Premature Ejaculation

What is Premature Ejaculation?

Premature ejaculation (PE), or now, as it is often referred, rapid ejaculation (RE), is a common medical condition that is tough to define and affects up to 30 percent of men.

It can be either primary, meaning the man has always had the problem, or secondary, meaning the man has acquired the condition later in life. Premature ejaculation has various timing definitions ranging from ejaculating within one minute of penetration to ejaculating prior to a man's partner achieving orgasm. Essentially, a man or a couple can suffer from rapid ejaculation if one or both is unhappy with how rapidly the man ejaculates. For some couples, RE can occur 30 seconds into vaginal penetration. For others, RE may extend out to five or ten minutes. As long as one of the partners is dissatisfied, RE is a problem.

How does Premature Ejaculation Occur?

A man doesn’t have much control over how quickly he ejaculates. Ejaculation is mostly an event of the autonomic nervous system, the part of our nervous system we can’t fully control. Heartbeat, digestion, sweating are all examples of neurologic processes our autonomic nervous system controls. Therefore, when a man gets a signal to ejaculate, the point of no return, he’s going to go. The most sensitive part of the penis is the area around the frenulum, the skin flap on the underside of the penis just below the urethral meatus (where he urinates). There is a spinal cord pathway that connects there and rapidly sends signals to the ejaculation center of the spinal cord. Ejaculation is also hormonal. Serotonin, dopamine, prolactin, testosterone and oxytocin are all hormones that play a role in ejaculation.

What Causes Premature Ejaculation?

This is a very troubling condition for men as it compromises their sexual satisfaction and inhibits them in relationships. Some recent studies shed light on PE and RE but the exact causes are still not known.

Psychological: Classic literature on RE suggests it is a trained sexual response fostered by men secretively masturbating as adolescents and trained to finish quickly. This behavior was then reinforced with early partner encounters where young couples engage in clandestine sexual activity in parents’ basements or car back seats. There is no proof that this is a real thing, however, and physicians suggesting this as a cause of RE reinforces guilt associations with sexuality.

Neurobiological: The neurotransmitter serotonin (5HT) plays a central role in the ejaculatory response. Low levels of serotonin in specific areas of the brain may lead premature ejaculation. Studies have shown that increases in serotonin levels can help delay ejaculation in some men. This provides the rationale for treating RE with anti-depressants in the selective serotonin reuptake inhibitor (SSRI) class.

Penile Sensitivity: The ejaculatory spinal cord pathway is located at the ventral tip of the corona (if you’re standing up and looking down at your penis, the ventral side is on the bottom. The corona is the mushroom head of your penis.) If a man has increased sensitivity at that point, he will likely ejaculate too fast. Applying topical numbing agents, usually containing lidocaine, is an effective way to reduce penile sensitivity and prolong ejaculation. It is important to wash the penis prior to intercourse, or wear a condom, to avoid desensitizing the partner, however.

Treatment Options for Premature or Rapid Ejaculation at UCLA

At UCLA Health—The Men’s Clinic, physicians are trained to treat rapid ejaculation and have a number of methods available. Treatment for PE and RE centers around behavioral, neurologic and hormonal modifications.

Behavioral Therapy: Some patients respond to techniques such as starting and stopping. This basically involves interrupting intercourse to decrease stimulation to the penis in hopes of cooling the nerves down. Although effective at times, most patients report limited sexual satisfaction with these methods.

Topical medications: One of the simplest treatment option is to temporarily desensitize the head of the penis by using a topical anesthetic medications for premature ejaculation. They are effective, easy-to-use, low-cost and have a negligible risk of systemic side effects. Topical numbing sprays and creams are available with either a prescription or over the counter. They all work by gently numbing the sensitive areas of the penis so the nerves don’t fire so fast and the man can prolong intercourse. The agent must be washed off prior to intercourse or a condom must be worn to make sure the partner is not also desensitized. One option for patients is a new product, Promescent®, from Absorption Pharmaceuticals, which provides improved ejaculatory latency (the time from penetration to ejaculation) with minimal loss of sexual sensation.

Oral medications: Some men respond well to low doses of the antidepressants known as selective serotonin reuptake inhibitors (SSRIs), that block serotonin, one of the hormones important in ejaculation. These are prescribed off-label, with some side effects. These pills have been around for over 20 years, are relatively safe, but are not FDA approved for PE / RE. It is therefore up to the patient and his doctor to make the call to use this class of drugs off label.

Don’t be afraid to seek treatment for premature or rapid ejaculation. It is a very common condition, and one of the most common sexual dysfunctions. Your UCLA Men’s Clinic provider will be understanding and likely have an effective treatment that will please you and your partner.

Scheduling an Appointment

Board-certified urologists staff The Men’s Clinic at UCLA and you can be assured you are getting an experienced physician performing your evaluation and procedure in a relaxed and comfortable environment. For more information and to schedule an appointment, please call the UCLA Urology Appointment line at 310-794-7700.