NOTJUSTAMOMENT

Premature Ejaculation (PE) is a complex medical condition and the most common sexual dysfunction in male < 60 years. Although – according to the DSM-IV definition – 1 in 5 men report PE,  it’s nevertheless one of the most under-diagnosed male disorders. It may be a chronic condition often present from the first sexual experience (Lifelong PE), or could appear later as a result of another medical condition (Acquired PE).

The International Society for Sexual Medicine (ISSM) has defined Lifelong PE as “A male sexual dysfunction characterised by:

• ejaculation which always or nearly always occurs before or within about 1 minute of vaginal penetration; and:
• the inability to delay ejaculation on all or nearly all vaginal penetrations; and:
• the suffering of negative personal consequences, such as distress, difficulty, frustration, and/or the avoidance of sexual intimacy”.

References:

1. Althof SE et al. J Sex Med. 2010;7(9):2947-2969.
2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th edition. Text revision: DSMIV-TR. Washington, DC: American Psychiatric Association; 2000.
3. Broderick GA. J Sex Med 2006;3(4):295-302.
4. EAU Guidelines on ED and PE 2012.
5. McMahon CG et al. J Sex Med 2008;5:1590–1606.
6. Porst H et al. Eur Urol 2007;51(3):816-824.

See more about what PE means.

The time considered normal varies depending on many factors and may differ from one person (or to a couple) to another. In surveys performed on the general male population (including both men with Premature Ejaculation, PE, and non-PE men) to investigate the mean values of the time to ejaculation after vaginal penetration, non-PE men reported an average value of around 7 minutes, with duration lasting up to 20-25 minutes.

According to the International Society for Sexual Medicine (ISSM) in PE men “ejaculation always or nearly always occurs before or within about 1 minute of vaginal penetration”. But it is important to remember that PE is not just a matter of time: the lacks of control over ejaculation and a negative impact on relations with the partner are equally important factors to define premature ejaculation.

References:

1. Althof SE et al. J Sex Med. 2010;7(9):2947-2969.
2. Broderick GA. J Sex Med 2006;3(4):295-302.
3. EAU Guidelines on ED and PE 2012.
4. McMahon CG et al. J Sex Med 2008;5:1590–1606.
5. Porst H et al. Eur Urol 2007;51(3):816-824.

See more about what PE means.

A significant proportion of the male population all over the World report having symptoms or a complaint of Premature Ejaculation (PE): around 20% to 30% of men report they feel to ejaculate too quickly. But only 9% actually turn to a doctor for help.

References:

1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th edition. Text revision: DSMIV-TR. Washington, DC: American Psychiatric Association; 2000.
2. EAU Guidelines on ED and PE 2012.
3. McMahon CG et al. J Sex Med 2008;5:1590–1606.
4. Porst H et al. Eur Urol 2007;51(3):816-824.

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When ejaculation occurs too quickly and this condition is persistent or chronic (onset from the first or almost the first sexual experience), it is probably Premature Ejaculation (PE).
But the time to ejaculation is not the only criterion to make a diagnosis of PE. The lack of ejaculatory control must also be present and the fact that this condition has a negative impact on one’s sex life, leading to negative emotions, such as distress. In any case, only a doctor can accurately diagnose PE.

References:

1. EAU Guidelines on ED and PE 2012.
2. McMahon CG et al. J Sex Med 2008;5:1590–1606.
3. Porst H et al. Eur Urol 2007;51(3):816-824.

See more about PE diagnosis

Premature Ejaculation (PE) is often confused with erectile dysfunction (ED). Nonetheless, PE and ED are completely different. In PE, the erection is normal, but ejaculation occurs before or within approximately 1-2 minutes of vaginal penetration; PE is characterised by the inability to control or delay ejaculation, is even more common than ED, appears from the first experience of sexual intercourse in about 50% of the cases and is equally present across all adult age-groups.

On the other hand, ED is a persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance, it has nothing to do with control and is more common in old age.

