: Discussing sexual concerns with a partner fosters support and reduces anxiety.
• Practice Controlled Masturbation: Helps men learn to delay ejaculation using techniques like start-stop or squeeze methods.
• Seek Professional Help: Healthcare providers or sex therapists can offer therapeutic techniques, medications, and counselling tailored to individual needs.

Is premature ejaculation a normal condition?

Yes, premature ejaculation is a common sexual issue experienced by many men at some point in their lives. It's considered normal if it occurs infrequently or intermittently.

At what stage of life do men typically experience changes in ejaculatory patterns?

Changes in ejaculatory patterns can occur at different stages of life due to hormonal changes, age-related factors, and health conditions. However, there's no specific age when men universally stop ejaculating; rather, patterns may change over time.

What types of physical activities are beneficial for managing erectile dysfunction?

Exercises that improve cardiovascular health, such as brisk walking, jogging, or swimming, can benefit erectile function. Additionally, pelvic floor exercises (Kegels) can help strengthen muscles involved in erectile function.

Are there any substances, such as alcohol, that are believed to aid in delaying ejaculation?

While alcohol may initially reduce inhibitions and increase relaxation, excessive consumption can impair sexual performance and lead to erectile dysfunction or worsen premature ejaculation over time.

What is the difference between erectile dysfunction and premature ejaculation?

Erectile dysfunction (ED) involves difficulty achieving or maintaining an erection sufficient for sexual activity, often due to physical or psychological factors. Premature ejaculation (PE) refers to ejaculating sooner than desired during sexual activity and is often related to psychological factors, sensitivity, or arousal levels.

Should premature ejaculation be a cause for concern regarding overall health or potential medical issues?

Premature ejaculation itself is not typically a sign of a serious medical condition but can impact quality of life and sexual satisfaction. Seeking treatment can help improve sexual performance and emotional well-being.

What are the potential effects of refraining from ejaculation for an extended period?

Refraining from ejaculation for a period can vary among individuals. Some may experience increased sexual tension and arousal, potentially leading to more intense orgasms. However, there are no harmful health effects associated with abstaining from ejaculation.

Can regular exercise improve sexual performance and reduce the likelihood of premature ejaculation?

Yes, regular exercise improves cardiovascular health, enhances blood flow, and reduces stress, which can positively impact sexual performance and help manage premature ejaculation.

Are there lifestyle changes that can help alleviate symptoms of premature ejaculation without medical intervention?

Lifestyle changes such as maintaining a healthy diet, managing stress levels, avoiding excessive alcohol consumption, and practising relaxation techniques can help alleviate symptoms of premature ejaculation and improve overall sexual health.

Reviewed By Ms. Rashida Amreliwala, Associate Consultant - Clinical Psychologist, Clinical Psychology on 24 July 2024.