Understanding Premature Ejaculation: Causes and Treatments

Premature ejaculation (PE) is one of the most common sexual issues among men, affecting between 20 to 30 percent of the population. The study "Premature Ejaculation: Aetiology and Treatment Strategies" (source) offers a thorough overview of why PE happens and the most effective ways to treat it.

The International Society for Sexual Medicine classifies PE into four types: lifelong, acquired, variable, and subjective. Lifelong PE usually begins with a man's very first sexual experiences and is often linked to genetics or neurotransmitter imbalances. Acquired PE, however, tends to appear later in life and is often triggered by psychological stress, erectile dysfunction, or hormonal changes. Variable and subjective types reflect inconsistent or personally perceived problems rather than a fixed physical cause.

When it comes to treatment, the most effective solutions involve both medication and behavior changes. Selective serotonin reuptake inhibitors (SSRIs), like Dapoxetine, Paroxetine, and Sertraline, have shown excellent results. These medications work by increasing serotonin levels, which helps delay ejaculation. Dapoxetine is currently the only SSRI specifically approved for PE and can increase ejaculation time by up to 200 to 300 percent.

Other options include topical anesthetics like lidocaine-prilocaine creams that reduce penile sensitivity and pelvic floor muscle training to strengthen ejaculatory control. Behavioral methods such as the Start-Stop Technique and Squeeze Technique also offer ways to train the body toward longer control, especially when paired with mindfulness and relaxation practices.

The key message from the study is that combination therapy works best. Using medication together with cognitive behavioral therapy and behavioral techniques leads to much better long-term outcomes than any single approach alone. In one cited study, combined therapy increased ejaculation time from 85 seconds to 370 seconds over 24 weeks.

In conclusion, the study reminds us that PE is a complex issue with multiple causes. Personalized treatment plans that combine medication and behavioral strategies offer the best hope for lasting improvement and a more satisfying sex life.