Furthermore, the two medical conditions can occur together: men with PE were more likely to self-report also ED. Studies in the literature as well as the clinical experiences have shown that is not uncommon for men with acquired PE to have also an associated ED.

Also, the normal process after the ejaculation is the penile detumescence but men with PE and so, that ejaculate too early and with a lack of control over ejaculation, may confuse the “normal” detumescence as an issue with their erectile function. Performance anxiety plays a major role in men suffering from both sexual dysfunctions ED and PE and contributes, over the course of time, to an aggravation of both symptoms.

Anyway, in both cases, ED and PE the right thing to do is to go to the doctor to get the right diagnosis (if any).

References:

1. EAU Guidelines 2012.
2. Jannini EA, Lombardo F, Lenzi A. Int J Androl. 2005 Dec;28 Suppl 2:40-45.
3. Porst H et al. Eur Urol 2007;51(3):816-824.
4. Sotomayor M. J Sex Med 2005;2(2):110-114.

Thus, PE is not only a problem of "duration" but also about a “lack of control” over the ejaculation and low overall satisfaction with intercourse. PE can however, be diagnosed only by a physician, who may also prescribe examinations and tests to rule out organic causes of the problem.

References:

1. EAU Guidelines on ED and PE 2012.
2. McMahon CG et al. J Sex Med 2008;5:1590–1606.
3. Porst H et al. Eur Urol 2007;51(3):816-824.

See more about PE diagnosis

Yes, there is general agreement among medical experts that from the aetiological point of view, Premature Ejaculation (PE) has to be separated in to lifelong and acquired. Lifelong PE, previously named primary PE, becomes manifest with the first (or almost the first) sexual activities, continues throughout the whole life span, and exists with all kinds of sexual activities.
PE may also have appeared later in their lifetime and this is known as Acquired PE (or secondary type). In that case, it’s likely to be a result of another medical condition.
About 65% of men reporting PE suffer from the Lifelong type. It’s a chronic condition characterised by all of the following:

• onset from the first (or almost the first) sexual experience;
• persistence throughout life and, possibly, a worsening with age;
• ejaculation occurring too quickly (less that 1 minute in 90% of cases);
• ejaculation occurring too quickly on every (or almost every) occasion of sexual intercourse;
• ejaculation occurring too quickly with every (or almost every) partner.

Some men even ejaculate during the foreplay phase, before penetration or on first contact with the vagina (the so-called ejaculatio ante portas). 49% of men with PE say that they ejaculate before penetration at least occasionally.
Acquired PE:

• begins at a certain time of life, with a gradual or sudden onset following previously normal ejaculation;
• can be related to other endocrine (such as thyroid hormone disorders or urological diseases (e,g. inflammatory prostatitis), anatomical condition (such as a short frenulum, hypersensitivity of the glans, phimosis etc.), neurological, psychological or relationship problems, traumatic sexual experiences or as a side-effect of medication or drug-taking;
• occurs only with just one or certain partners (the so-called Situational PE).

References:

1. EAU Guidelines on ED and PE 2012.

See more about what PE means

Unlike Erectile Dysfunction (ED), more prevalent with aging, Premature Ejaculation (PE) affects men in all age-groups. It may occur after first  (or almost the first) sexual intercourse or develop at a later stage of life, but it is more commonly a problem for the younger man. The occurrence of PE is more related to the novelty of the sexual experience (new partner or different situation) than to the man's age.

References:

1. EAU Guidelines on ED and PE 2012.

Premature Ejaculation (PE) is a medical condition. The chronic PE (the so-called Lifelong PE) is presumed to be associated with reduced serotonin levels, a neurotransmitter that plays a key role in ejaculation. All findings support a genetic involvement regarding lifelong PE.
Many other conditions and diseases – such as prostatitis, urinary tract disorders, or endocrine diseases – can have a negative impact on ejaculation and cause Acquired PE, that could also be a side-effect of medication or drug-taking or one of the manifestations of social, psychological or interpersonal problems.

