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Premature ejaculation (PE), also known as rapid ejaculation, premature climax, early ejaculation, or by the Latin term ejaculatio praecox, is the most common sexual problem in men, affecting 25%-40% of men. It is characterized by a lack of voluntary control over ejaculation. Masters and Johnson stated that a man suffers from premature ejaculation if he ejaculates before his partner achieves orgasm in more than fifty percent of his sexual encounters. Other sex researchers have defined premature ejaculation as occurring if the man ejaculates within two minutes or less of penetration; however, a survey by Alfred Kinsey in the 1950s demonstrated that three quarters of men ejaculated within two minutes of penetration in over half of their sexual encounters. Today, most sex therapists understand premature ejaculation as occurring when a lack of ejaculatory control interferes with sexual or emotional well-being in one or both partners.

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Diagnosis

Diagnostic criteria for Premature Ejaculation DSM-IV-TR (American Psychiatric Association)

A. Persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it. The clinician must take into account factors that affect duration of the excitement phase, such as age, novelty of the sexual partner or situation, and recent frequency of sexual activity.

B. The disturbance causes marked distress or interpersonal difficulty.

C. The premature ejaculation is not due exclusively to the direct effects of a substance (e.g., withdrawal from opioids).

Differential diagnosis

Premature ejaculation should be distinguished from erectile dysfunction related to the development of a general medical condition. Some individuals with erectile dysfunction may omit their usual strategies for delaying orgasm. Others require prolonged noncoital stimulation to develop a degree of erection sufficient for intromission. In such individuals, sexual arousal may be so high that ejaculation occurs immediately. Occasional problems with premature ejaculation that are not persistent or recurrent or are not accompanied by marked distress or interpersonal difficulty do not qualify for the diagnosis of premature ejaculation. The clinician should also take into account the individual's age, overall sexual experience, recent sexual activity, and the novelty of the partner. When problems with premature ejaculation are due exclusively to substance use (e.g., opioid withdrawal), a substance-induced sexual dysfunction can be diagnosed.

Associated conditions

Neurological disorders, e.g.,

multiple sclerosis

Prostatitis
Psychological disorders
Interpersonal disorders
ABC's Premature Ejaculation, e.g., [[1]]

References

Metz, Michael E. and Barry W. McCarthy. Coping with Premature Ejaculation. Oakland, CA: New Harbinger Publications. 2003.
Ringold MD, Warren J, "The ABC's of Premature Ejaculation"; Department Chief of Family Medicine; "Understanding and Coping with PE"
Waldinger MD, Quinn P, Dilleen M, Mundayat R, Schweitzer DH, Boolell M. A multinational population survey of intravaginal ejaculation latency time. J Sex Med. 2005 Jul;2(4):492-7.
Waldinger MD, Zwinderman AH, Olivier B, Schweitzer DH. Proposal for a definition of lifelong premature ejaculation based on epidemiological stopwatch data. J Sex Med. 2005 Jul;2(4):498-507.

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-==Treatment==
-{{howto|there are some things in this section that sound like directions}}
-Depending on severity, premature ejaculation symptoms can be significantly reduced.
-In mundane cases, treatments are focused on gradually training and improving mental habituation to sex and physical development of stimulation control. In clinical cases, various medications are being trialled to help slow down the speed of the arousal response.
-SSRI [[antidepressant]]s have been shown to delay ejaculation in men treated for different psychiatry disorders. SSRIs are considered the most effective treatment currently available for PE. These include paroxetine, fluoxetine, sertraline and more. The use of these drugs, that require chronic therapy is limited by the neuropsychiatric side effects. New SSRI [[drugs specifically targeted to treat premature ejaculation]] (e.g. [[dapoxetine]]) can be taken on an as needed basis and have been recently shown positive results in large phase III studies. Nevertheless dapoxetine is not yet approved by any regulatory authority around the world. There is speculation that some of the associated effects are caused by lowered libido and blood pressure as well as lowered anxiety levels. Other pharmaceutical products known to delay male orgasm are; [[opioids]], [[cocaine]], and [[diphenhydramine]].
-Local anesthetic creams (like lidocaine, prilocaine and combinations) have shown to be very effective in clinical trials and are being used of the treatment of PE. Their use is limited by its own anesthetic effect that reduce sensation on the penis and female vagina.
-Most sex [[sex therapy|therapists]] prescribe a series of exercises to enable the man to gain ejaculatory control. While the exercises are intended for men who suffer from premature ejaculation, other men can use the exercises to enhance their sex lives. By far the most common exercise is the so-called ''start-stop'' technique. While the technique varies, the purpose is to get the male accustomed to maintaining an erection for an extended period of time while gradually increasing sexual tolerance. In doing this exercise, the male obtains an [[erection]] through self-stimulation, or [[masturbation]]. After achieving an erection, he stops stimulating himself until he begins to lose his erection; at that point, he begins to stimulate himself again. Gradually, over a period of several weeks, he is able to stimulate himself for longer periods of time, eventually gaining ejaculatory control. In order for this technique to be successful, the male should avoid feeling discouraged if he ejaculates rapidly; instead, he should use his sexual responses to learn how to vary the technique in a way that most benefits him. The male can choose to integrate his partner into these exercises.
-The male's partner is usually integrated into the exercises. They can stimulate the partner using the ''stop-start'' technique. When the male has achieved some level of ejaculatory control, he can insert his penis into his partner without thrusting. After his penis becomes accustomed to being inside his partner, thrusting can be gradually included, according to the male's abilities, using the ''stop-start'' technique. In less severe cases, the male might overcome his premature ejaculation early on, making exercises with his partner superfluous.
-The male's partner plays an essential role in enabling him to overcome premature ejaculation. Without understanding and emotional support, the male is unlikely to obtain the level of relaxation required for sexual satisfaction. Both the male and his partner should communicate their feelings openly and with sensitivity. The male should learn to sexually satisfy his partner, orally or otherwise, while they work with him to overcome his premature ejaculation.
-External latex rigid sheathes fastened to the body have been developed that cover all part of the penis during penetration so that the penis is protected from all the stimulation of the vagina. these help to gain control and to provide satisfaction to the partner.
-===Alternative therapies===
-{{Unreferenced|date=January 2007}}
-Many alternative therapies are available for the treatment of PE. Caution should be exercised when researching alternative sources of advice however, most treatments have not actually been shown to be effective. Some web sites even advocate the dangerous and antiquated method of pulling the testes downwards when aroused. This is actually a good way to slightly strain the interior of the testes and is associated with reports of injury and weakened/deteriorated erection. For some reason this advice is still widespread on the Internet.
-Hypnosis has also proven very effective in the treatment of premature ejaculation.{{Fact|date=January 2007}} It is believed by some that ejaculation is a subconscious habit and by giving the mind hypnotic suggestions to last longer, the problem can be greatly alleviated if not completely cured.{{Fact|date=January 2007}} Most men report dramatic improvement after only a few sessions of hypnosis.
-The prostate gland plays a very important part in regulating arousal. Pressure in between the engorged prostate and the erection causes most of the pleasurable sensations and it may be emptied manually before sex by [[prostate massage]]. This causes the erection to be strong but less sensitive, and increases a patients awareness of his physiology.
-There is a trend toward the use of nutritional supplements when treating men who suffer from PE. Effective supplements must contain 5HTP which is a precursor to serotonin. Famed physiologist, Dr. William Ganong, noted over 50 years ago that serum serotonin levels could be increased through dietary means. Increasing the serum level of serotonin helps inhibit the ejaculatory reflex. There are a number of nutritional remedies available primarily on the Internet.
 ==Diagnosis==