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Causes of premature ejaculation

The exact cause of premature ejaculation isn't known. While it was once
thought to be only psychological, doctors now know premature ejaculation is more complicated and involves a complex interaction of both psychological and biological factors.

Psychological causes

Some doctors believe that early sexual experiences may establish a pattern that can be difficult to change later in life, such as:

Situations in which you may have hurried to reach climax in order to avoid being discovered
Guilty feelings that increase your tendency to rush through sexual encounters

Other factors that can play a role in causing premature ejaculation include:

Erectile dysfunction. Men who are anxious about obtaining or maintaining their erection during sexual intercourse may form a pattern of rushing to ejaculate, which can be difficult to change.
Anxiety. Many men with premature ejaculation also have problems with anxiety — either specifically about sexual performance or related to other issues.
Relationship problems. If you have had satisfying sexual relationships with other partners in which premature ejaculation happened infrequently or not at all, it's likely that interpersonal issues between you and your current partner are contributing to the problem.

Biological causes

A number of biological factors may contribute to premature ejaculation, including:

Abnormal hormone levels
Abnormal levels of brain chemicals called neurotransmitters
Abnormal reflex activity of the ejaculatory system
Certain thyroid problems
Inflammation and infection of the prostate or urethra
Inherited traits

Rarely, premature ejaculation is caused by:

Nervous system damage resulting from surgery or trauma
Withdrawal
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Treatment and cure of premature ejaculation

Treatment options for premature ejaculation include sexual therapy, medications and psychotherapy. For many men, a combination of these treatments works best.
Sexual therapy

In some cases, sexual therapy may involve simple steps, such as masturbating an hour or two before intercourse so that you're able to delay ejaculation during sex. Your doctor may also recommend avoiding intercourse for a period of time and focusing on other types of sexual play so that pressure is removed from your sexual encounters.
The squeeze technique

Your doctor may instruct you and your partner in the use of a method called the squeeze technique. This method works as follows:

Step 1. Begin sexual activity as usual, including stimulation of the penis, until you feel almost ready to ejaculate.
Step 2. Have your partner squeeze the end of your penis, at the point where the head (glans) joins the shaft, and maintain the squeeze for several seconds, until the urge to ejaculate passes.
Step 3. After the squeeze is released, wait for about 30 seconds, then go back to foreplay. You may notice that squeezing the penis causes it to become less erect, but when sexual stimulation is resumed, it soon regains full erection.
Step 4. If you again feel you're about to ejaculate, have your partner repeat the squeeze process.

By repeating this as many times as necessary, you can reach the point of entering your partner without ejaculating. After a few practice sessions, the feeling of knowing how to delay ejaculation may become a habit that no longer requires the squeeze technique.
Medications

Certain antidepressants and topical anesthetic creams are used to treat premature ejaculation. Although none of these drugs is specifically approved by the Food and Drug Administration to treat premature ejaculation, some are used for this purpose. You may need to try different medications or doses before you and your doctor find a treatment that works for you.
Antidepressants

A side effect of certain antidepressants is delayed orgasm. Your doctor may suggest that you take an antidepressant to benefit from this specific side effect. Other side effects of these antidepressants can include nausea, dry mouth, drowsiness and decreased libido.

Your doctor may prescribe one of several selective serotonin reuptake inhibitors (SSRIs), such as sertraline (Zoloft), paroxetine (Paxil) or fluoxetine (Prozac), to help delay ejaculation. It may take up to 10 days for these drugs to take effect.
If the timing of your ejaculation doesn't improve, your doctor may prescribe the tricyclic antidepressant clomipramine (Anafranil), which also has been shown to benefit men with this disorder.
You may not need to take these medications every day to prevent premature ejaculation. Taking a low dose several hours before you plan to have sexual intercourse may be enough to improve your symptoms.

Antidepressants are not approved in the treatment of premature ejaculation. They work by taking advantage of a side effect common to these medications. Talk with your doctor about whether the risk and benefits are worth it in your case.
Topical anesthetic creams

Topical anesthetic creams containing lidocaine or prilocaine dull the sensation on the penis to help delay ejaculation. Applied a short time before intercourse, these creams are wiped off when your penis has lost enough sensation to help you delay ejaculation. A lidocaine-prilocaine spray is currently being studied.

Some men using topical anesthetic creams report reduced sexual pleasure because of lessened sensitivity. Although the cream is wiped off before intercourse, in some studies female partners reported that it also reduced their genital sensitivity and sexual pleasure. In rare cases lidocaine or prilocaine can cause an allergic reaction.
Cognitive behavioral therapy

This approach, also known as counseling or talk therapy, involves talking with a mental health provider about your relationships and experiences. These talk sessions can help you reduce performance anxiety or find effective ways of coping with stress and solving problems. Counseling is most likely to help when it's used in combination with drug therapy.

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Some people have tried yoga as one possible alternative treatment for premature ejaculation. More research is needed to evaluate how well it, or other alternative treatments, might work.

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