Is premature ejaculation in men considered abnormal?

Premature ejaculation refers to a condition in which a man is unable to delay ejaculation long enough for his partner to reach orgasm during sexual intercourse. This issue is quite common, affecting approximately 30–40% of men of reproductive age. It can cause significant distress for both the man and his partner, often leading to relationship problems and emotional strain.

Although it is a widespread condition among men, very few seek medical advice or treatment. This may be due to a lack of awareness about the problem or feelings of embarrassment about discussing it. Some reports even suggest that the actual prevalence of premature ejaculation could be as high as 75%.

The criteria for diagnosing premature ejaculation are based on three key factors:

1. Ejaculation occurs with minimal sexual stimulation, which may happen before penetration, during penetration, or shortly after penetration.

2. It causes emotional frustration or dissatisfaction, which negatively impacts the relationship between partners or spouses.

3. Premature ejaculation must not be caused by the effects of medication or certain chemicals the body has been exposed to.

Premature ejaculation can be broadly categorized into two causes: physical and psychological.

1. Physical causes: This includes issues related to the nervous system, such as inflammation of the prostate in some cases, increased sensitivity of the skin at the tip of the penis, or even consequences of erectile dysfunction. In such cases, men may ejaculate quickly due to the fear of their penis losing firmness before reaching orgasm.

2. Psychological causes: These include fears related to vaginal penetration, emotional conflicts with a partner, anxiety, and fear of pregnancy. Notably, men with psychological causes of premature ejaculation are often younger, and it's believed that the ability to control ejaculation improves with age and sexual experience, similar to how bedwetting in children typically resolves as they grow older due to improved bladder control.

The goal of treatment for premature ejaculation is to help the patient gain better control over ejaculation or reduce sensitivity to stimuli. Several methods are available, including:

1. Behavioral Therapy: This involves various techniques such as:

   • Pausing movements occasionally.

   • Temporarily withdrawing the penis from the vagina and applying pressure to the tip of the penis.

   • Performing pelvic muscle exercises (similar to controlling urination).

   • Masturbating before intercourse to control ejaculation longer during subsequent sessions.

   • Changing positions during sex, as having the male partner on the bottom or side may help reduce premature ejaculation, as being on top tends to lead to quicker ejaculation. Using condoms may also help in some cases.

2. Repetitive Training Program (Squeeze and Pause Technique): This method involves stimulating the penis until aroused, then squeezing the tip of the penis tightly for 3-5 seconds, followed by a 5-10 minute break before stimulating again. This is intended to improve endurance. Eventually, when the sensation is too intense, the man can withdraw and apply pressure to the penis again. This technique can be quite challenging and painful for some men.

3. Medications: If the first two methods are ineffective, medications, usually those used for depression and anxiety, can be prescribed. These are typically taken 3-4 hours before intercourse and may help delay ejaculation. Side effects may include dry mouth, drowsiness, constipation, or nausea.

Although premature ejaculation is not physically harmful, it significantly affects the quality of life and can impact relationships. It may also lead to difficulties with fertility in the future. Therefore, men experiencing these issues should not feel embarrassed and should seek medical advice and treatment.

Information thanks to Professor Phunsak Suchanawit.