Premature ejaculation (PE) is one of the leading male sexual dysfunctions affecting about 30% of men worldwide. It is considered the most common sexual dysfunction in men. There are a variety of definitions for PE. We prefer to define it as any time a man ejaculates prior to providing sexual satisfaction for him and his partner.
Causes of Premature Ejaculation
The exact cause of PE is not well known. Studies have shown a variety of factors that may contribute to PE:
- Psychological – temporary depression, stress, or anxiety about the relationship
- Biological – abnormal hormone levels, abnormal reflex activity of the ejaculatory system, hyperthyroidism, or inflammation/infection of the prostate or urethra
- Neurobiological – low levels of serotonin in the brain
- Penile Sensitivity – many experts believe that men with higher sensitivity of the penis may be prone to PE
Types of Ejaculatory Disorders
- Retrograde ejaculation – A condition in which the semen is redirected from its normal direction, through the penis, and instead the semen is redirected to the bladder.
- Premature ejaculation (PE) – PE is a premature voluntary ejaculation caused by a lack of control over ejaculation.
- Delayed ejaculation – The inability to achieve orgasm during sexual intercourse.
- Failure of ejaculation (Anejaculation) – Little or no difficulty attaining or keeping an erection yet, a lack of ability to achieve orgasm.
Treating Premature Ejaculation
Premature ejaculation is very treatable. Each patient will work with his urologist to determine the best treatment for his unique situation. In many cases, a combination of therapies will be required.
Behavioral Techniques & Sexual Therapy
PE treatment may include some behavioral techniques such as the start/stop or squeeze methods and/or some sexual therapy such as masturbating an hour or two prior to intercourse.
Topical anesthetic medications are often the first course of action for premature ejaculation. They are effective, easy-to-use, low cost and the risk of side effects is very low. A new desensitizing spray, Promescent®, from Absorption Pharmaceuticals has shown to effectively improve ejaculatory latency (the time from penetration to ejaculation). Absorbed below the surface of the skin where the nerve endings that control ejaculation are located, Promescent is used 10 minutes prior to intercourse and the effects typically last 30-45 minutes.
Some men respond well to low doses of the prescription antidepressants known as selective serotonin reuptake inhibitors (SSRIs). Although not specifically approved by the Food and Drug Administration for the treatment of premature ejaculation, it is well documented that a side effect of taking low-doses of SSRIs is increased time to reach ejaculation and delayed orgasm. The medication may not need to be taken daily and in some cases only taking the medication a few hours before intercourse will be effective.
Cognitive therapy or talk therapy with a counselor may be helpful in reducing anxiety surrounding sexual intercourse and for developing coping strategies. This type of therapy can be most successful when combined with drug therapy.