References:

1. EAU Guidelines on ED and PE 2012.

See more about what PE means

Yes, prostatitis can be an important risk factor. Considering the role of the prostate gland in the mechanism of ejaculation, prostate inflammation can cause PE (Acquired PE). Treating prostatitis (e.g. with antibiotics) may restores patients normal ejaculatory pattern, while not treated prostatitis can in long term determine a more detrimental effects on ejaculatory function.
That is why, if you suspect having PE, you must see a doctor (e.g. an urologist) in order to identify the cause(s) so that it can be treated.

References:

1. El-Nashaar A, Shamloul R. J Sex Med. 2007;4(2):491-496.
2. Screponi E, Carosa E, Di Stasi SM et al. Urology. 2001;58(2):198-202.

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It may be. The shortness of the frenulum (the elastic band of tissue under the penis that helps contract the prepuce over the glans) may contribute towards causing PE.
When frenulum is too short, it restricts the movement of the prepuce during the erection, causing an excessive sexual stimulation. In fact, more than 40% of men with Lifelong PE have a short frenulum.
Those who have PE and also a short frenulum should therefore contact the doctor, who may consider the possibility of a frenulectomy (the surgical removal of the frenulum).

References:

1. Gallo L, Perdonà S, Gallo A. J Sex Med. 2010;7(3):126976.

A possible relationship between varicocele, prostatitis and ejaculatory disorders such as PE has been found. In case of a varicocele, it is instead important to visit a doctor since it could affect fertility.

References:

1. Lotti F, et al. J Sex Med. 2009 Oct;6(10):2878-2887

PE and ED are very different sexual dysfunctions but, even if PE is not necessarily associated with an erection deficiency, they may sometimes occur together. A significant proportion of men with PE also reported ED (31.9%), particularly in cases where PE arises with age as the incidence of ED increases with age.
In men with ED, who need constant penile stimulation to maintain a penetrable erection, the incidence of PE tends to be high, probably because the fear of not being able to maintain a satisfactory erection can lead a man to "speed up" the sexual intercourse. On the other hand, some suggest that PE could lead to the development of ED over a period of time.

References:

1. Jannini EA, Lombardo F, Lenzi A. Int J Androl. 2005 Dec;28 Suppl 2:40-45.

See more about PE and ED

Premature Ejaculation (PE) is a male sexual dysfunction and has nothing to do with sexual orientation. In fact, as some evidence suggests, the latter does not significantly change the clinical pattern of ejaculatory dysfunction and PE is as common in homosexual as in heterosexual men.

The ejaculatory latency time is measured based on the time to intravaginal ejaculation (IELT) – resulting in exclusion of homosexual sexual activities from the experimental protocols – the studies on PE were actually conducted only on heterosexual couples.

References:

1. Jern P, Santtila P, Johansson A et al. J Sex Marital Ther. 2010;36(4):303-312.

Premature Ejaculation (PE) is a male sexual dysfunction and has nothing to do with sexual orientation. In fact, as some evidence suggests, the latter does not significantly change the clinical pattern of ejaculatory dysfunction and PE is as common in homosexual as in heterosexual men.

The ejaculatory latency time is measured based on the time to intravaginal ejaculation (IELT) – resulting in exclusion of homosexual sexual activities from the experimental protocols – the studies on PE were actually conducted only on heterosexual couples.

Sexual health and satisfaction are hugely important to a person's wellbeing, to their quality of life and also to having a good relationship with their partner. The World Health Organisation (WHO) states that "a satisfying, safe and enjoyable sex life" is a central aspect of human existence.

There are many aspects to Premature Ejaculation (PE) which can have negative effects on the couple. A man's discomfort (both physical and psychological) combined with his partner's reduction in sexual satisfaction, can cause serious problems in both a couple’s sexual and emotional life. For both men with PE and their partners, a lack of control leads to dissatisfaction, a feeling that something is missing from the relationship, and an impaired sense of intimacy. In other words, PE leads to an imbalance in a couple's relationship, creating misunderstanding and discomfort.

