Premature ejaculation is a common male sexual problem. It is defined as "the constant failure to maintain intromission of sufficient duration to satisfy a responsive partner." It can also be defined as ejaculation occurring before the individual wishes.

Ejaculation is usually preceded by orgasm or climax. Ejaculatory control is an acquired behavior that is minimal in adolescence and increases with experience.

What causes premature ejaculation?

The normal biologic response is to ejaculate within two minutes of vaginal penetration. Since this is not usually enough time for the female partner to reach orgasm, most men must learn how to retard ejaculation.

In the adolescent, premature ejaculation may be aggravated by pathogenic factors that interfere with learning control - most frequently sexual ignorance. Other factors include feelings of sinfulness about sex, fear of discovery and impregnating the female partner, fear of getting a sexually transmitted disease, anxiety over performance, and depression. Some of these concerns continue into adulthood. In addition, marital problems, unresponsiveness of the mate, and power struggles may also play a role. Obscure physical causes are usually not present, although prostatitis, organic diseases affecting the nerve pathways (due to either trauma or surgery), and/or certain medications can be involved.

How is it treated?

Sometimes all that is needed is an explanation of what causes premature ejaculation, a bit of reassurance and some simple advice. Sexual tension may also be decreased by increasing the number of opportunities for ejaculation.

The most reliable behavioral treatment is the "pause-squeeze" technique. This "stop and start" exercise involves stimulating the penis either manually or through intercourse until ejaculation is imminent, stopping or pausing the stimulation for about 20-30 seconds until the urge to ejaculate passes and then resuming stimulation. The process should be repeated without allowing ejaculation until the fourth time. This is not an overnight solution, and success depends on both patient motivation and how frequently the technique is practiced.

Another option is to use the anti-depressant medication Zoloft (sertaline) or Anafranil (clomipramine). Studies over the past few years have shown both drugs to be effective in inhibiting ejaculation. A positive response is usually seen within a week, but these medications may need to be taken for extended periods of time.

Occasionally, premature ejaculation masks serious psychic or interpersonal conflicts and marital counselors and psychotherapists can be helpful.