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Why can’t I delay ejaculation?

What is premature ejaculation?

Premature ejaculation (PE) is when a man ejaculates (releases semen) sooner than he or his partner would like during sex/ within 1 minute of inserting the penis into the vagina. It is a common problem that affects up to 30%-40% of men.

A detailed diagram showing the different parts of the male reproductive system

Note: PE is not erectile dysfunction (ED), but ED may lead to PE.

How does ejaculation work?

Ejaculation is controlled by the central nervous system (brain & spinal cord). When a man is sexually stimulated, signals will be sent to the brain and spinal cord, which will then be sent to the reproductive organs when the man reaches a certain level of excitement. This releases semen through the penis – which is a process called ejaculation.

How do I know if I have PE?

The main symptom of PE is the inability to delay ejaculation for more than one minute/ unable to control ejaculation after penetration.

PE can be classified into two groups:

1. Lifelong (primary)

  • Occurs (nearly) all the time
  • Early ejaculation exists from the (nearly) first sexual intercourses
  • Present in (nearly) every female partner in more than 80%-90% of sexual intercourse events

2. Acquired (secondary)

  • Develops after you have had previous sexual experiences without ejaculatory problems

What are some factors that increase my risk of PE?

The factors that cause PE can be sorted into 2 categories: physical/ chemical and emotional/ psychological.

Physical/ Chemical Factors:

  • Irregular hormone levels

    • Oxytocin, luteinizing hormone, prolactin: High levels of these hormones leads to high levels of testosterone, which may result in PE
    • Thyroid stimulating hormone (TSH): Low levels of TSH leads to hypothyroidism (a common condition where an insufficient amount of thyroid hormone is in the bloodstream, affecting a man's ability to keep an erection. Low levels of TSH therefore leads to PE
  • Irregular serotonin/ dopamine levels

    • Serotonin and dopamine are neurotransmitters that send signals which cause the body to become aroused and/or ejaculate

      • Research has proven that a rat can ejaculate without being touched if the neurotransmitter receptors are stimulated
    • Serotonin delays ejaculation; low levels of serotonin result in faster ejaculation, therefore leading to PE

    • Dopamine causes an ejaculation to take place; a high level of dopamine results in PE

  • A penis that is extra sensitive to stimulation

    • The ejaculatory spinal cord pathway, which contains semen, is located at the frenulum

A diagram showing the ejaculatory spinal cord pathway

  • Increased sensitivity at the frenulum will open up the pathway, resulting in early ejaculation

Emotional/ Psychological Factors:

  • Performance anxiety

    • Could occur when having sexual intercourse with a new partner, having sexual intercourse again after a long period of abstinence, lack of confidence, guilt, being overly excited or stimulated
    • Anxiety may result in overly high dopamine levels
  • Stress and depression

    • A patient with depression typically has low levels of serotonin, while a patient that is abnormally stressed has high dopamine levels. This may lead to PE
    • Other issues that lead to stress and depression (eg. relationship problems) may also result in PE

How can I confirm if I have PE?

If you suspect that you have PE, you should see your healthcare provider. You will be diagnosed after going through a physical examination and talking with your healthcare provider.

Some questions that the healthcare provider may ask include:

  • How long have you been sexually active?
  • When did PE become a concern?
  • How long have you had this problem?
  • How often does PE occur?
  • Does PE occur with just one partner, or all partners?
  • How long do you usually take before ejaculating during intercourse and when you masturbate?
  • How has PE changed your sexual activity?

If your healthcare provider thinks that your PE is caused by emotional issues, you may be referred to a mental health professional who specializes in sexual dysfunction.

If you have both PE and trouble getting/ maintaining an erection, your healthcare provider might order blood tests to check your testosterone (male hormone) levels or other tests.

For more information or if you require a medical consultation, please contact My Healthcare Collective here.