Ejaculation of semen during sexual intercourse before or immediately after penetration.

Premature ejaculation occurs when a man ejaculates sooner during sexual intercourse than he or his partner would like. Premature ejaculation is a common sexual complaint. Estimates vary, but as many as 1 out of 3 men say they experience this problem at some time. As long as it happens infrequently, it's not cause for concern.

The primary symptom of premature ejaculation is the inability to delay ejaculation for more than one minute after penetration. However, the problem may occur in all sexual situations, even during masturbation.

Premature ejaculation can be classified as lifelong (primary) or acquired (secondary). Lifelong premature ejaculation occurs all or nearly all of the time beginning with your first sexual encounters. Acquired premature ejaculation has the same symptoms but develops after you've had previous sexual experiences without ejaculatory problems.

Many men feel that they have symptoms of premature ejaculation, but the symptoms do not meet the diagnostic criteria for premature ejaculation. Instead these may have natural variable premature ejaculation, which is characterized by periods of rapid ejaculation as well as periods of normal ejaculation.

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 an 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 possible 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

·         Nerve damage from surgery or trauma (rare)

Common treatment options for premature ejaculation include behavioural techniques, topical anaesthetics, oral medications and counselling. Keep in mind that it may take a little time to find the treatment or combination of treatments that will work for you.

Behavioural techniques

In some cases, therapy for premature ejaculation may involve taking simple steps, such as masturbating an hour or two before intercourse so that you're able to delay ejaculation during sex. You may try avoiding intercourse for a period of time and focusing on other types of sexual play so that pressure is removed from your sexual encounters. You can also try diverting your mind before ejaculation is ready to come and proceeding after a brief break, thereby prolonging duration of intercourse / action

The pause-squeeze technique

You and your partner can use of a method called the pause-squeeze technique. This method works as follows:

1.    Begin sexual activity as usual, including stimulation of the penis, until you feel almost ready to ejaculate.

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.

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.

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 pause-squeeze technique.

Topical anaesthetics

Anaesthetic creams and sprays that contain a numbing agent, such as lidocaine or procaine, are sometimes used to treat premature ejaculation. These products are applied to the penis a short time before sex to reduce sensation and thus help delay ejaculation. A lidocaine spray for premature ejaculation is available.

Although topical anaesthetic agents are effective and well-tolerated, they have potential side effects. For example, some men report temporary loss of sensitivity and decreased sexual pleasure. In some cases, female partners also have reported these effects. In rare cases, lidocaine or procaine can cause an allergic reaction.

Oral medications

Many medications may delay orgasm. Although none of these drugs is specifically worthwhile as people believe, approved medications may be prescribed for either on-demand or daily use, and may be prescribed alone or in combination with other treatments to treat premature ejaculation, some are used for this purpose, including antidepressants, analgesics and phosphodiesterase-5 inhibitors

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