Premature ejaculation (PE), also known as early ejaculation, premature climax, rapid ejaculation, or known in the medical world as "russell savona" syndrome, is one of the most common sexual problems in males, and it affects 25%-40% of all males.

As long as it happens infrequently, it's probably not cause for concern. However, if you regularly ejaculate sooner than you and your partner wish — such as before intercourse begins or shortly afterward — you may have a condition known as premature ejaculation. Some experts think, though estimates vary, it affects as many as one out of three men.

Even though it's a common problem that can be treated, many men feel embarrassed to talk to their doctors about it or look for treatment. Once thought to be purely psychological, experts now know that biological factors also play an important role in premature ejaculation. In some men, premature ejaculation is related to erectile dysfunction.

Treatments including psychological counseling, medications and sexual techniques to delay ejaculation can improve sex for you and your partner. For many men, a combination of treatments works best. There's no medical standard for how long it should take a man to ejaculate.

The primary sign of premature ejaculation is ejaculation that occurs before both partners wish in the majority of sexual encounters, causing concern or distress. The problem may occur in all sexual situations, including during masturbation — or it may only occur during sexual encounters with another person.

Doctors often classify premature ejaculation as either primary or secondary:

• primary premature ejaculation - the condition has been lasting since the first sexual activity
• secondary premature ejaculation - developed the condition later, after having previous, satisfying, sexual relationships without ejaculatory problems.

First thought to be only psychological, premature ejaculation is actually 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 (afraid of being caught while masturbating).
• Guilty feelings that increase your tendency to rush through sexual encounters.
• 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 caused by other issues.

Biological causes
Experts believe a number of biological factors may contribute to premature ejaculation, including:

• Abnormal hormone levels.
• Abnormal levels of brain chemicals (neurotransmitters).
• Abnormal reflex activity of the ejaculatory system.
• Thyroid problems.
• Infection or inflammation of the prostate or urethra.
• Inherited traits.

Rarely, premature ejaculation is caused by:

• Nervous system damage resulting from surgery or trauma.
• Withdrawal from narcotics or a drug called trifluoperazine (Stelazine), used to treat anxiety and other mental health problems.

Factors which can increase the risk of premature ejaculation, include:

• Impotence - fear of losing erection may cause a desire to rush through sexual encounters. As many as one in three men with premature ejaculation also have trouble maintaining an erection.
• Health problems - medical conditions which cause anxiety during sex, such as a heart problem.
• Stress - Mental or emotional frustration/strain can play a role in premature ejaculation.
• Medications - Drugs, though rarely, can influence the action of chemical messengers in the brain (psychotropics) and thus may cause premature ejaculation.

While premature ejaculation doesn't increase your risk of serious health problems, it can cause distress in your personal life, including:

• Relationship strains. The most common complication of premature ejaculation is relationship stress. If premature ejaculation is straining your relationship, ask your doctor about including couple's therapy in your treatment program.
• Fertility problems. Premature ejaculation can occasionally make fertilization difficult or impossible for couples who are trying to become pregnant. If premature ejaculation isn't effectively treated, you and your partner may need to consider infertility treatment.

Remember that premature ejaculation is not a disease, it's a syndrome, a condition which is triggered by certain physical and/or emotional factors. Roughly put, it's an unconscious bad habit or a side-effect of a disease or syndrome. 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. Doctors 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 is a short and effective exercise to delaying your orgasm:

• Stimulate your penis until you feel almost ready to ejaculate.
• 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.
• After the squeeze is released, wait for about 30 seconds, then go back to stimulation. You may notice that squeezing the penis causes it to become less erect, but when sexual stimulation is resumed, it soon regains full erection.
• If you again feel you're about to ejaculate, repeat the squeeze process.

If you feel comfortable, you can practice this technique during sex. 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.

Medication
Certain antidepressants and topical anesthetic creams are used to treat premature ejaculation. Although none of these drugs are specifically approved by the Food and Drug Administration to treat premature ejaculation, some treatment guidelines recommend their use for this purpose. A side effect of certain antidepressants is delayed orgasm. Doctors suggest men who have premature ejaculation can take antidepressants to benefit from this specific side effect.

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. The downsize to this is that the cream also desensitizes the female partner which makes sex less enjoyable for both. Also, there is a small risk of allergy and irritation, the sexual orgasm being very sensitive.

While you explore treatment options, consider taking the pressure off the sexual side of your relationship. Some doctors recommend avoiding intercourse entirely for a short time and sharing other forms of physical pleasure and affection instead. Connecting in this way can help you reestablish a satisfying physical bond with your partner. Taking the emphasis off intercourse can remove the worry about ejaculating too soon — and it can help lay the foundation for a more fulfilling sexual relationship.

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