Premature Ejaculation - Causes - Symptoms - Treatment - Complications

Premature ejaculation refers to an undesirable condition of discharge of semen with minimum sexual stimulation before.
Sometimes the condition becomes so severe that the patient ejaculates before or just after penetration.

Causes: 
Premature ejaculation is a common complaint. People all around the world are suffering from this problem.
The possible causes of premature ejaculation are ;

• Psychological.
• Trauma
• Infections
• Surgery
• Drugs
• Structural Problem of  Male or Female genitalia.

The most common cause of premature ejaculation is psychological and is common in adolescents (teens and twenties) . Psychological fears include;

• feelings of sinfulness.
• fear of shame.
• fear of not being able to satisfy the partner
• fear of discovery
• fear of making partner pregnant.
• Fear of getting the sexually transmitted disease. 
• Other anxieties.

All other causes of premature ejaculation are rare. 

Trauma and the anxiety related to trauma may cause premature ejaculation but it goes away with time.

Infections (urethritis-infection of urethra or prostatitis-infection of the prostate, vesiculitis-infection of seminal vesicles) are commonly associated with Premature ejaculation.

Surgery has same effects on Premature ejaculation as trauma.

Drug withdrawal may be associated with premature ejaculation, many such cases has been recorded, (especially withdrawal from opioid) 

Structural abnormalities, for example, Peyronie's disease in males and abnormal tightness of vagina are associated with premature ejaculation.

Symptoms:

In premature ejaculation, ejaculation occurs before it is desirable by either of partners. Patient and his partner are unable to get sexual satisfaction from intercourse, especially the partner of the patient. Ejaculation may occur before or just after penetration. All fears stated above are commonly associated with the problem.

Diagnosis: 

Normally physical examination of patient results in normal findings. The best source of diagnosis is the patient's sexual history. A partner should help in reporting sexual history because the patient might have missed some important points or he was unwilling to reveal some important secrets. The purpose is just to confirm what type of psychological fear the patient is facing.

Treatment:

              Therapy for Premature ejaculation should be conducted under the supervision of a doctor. Normally a doctor helps the patient to find out ways of controlling his ejaculation. Treatment of premature ejaculation requires patience, dedication and commitment by both partners. the first part of the therapy is to avoid sexual relation for several weeks. This period of abstinence helps the patient to relax and remove the performance anxiety from his mind. the other options include;

• Stop and Start Technique; In this technique, the person stops all sexual stimulation when he feels that he is about to come, the duration should be of 30 seconds. After 30 seconds he starts again and may continue this process until ejaculation is desired by both partners. 
• Squeeze Technique: In this technique, the patient or his partner squeezes the penis at the junction of the glans penis and the shaft for about 30 seconds. all types of sexual stimulation must be stopped then they may continue. 

The patient and his partner should not use any unapproved medicine. 

Recently selective serotonin re-uptake inhibitors (SSRIs) are found to be useful in the treatment of premature ejaculation.

The common SSRIs being used for this purpose are 

• Fluoxetine
• Sertraline

It is important to emphasize that the use of these drugs to treat premature ejaculation is still considered experimental, as the FDA has not approved them for this specific use
Complications:
If premature ejaculation occurs before penetration,  pregnancy can't take place. other complications are the same as stated above i.e ., depression, sexual dis-satisfaction, and dissolution of marriage.