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Premature Ejaculation: What should I do?!

Picture of 2 banana imitating couple in bed

While not life threatening, premature ejaculation could signal an underlying physical or mental issue. 

Premature ejaculation can be a pretty sensitive subject. Often men are unwilling to seek help because they feel embarrassed or ashamed. 

However, premature ejaculation or early ejaculation is a common health issue many men face; about 20-30%1 of men will experience unpleasant symptoms and/or shoot too early at some point during their lifetime. 

So, if you are having issues - nothing to be ashamed of! But you should definitely seek help as it is a condition that —while not life threatening— can affect a person’s self esteem and relationships greatly. 


Firstly, let's first clarify exactly what is considered premature ejaculation

By definition, premature ejaculation is when a man ejaculates much sooner than he intended to during sexual intercourse.

Of course, this affects the satisfaction of both you and your partner.

It is usually nothing to be concerned about if it does not happen very often. Anyone can have an off day

However, it becomes problematic if you feel like you have no control of your ejaculation at all. You may find that you: 

  • Ejaculate within a minute of penetrating your partner
  • Can't seem to delay your ejaculation even if you want to
  • Feel depressed, frustrated and the entire situation seems to be taking a toll on your mental health

What causes early ejaculation?

Physical Causes

  • Infection and inflammation of your urethra or prostate (The associated swelling and pain affect the control of your ejaculation.
  • Abnormal hormonal levels within your body
  • Hereditary traits
  • Abnormal levels of neurotransmitters (These are chemicals that transmit messages between neurons)

Psychological Causes

What you are going through mentally and emotionally can cause premature ejaculations - the mind has an undeniable effect on the body. Here are some of the most common triggers: 

  • Sexual abuse

The trauma of sexual abuse can cause you to subconsciously rush sexual encounters.

  • An unhealthy body image

If you don't feel comfortable in your own skin, chances are your sexual performance may be affected.

  • Being sexually active at a young age

Early sexual experiences often colour your sexual performance going forward.

  • Depression

There’s usually a vicious cycle at play - depression causes premature ejaculation and the fact that it is happening makes the depression worse.

  • Worry

Worrying about it certainly does not help performance issues.

  • Guilt

 If you are in a relationship that is socially unacceptable or feel religious pressure about having sex, premature ejaculation may occur.

  • Anxiety

Everyone feels some anxiety from time to time. However, when feelings of nervousness and unease become the norm rather than the exception, it becomes a problem. You can feel anxiety about your actual sexual performance or other matters that are bothering you.

  • Relationship woes

If satisfying relationships (no premature ejaculation) have been your boon, up until your current turbulent relationship, the two things may be connected. Sometimes the friction between you and your partner may be a contributory factor.

  • Erectile dysfunction

If a man has trouble maintaining or even getting an erection due to erectile dysfunction, he may feel the need to rush his sexual interaction. This unfortunately becomes a bad habit hard to break.


Illustration of unhappy couple one bed

How is premature ejaculation diagnosed in Singapore?

Firstly, let me reiterate - there is nothing to be embarrassed about. If you decide to see a doctor, kudos to you! When I see a patient for ejaculation issues I usually start by asking symptom-related questions, including; 

  • When did your symptoms first start? 
  • How often do they occur? 
  • Do you have trouble obtaining and/or maintaining an erection? 

Additionally, I will also enquire about your personal medical history to confirm if you have any underlying condition that may be contributing to your premature ejaculation. 

You may also be required to take some blood tests to check your hormone levels.

Depending on the results, I will then be able to recommend what kind of treatment would be most effective.


What are the treatment options available for premature ejaculation in Singapore?

Your treatment plan will depend on what is triggering your premature ejaculation. Treatment options in Singapore usually involve a combination of any one of these treatment options2

Behavioural Methods

  • Pause-squeeze technique

This technique involves stimulating the penis and your partner squeezing the head of the penis for a couple of seconds. Eventually, the urge to ejaculate will pass.

This process is repeated as often as necessary. Ultimately, the delayed ejaculation will become second nature and the technique will no longer be required.

  • Stop and start technique

This is an alternative method that can be used if the pause-squeeze technique proves to be too uncomfortable or painful. 

Sexual stimulation is stopped right before ejaculation. Then you wait for the arousal feeling to ebb away. Repeat the process. 

Kegel exercises

These are exercises that are used to strengthen your pelvic floor - you work the same muscles that you use for urination. Your doctor will guide you regarding the number of repetitions required. Strengthening these muscles will give you more control of your ejaculations.

Condoms

Condoms usually make the penis less sensitive allowing for delayed ejaculation.

Medications

This treatment option can either be topical or oral.

Topical formulas are available as numbing sprays and creams; they are for the most part well tolerated by patients. However, they may be temporary side effects like decreased sexual pleasure which may affect your partner. 

Oral medication used to treat premature ejaculations are analgesics, antidepressants, and phosphodiesterase-5 inhibitors3

Therapy/Counselling

Counselling helps with premature ejaculation by giving you coping mechanisms for stress. It may also help you work past any performance issues that you may have.

It can help put the intimacy back into your relationship and deal with unwanted feelings like shame and anger.

Premature ejaculation does not have to be a problem that you have to live with for the rest of your life. Contact us to explore your treatment options today! 


References

  1. Chung E, Gilbert B, Perera M, Roberts MJ. Aust Fam Physician. 2015 Oct;44(10):737-43. PMID: 26484490
  2. Cooper K, Martyn-St James M, Kaltenthaler E, Dickinson K, Cantrell A. Health Technol Assess. 2015 Mar;19(21):1-180, v-vi. doi: 10.3310/hta19210. PMID: 25768099
  3. DL. Curr Med Res Opin. 2011 Aug;27(8):1509-18. doi: 10.1185/03007995.2011.590968. Epub 2011 Jun 13. PMID: 21663497

This article was written and medically reviewed by Dr Ben, M.D on 04/01/22

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