Premature ejaculation affects the couple of different ways. There are two main types of consequences: effects on sexual satisfaction and psychological. From a sexual standpoint, 25% of respondents reported having sexual satisfaction low or very low. 52% of PE partners have had no orgasm compared to 21% in the control group. 75% of PE partners reported arousal problems compared to only 20% in the control group. In an European observational study on PE, only 53% of sexual partners of PE men experienced more or less regular orgasm during coitus whereas this was the case in 84% of partners of non-PE men.

From a psychological perspective partners of patients with premature ejaculation refer felt "uncomfortable" with their partner, 50% of them suffer distress and interpersonal difficulties 32%.

That’s why PE is something that the couple should tackle together. Studies have shown that couples who communicate openly and honestly about male sexual dysfunction have the best chance of dealing with the issue effectively. The partner plays a fundamental role by supporting the man with PE, who needs to realise that the problem can be resolved by going to see a doctor together.

References:

1. UN. The Right to Reproductive and Sexual Health. http://www.un.org/ecosocdev/geninfo/women/womrepro.htm
2. Graziottin A. “Sessualità e fisiopatologia sessuale” in: Zanoio L, Barcellona E, Zacché G. (a cura di), Ginecologia e Ostetricia; Elsevier Masson, Milano 2007; pp:165-196
3. Graziottin A. Althof S. The Journal of Sexual Medicine 2011; 8 Suppl 4: 304-309.

See more about personal distress and partners relationship.

A man’s discomfort (both physical and psychological) combined with his partner’s low sexual satisfaction can cause serious problems, both in a couple’s sexual and emotional life. Men with Premature Ejaculation (PE) and their partners can experience:

• impaired sexual functioning;
• less satisfaction during sexual intercourse;
• reduced quality of life;
• increased levels of distress;
• more interpersonal difficulty.

References:

1. McCarty EJ. Core Evidence 2012;7:1-14.
2. McMahon CG et al. J Sex Med 2011;8:524-539.

See more about personal distress and partners relationship

In a couple who have no fertility problems, a man with Premature Ejaculation (PE) is still able to fertilise, provided that ejaculation, even if too early, occurs during penetration and not before the penis is inserted into the vagina (ejaculation ante portas). In the latter case, it is always advisable to see a doctor, because he is likely to be able to recommend a solution.

Premature Ejaculation (PE), both chronic (Lifelong) or Acquired, is a medical condition. When acquired, PE could be cured. If, for example, doctor finds out that your PE is actually caused by another disease, for instance by a prostatitis, an antibiotic therapy will resolve the inflammation with a positive effect also on your PE.
In Lifelong form of PE there are different options the doctor could prescribe. Therefore, you need a physician to decide whether and which treatment is indicated in your case.

So, if you think you have PE, you must acknowledge that PE is a common medical condition that needs and can be treated, you must avoid attempting to treat it by yourself since that is almost certainly useless and probably dangerous and you have to go to the doctor instead, in order to get the right diagnosis and treatment as there are safe and effective solutions available.

References:

1. EAU Guidelines on ED and PE 2012.

Premature Ejaculation (PE) is a medical condition that can be treated. It was initially seen as a psychological problem and for decades was treated with behavioural and cognitive therapies. Subsequently, pharmacological treatments such as prescription drugs and topical preparations have become available.

In any case, a doctor’s consultation is the only safe way for a correct diagnosis and treatment. Only a doctor can identify the causes (whether it is a primary or a secondary PE) and the most appropriate therapies for you. And only a doctor can prescribe the pharmacological treatments available.

