The Hard Truth about Premature & Delayed Ejaculation ft. Dr. John Mulhall

Premature Ejaculation

Dr. John Mulhall explains that premature ejaculation (PE) can be lifelong or acquired. Lifelong PE is defined as ejaculation within about a minute since the onset of sexual activity, often causing personal distress or relationship issues. Acquired PE, on the other hand, occurs later in life and is often linked to conditions like erectile dysfunction (ED) or hyperthyroidism 1. Treatment options include psychological methods, transdermal agents, and off-label use of SSRIs, though none are FDA-approved 2.

Lifelong PE is a neurochemical disorder, a serotonin disorder, and that's why SSRIs work.

--- John Mulhall

Psychological methods like the stop-start technique have a low long-term success rate, while SSRIs show significant improvement in ejaculatory latency time 2.

   

Delayed Ejaculation

Delayed ejaculation (DE) can be caused by factors such as low testosterone, penile sensation loss, and psychological issues. John Mulhall highlights that men with low testosterone or those experiencing neuropathy, often due to diabetes or chemotherapy, are more likely to suffer from DE 3. Psychological factors also play a significant role, and DE is often a diagnosis of exclusion after ruling out other organic causes.

Most people with delayed orgasm have more than one factor, often both organic and psychological.

--- John Mulhall

Treatment strategies include addressing low testosterone and encouraging patients to defocus on orgasm, exploring intimacy with their partner instead 4.

   

Psychological Factors

Psychological factors significantly impact ejaculatory function. Rena Malik notes that sexual dysfunction inherently involves psychological stress, which can exacerbate the condition 5. John Mulhall adds that anticipatory anxiety, often stemming from previous unsatisfactory sexual experiences, can lead to performance issues. Adrenaline, a potent anti-erectile chemical, can worsen the problem by causing muscle contraction in the penis 6.

You're only as good as your last erection.

--- John Mulhall

Addressing these psychological components is crucial for effective treatment of ejaculatory dysfunction 6.