Premature ejaculation and antidepressants

Dear Dr G,

I'm writing to you, as I am desperate and depressed.

I'm a 24-year-old man who has been sexually active for the last two years.

My problem is that I ejaculate too early, which causes a lot of embarrassment during sexual encounters.

The problem began since I started having sex. Sometimes, even during masturbation! 

So far, I have a few partners and the same problem occurs - I ejaculate even with minimal penile stimulation.

A doctor told me it’s all in my mind, and I just need to distract my focus from sex, during sex. Frankly, it is easier said than done!

I became so depressed that I started taking some antidepressants.

Strangely, one month after taking the medications, I started prolonging my ejaculation period. It's a lot better.

Truthfully, I feel like a complete fool putting Dr G on the spot. I would like to know what are the causes of early ejaculation. Is it all in my mind?

Is premature ejaculation really related to depression? Why antidepressants help with sexual dysfunction? Or am I being foolish that all these problems are just in my mind.

If the antidepressants are working, does that mean I need to take them for life?

Can Dr G help to resolve my problems as I feel like a fool in the bedroom even at this young age!

Regards,
Henry

Early ejaculation is often referred as premature ejaculation (PE). Such early or rapid climax occurs when men experiences orgasm and expels the semen too rapidly with minimal penile stimulation. 

Experts from the International Society of Sexual Medicine have endorsed that the vast majority of sufferers have a tendency to ejaculate within one minute.

However, it is apparent some men even ejaculate just prior to, or shortly after vaginal penetration. 

In reality, most men cannot estimate the actual interval of ejaculation. Premature ejaculation is often described as the most prevalent sexual dysfunction, as it affects as many as one in three sexually active men. 

When premature ejaculation bothers men from the first encounter of sexual activities, it is considered primary PE. On the other hand, the condition that affects men at later stage of life is generally considered acquired PE.

The issues of premature climax have been recognised and documented for more than 1,500 years. 

The real etiology of PE is unknown. One school of thought is that adolescent boys developed fast climax, due to masturbating too quickly to avoid being caught! 

Other theories implicated performance anxiety or guilt, as the result of either having too little or too much sex in younger days. 

Sigmund Freud even proposed the concept of Oedipus complex, which is the psychoanalytic theory.

It relates to the child’s unconscious desire for the opposite-sex parent, thought to be the necessary stages of psychosexual development!

On the neuroscience viewpoint, several mechanisms have been postulated to contribute to PE. It includes genetic predisposition, penile nerve sensitivity and serotonin neurotransmitter deficiency.

The involvement of the serotonin brain signalling was accidentally discovered when men treated with anti-depressants such as paroxetine and clomipramine were noted to have prolonged ejaculation. 

Hence, medications such as serotonin reuptake inhibitors (SSRIs) are used for men with PE, despite the absence of depression. 

The treatment can typically prolong the interval of ejaculation by six to 20 times, compared with the initial state of prematurity. 

Although taking antidepressants to treat premature ejaculation may seem like an April Fool's story, this is actually verified by scientific evidence.

A man who suffers from any form of sexual dysfunction often consider the questions he poses either foolish or embarrassing, and would rather suffer in silence. 

When Dr G is put on the spot on “foolish” questions about the causes and treatment of PE, his response is: “When it cums to the solution of premature ejaculation, a wise man can explore from foolish moves than a fool can learn from suffering in silence!” 

On that note, Happy April Fool's Day!

> The views expressed are entirely the writer’s own.