The real danger is self-medication. If the doctor has prescribed a pharmacological treatment, such as a medicine, it is important to be absolutely sure that the product purchased is genuine and not counterfeit. Taking genuine medication is important, first of all for your health and wellbeing and also for your safety, since fake medicines have been found to contain very dangerous substances. Because of this, you should always get the products your doctor prescribed to you from a reputable pharmacist whom you know and trust or from an authorised and certified online pharmacy (be aware that online pharmacies are allowed and so, certified and safe, only in some countries).

References:

1. World Health Organisation. ICD-10;1992. p. 355–356.
2. www.eaasm.eu "The Counterfeiting Superhighway" report.

See more about safety of remedies

PE was initially seen as a psychological problem and for decades was treated with behavioural and cognitive therapies. Among these, the so-called breathing control techniques appeared to have a calming effect and, at that moment, seemed to really work.

But clinical experience and scientific studies suggests that improvements achieved with these methods are generally not maintained long term. That is because PE is a medical condition caused by many factors. Psychological and physical factors may be associated in the same individual, and only a doctor can make an accurate diagnosis and find the most appropriate solution. Not to mention that, if you focus all your attention on your breathing rather than on your partner, what will become of the relationship as well as your own satisfaction?

References:

1. Revicki V et al. Health and Quality of Life Outcomes 2008;6:33.

Masturbation before sexual intercourse, while partially effective in the short term, may ultimately exacerbate rather than alleviate PE, as men deliberately ignore or fade the sexual sensations that need to be controlled in order to improve the condition. Furthermore, bad masturbation practice, i.e. a non-stop rush to climax, can further impede the development of ejaculation control mechanisms.

Masturbation before sexual intercourse is one of the so called behavioural self-techniques and it’s used by many younger men. The reasons that support in theory this method are related to the fact that, following masturbation, the man could partially increases ejaculatory control, learning to recognise the signs of increased sexual arousal and how to keep his level of sexual excitement below the intensity that elicits the ejaculatory reflex. Moreover, the penis is desensitised resulting in greater ejaculatory delay after the recovery period.

However, the effectiveness of behavioural self-help techniques has not supported by controlled researches. Furthermore, clinical experience suggests that any improvements achieved with these techniques are generally not maintained long term.

References:

1. EAU Guidelines on ED and PE 2012.
2. Revicki V et al. Health and Quality of Life Outcomes 2008;6:33.

In case of Premature Ejaculation (PE), talking with your partner is very important. Sexual dissatisfaction can cause feelings of frustration, anger and disappointment and may negatively impact a couple’s intimacy and harmony. Without a heart-to-heart talk, both sides can develop a sense of inadequacy, which can affect their sexual well-being and even the couple's stability.

Therefore, premature ejaculation is a problem that a couple should try to resolve together. Mutual dialogue unites the couple and represents one of the most effective "weapons" in finding a solution. The role of the partner, in fact, is essential and can facilitate the realisation of the problem by the man and together they can seek a solution. It is often thanks to the partner that men go to see a doctor. But in any case, going to a doctor is also essential, since this is the only way to diagnose the problem properly, find the cause and, if necessary, undergo effective therapy to treat it.

Getting information about a medical condition is very important but you must select a source you can safely trust. Internet websites of scientific associations or supported by them can provide useful and reliable information, but in any case doctor’s consultation is fundamental.

Information available on the Internet does not always have scientific support and may have a confounding effect and generate unsubstantiated myths.

Premature Ejaculation (PE) is a medical condition that can be treated but self-medication is a real danger both for a mistake on the diagnosis and the risk to take the wrong treatment. Only a doctor can identify the causes (whether it is a primary or a secondary PE) and prescribe the most appropriate treatment for you. Also, please notice that many treatments available are prescription only medicines and so, be aware of the websites that sell those treatment without asking for the prescription, since they may be illegitimate online pharmacies that sell counterfeit medications.

Taking genuine medication is important, first of all for your health and wellbeing and also for your safety, since fake medicines have been found to contain very dangerous substances. Because of this, you should always buy the prescribed products from a reputable pharmacist whom you know and trust or from an authorised and certified online pharmacy (be aware that online pharmacies are allowed and so, certified and safe, only in some countries).

