Premature Ejaculation (PE): Causes, Diagnosis, and Effective Treatment Options

When Is It Considered Premature Ejaculation?

Premature Ejaculation is clinically defined based on the following criteria:

• Intravaginal Ejaculatory Latency Time (IELT) of less than 60 seconds
  
• IELT is measured from the moment of vaginal penetration until orgasm
  
• The average IELT in healthy men is approximately 5.4 minutes
  
• IELT may decrease due to physical health conditions and psychological factors

Causes of Premature Ejaculation

1. Organic (Physical) Causes of Premature Ejaculation
   Genetic predisposition
   Men with first-degree relatives (father or brothers) affected by PE have up to a 30% increased risk
   Urological conditions
   such as prostatitis or varicocele
   Neurological disorders
   including spinal diseases, cerebrovascular disease, or brain tumors
   Penile hypersensitivity, where the penis responds excessively to stimulation
   Endocrine disorders
   such as low prolactin levels, hyperthyroidism or hypothyroidism, and diabetes mellitus
   Weak pelvic floor muscles
   Medications and substance use
2. Psychogenic (Psychological) Causes
   Commonly associated with performance anxiety
   Relationship-related stress and emotional factors

Treatment Options for Premature Ejaculation and Erectile Dysfunction

• Lifestyle Modification
• Weight reduction
• Smoking cessation
• Regular exercise
• Adequate sleep and stress management

Ejaculation Delay Training Techniques

• Start–Stop Technique
  • Sexual stimulation continues until nearing orgasm, then stops for 5–10 seconds until the sensation subsides. Repeat 3–4 cycles.
• Squeeze Technique
  • Gentle pressure is applied at the base of the glans penis for approximately 30 seconds when nearing orgasm. This may be repeated 3–4 times and can be combined with the Start–Stop technique.
• Pelvic Floor Muscle Exercises (Kegel Exercises)A simple yet highly effective method to improve ejaculatory control.

Medical Treatments

• Topical Anesthetics (Cream or Spray)
  Reduce penile sensitivity. Applied 15–20 minutes before intercourse, typically used alongside condoms to prevent transference.
• Selective Serotonin Reuptake Inhibitors (SSRIs)
  Two main usage strategies:
  • On-demand therapy (taken 1–3 hours before intercourse)
    Can increase IELT by approximately 3 times
    Recommended medication: Dapoxetine
  • Daily therapy
    Can increase IELT by 5–8.8 times
    Medication choice should be discussed with a physician, as each option has unique benefits and limitations.

Advanced & Adjunctive Therapies

• Electromagnetic Chair Therapy
  Strengthens pelvic floor muscles and improves ejaculatory control.
• PDE5 Inhibitors for patients with coexisting Erectile Dysfunction
  • Sildenafil (short-acting)
  • Tadalafil (long-acting)
• Penile Filler Injection
  Reduces penile sensitivity, resulting in prolonged time to orgasm.

Do Delay Condoms Really Work?

• Delay condoms are coated with desensitizing agents such as benzocaine on the inner surface to reduce penile sensation.
• However, in clinical practice, the anesthetic may spread to the outer surface, causing numbness in the sexual partner and reducing shared pleasure.
• Caution is advised when using delay condoms.

Can Surgery Treat Premature Ejaculation?

• Selective Dorsal Neurotomy involves cutting penile sensory nerves to reduce sensation.
• While ejaculation may be delayed, this procedure carries a high risk of permanent sensory loss.
• As a result, the International Society for Sexual Medicine (ISSM) does not recommend surgical treatment for Premature Ejaculation.

Doctor Dong’s Perspective

Premature Ejaculation is the most common male sexual disorder and often involves both physical and psychological factors. If left untreated, it may trigger a cascade effect leading to Erectile Dysfunction.
Targeted, individualized treatment offers the most sustainable and effective outcomes, restoring confidence, sexual satisfaction, and quality of life.