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.

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

• 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.