Premature ejaculation is one of the major male sexual concerns. About one-third of males experience premature ejaculation at some point in their life.
Premature ejaculation is the early and fast release of semen during sexual activity. It is also known as the premature climax, and as per Ayurveda, it is known as Shukra Gata Vata.
Premature ejaculation affects intimate relationships and can be frustrating for both partners. Premature ejaculation is involuntary, and semen ejaculation occurs usually within a minute of sexual activity.
It can lead to fertility problems and, therefore, is worrisome. Premature ejaculation can be of two types – primary or secondary. In primary premature ejaculation, there is a problem since the first sexual activity, but secondary premature ejaculations develop over time.
There are many psychological and biological factors responsible for premature ejaculation. Some of them are:
- Early sexual exposure
- Sexual abuse
- Depression or stress
- Poor body image or low esteem
- Feelings of guilt
- Not being in a healthy relationship
- Performance pressure
- Less interested in sexual activity
The biological factors that may lead to premature ejaculation are:
- Abnormal sexual hormone levels
- Abnormal levels of neurotransmitters like serotonin
- Urologic conditions like urethritis, prostatitis, benign prostatic hypertrophy
- Neurological conditions like multiple sclerosis, alcoholic neuropathy, spinal cord tumours, and polyneuritis
- Genetic inheritance
Erectile dysfunction can lead to a greater probability of premature ejaculation and can happen at any age.
There are a variety of ways to overcome premature ejaculation, and several medicines are available on the market for the treatment of premature ejaculation.
People nowadays prefer an Ayurvedic method for the treatment of diseases due to minimum or no potential side effects.
Th treatment options for premature ejaculation include behavioural techniques, topical anaesthetics, medications, and counselling. You must understand that you might take time to find a treatment option that fits best for you.
Behavioural therapies are simple ways that might be beneficial. Like you can masturbate one or two hours before sexual activity to delay ejaculation and prolong the time.
If you have any performance pressure, talk with your partner. You can engage in other sexual activity besides intercourse. It may help you.
Pelvic floor exercises
Premature ejaculation can be a consequence of weak pelvic floor muscles. Pelvic floor exercises, also known as Kegel exercises, can strengthen the pelvic floor muscles.
How to perform these exercises?
- Find the right muscles.
The first and foremost is to identify pelvic floor muscles. The muscles which relax during peeing or passing gas are your pelvic floor muscles.
- Master the exercise
Tighten these pelvic floor muscles by holding pee mid-stream or by preventing the passing of gas. Repeatedly hold and relax the contraction of the muscle for three seconds.
- Be focused
Keep your focus on the contraction of pelvic floor muscles. Do not flex the muscles of the abdomen, thighs, or gluteus. Breathe freely.
- Repeat these exercises three times a day.
It is advised to perform these exercises at least three times a day for better results.
The pause-squeeze technique
Your healthcare expert may advise you and your partner about the pause-squeeze technique. It is performed as follows:
- Engage in sexual intercourse as usual and stimulate the penis until you get erect and about to ejaculate.
- You can ask your partner to squeeze the glans part of your penis for a few seconds till your urge fades.
- You may repeat this as per your need and convenience.
This technique aids in the delay of ejaculation. It requires some practice and you may feel normal in delaying your ejaculation. After a while, you might not even need to perform it.
Another technique that might be helpful in overcoming premature ejaculation is the start-stop technique. It can be a substitute for the above-mentioned pause squeeze technique as it can cause pain and discomfort.
After stimulating the penis and when you feel ready to ejaculate, stop the stimulus and think or talk about a random topic with your partner till the urge passes and then start over again.
There are many medications that are beneficial in the treatment of premature ejaculation.
The anaesthetic creams and sprays that contain numbing substances like benzocaine, lidocaine, or prilocaine are helpful in the management of premature ejaculation. You can apply them topically over the penis before 10 to 15 mins of sexual activity. It aids in delaying ejaculation.
These creams and sprays can be bought from the market by prescription and as over-the-counter drugs. These creams are effective but also can have side effects like reduced sexual pleasure and loss of sensitivity for some time.
Oral medications like antidepressants, analgesics, and phosphodiesterase-5 inhibitors help delay climax and ejaculation. Though, these drugs are not FDA approved.
Delay in ejaculation is a side effect of some antidepressants. Due to this, selective serotonin reuptake inhibitors (SSRIs) such as escitalopram (Lexapro), sertraline (Zoloft), paroxetine (Paxil), or fluoxetine (Prozac, Sarafem) are used in the management of premature ejaculation.
They are effective after five to ten days and reach their peak effect after two to three weeks of treatment.
Your doctor can also advise tricyclic antidepressants like clomipramine (Anafranil) for the treatment of premature ejaculation.
These drugs show other side effects like gastrointestinal symptoms, drowsiness, and decreased libido.
Analgesics like tramadol can be used to cure premature ejaculation.
It is advised not to take tramadol in combination with an SSRI
- Phosphodiesterase-5 inhibitors.
These medications are used to treat erectile dysfunction. It includes sildenafil (Viagra), tadalafil (Cialis, Adcirca), or vardenafil (Levitra, Staxyn).
They are also beneficial in delaying ejaculation. These medications are effective if used in combination with an SSRI.
Potential future management
Research on various drugs has found that some drugs like Dapoxetine, Modafinil, and Silodosin can be beneficial for the treatment of premature ejaculation.
Condoms reduce the sensitivity of the penis and hence, aid in delaying ejaculation. There are climax control condoms available in the market that have anaesthetic agents like benzocaine or lidocaine or are made of thicker latex to overcome premature ejaculation.
Counselling can prove beneficial for some people. It helps to reduce stress, anxiety, and performance pressure.
Counselling is more effective along with drug therapy.