References:

1. Jannini EA, Limoncin E, Ciocca G et al. J Sex Med 2012;9:2994–3001.
2. Popovic M. Arch Sex Behav 2011;40:449–456.
3. Malamuth N, Huppin M. Adolesc Med Clin. 2005;16(2):315-326.

If you think that you have PE, then the only person who can really help is a doctor.
PE is certainly a delicate subject to discuss, but talking openly with a doctor is the right and only way to overcome the problem. Only a doctor can identify the causes (whether it is a primary or a secondary PE) and the most appropriate therapies for you. And only a doctor can prescribe the pharmacological treatments available, if needed.

Overcoming taboos and embarrassment is a crucial step. You should also talk to your partner in order to have strong support in going to the doctor and seek a solution together. There are also some tools that can help you and your partner to have a more objective evaluation for example the PEDT test (please notice that PEDT doesn’t substitute doctor’s diagnosis), that could also be useful as a starting point in the conversation with a doctor.

Talking about sexual problems, and especially about Premature Ejaculation (PE), is always complicated and causes embarrassment and anxiety. It is therefore perfectly understandable that you feel ashamed. Most men with PE are sensitive to being labelled as premature ejaculators. Moreover, most men feel embarrassed at the thought of having to discuss their problem with a relative stranger, such as a doctor. This is why most men with PE do not seek assistance from their physician, and over half of the men who did not talk to a doctor about their PE said that they had never considered doing it.

But it is actually important that you are able to overcome any shame and talk to your doctor, because it is the only way to get the right diagnosis and effective treatment and so, to improve the quality of your sexual relationship. There are also some tools that can help you to overcoming taboos and embarrassment: for example the PEDT test (please notice that PEDT doesn’t substitute doctor’s diagnosis), that could also be useful as a starting point in the conversation with a doctor.
See more and try the PEDT test

Only a doctor can identify the causes (whether it is a primary or a secondary PE) and the most appropriate therapies for you. And only a doctor can prescribe the pharmacological treatments available. Instead, self-medication is generally useless, or worse, harmful and should be avoided, because it involves many risks (e.g. the risk of using an inadequate or ineffective remedy). But above all, avoid trying to obtain a drug on the internet from unauthorised online dealers.

Please notice that many treatments are prescription only and so, be aware the website that sell them without asking for the prescription may be illegitimate online pharmacies that sell counterfeit medications.
Taking genuine medication is important, first of all for your health and wellbeing and also for your safety, since fake medicines have been found to contain very dangerous substances. Because of this, you should always get the products your doctor prescribed to you from a reputable pharmacist whom you know and trust or from an authorised and certified online pharmacy (be aware that online pharmacies are allowed and so, certified and safe, only in some countries).

References:

1. Revicki V et al. Health and Quality of Life Outcomes 2008;6:33.
2. Porst H, Montorsi F, Rosen RC et al. Eur Urol 2007;51:816–824.

Premature Ejaculation (PE) is a problem that a couple should try to resolve together. Mutual dialogue unites the couple and represents one of the most effective "tools" for finding a solution. A partner, who shares the burden of PE may also contribute to the solution, talking to the man gently, and helping him to become aware of the problem so that he can seek a way to resolve it. In fact, it’s often thanks to a partner that men go to see a doctor, which is the only way to diagnose the problem properly, find the cause and if necessary, undergo effective therapy to treat it.
While some men wish to hide their condition, studies have shown that couples who communicate openly and honestly about male sexual dysfunction have the best chance of dealing with the issue effectively.

A majority of men with PE (more than 60%) stated that they would seek treatment for PE if their partner suggested it, and nearly 75% of men with PE who did seek treatment did so based on a desire to increase the sexual satisfaction of their partner. 

References:

1. Porst H, Montorsi F, Rosen RC et al. Eur Urol 2007;51:816–824.

See more about how to talk to your partner