Premature Ejaculation

Causes

• Anxiety and Stress: Performance anxiety, general anxiety, and high-stress levels (from work or relationships) are common contributors.
• Relationship Issues: Communication problems or unresolved conflicts with a partner can play a significant role.
• History: Early sexual experiences characterized by haste (e.g., to avoid being caught), a strict upbringing about sex, or a history of sexual trauma can establish a pattern.
• Depression and Confidence: Feelings of guilt, depression, or poor self-esteem can affect sexual function. 

Biological factors:

• Chemical and Hormone Levels: Irregular levels of certain brain chemicals (neurotransmitters) like serotonin and dopamine, or hormones such as testosterone and those related to the thyroid, may be involved.
• Inflammation or Infection: Problems with the prostate or urethra can contribute to PE.
• Erectile Dysfunction (ED): Men with ED may rush through sex to ejaculate before losing their erection, forming a difficult habit to break.
• Genetics: Lifelong PE may have a genetic predisposition.
• Penile Sensitivity: Increased sensitivity of the penis has been suggested as a possible cause in some cases. 

Treatment and Management

• Behavioral Techniques: These are often the first line of treatment and aim to build tolerance and control over ejaculation.
  • Start-and-Stop Method: The man or partner stimulates the penis until the man feels he is near orgasm. Stimulation is stopped until the sensation passes, then resumed. This is repeated multiple times before allowing ejaculation.
  • Squeeze Technique: Similar to the start-and-stop method, but when the man is close to ejaculating, the partner or the man himself gently squeezes the head of the penis for several seconds until the urge to ejaculate lessens.
  • Other self-help options: Masturbating an hour or two before sex, using thicker condoms to reduce sensation, or trying to distract oneself (though this may reduce pleasure for both partners).
• Medications: Oral medications or topical numbing agents can help delay ejaculation.
  • Topical Anesthetics: Creams or sprays containing lidocaine or prilocaine can be applied to the penis 10 to 15 minutes before sex to reduce sensation. A condom should be used to prevent the numbing effect from transferring to the partner.
  • Oral Medications: Certain selective serotonin reuptake inhibitors (SSRIs), which are a type of antidepressant, can be prescribed off label to delay orgasm. Dapoxetine (Priligy) is an SSRI developed specifically for on-demand use for PE and is available in some countries.
  • Other Medications: Tramadol (a pain reliever) or medications for erectile dysfunction may also be used in some cases, often in combination with SSRIs.
• Counseling and Therapy: Talking with a mental health professional, certified sex therapist, or couple’s counselor can help address underlying psychological or relationship issues, reduce performance anxiety, and improve communication.