Premature ejaculation - the secret condition

Dear Dr Williams-Green,

I am having premature ejaculation (PE). I wish you could help me please. My erection does not stay during sex and it is weak. I am 20 years old. I am looking forward to your response. Thanks.

Dear Reader,

Premature ejaculation is the inability to delay ejaculation sufficiently to enjoy lovemaking. This manifests as difficulty with penetration or ejaculation shortly after penetration. At least a third of men surveyed in the USA report at least one incident of premature ejaculation in the previous year. It may well be the most common male sexual problem. Some men report the condition from the very first sexual contact. Often they refuse to discuss the problem with their partners and may seek several partnerships in an effort to solve the problem. Men often suffer in silence and the condition causes severe distress to both partners.

Ejaculation is distinct from orgasm in the man. While ejaculation describes the release of semen from the man's body, orgasm describes the subjective pleasurable sensations which occur before ejaculation. So, premature ejaculation is a non-issue for men who are concerned only with their own orgasm. In fact, in some cultures it is considered very masculine to ejaculate very quickly.

Just two minutes

Men are capable of orgasm within two minutes of initial stimulation. Women usually require about eight minutes to reach orgasm. It is, therefore, 'normal' for young, inexperienced men to ejaculate before their partners reach orgasm. To achieve mutual satisfaction men have to be able to time their ejaculation. Too much anxiety will cause premature ejaculation in any relationship.

Premature ejaculation becomes a problem only when there is the persistent and recurrent absence of reasonable voluntary control of ejaculation. Men may have early sexual experiences which caused them to hurry through intercourse. Sometimes premature ejaculation occurs many years in a relationship and this may represent interpersonal problems due to underlying conflict in the relationship. Premature ejaculation results in disappointment and frustration and ultimately loss of self-esteem on the part of men.

Medical therapy

Treatment is two-fold including medications that delay ejaculation as well as psychotherapy. Antidepressants and benzodiazepine anxiolytics are useful in the short term. Many men are too embarrassed to discuss this problem with their primary care provider. The condition requires a detailed interview with the man and his partner in order to define the problem. Often, a urologist is also consulted.

Dr Pauline Williams-Green is a family physician and past president of the Caribbean College of Family Physicians; email: yourhealth@gleanerjm.com.