Premature ejaculation

Definition

• Premature ejaculation is usually lifelong (i.e. it usually dates back to the first sexual experience)
• Rarely, premature ejaculation may develop in later life when it is often progressive
• 1 in 3 & 1 in 5 men (20-30%) are thought to have premature ejaculation
• Less than a quarter of men with premature ejaculation actually seek medical advice for their condition Causes of premature ejaculation

It appears unrelated to performance anxiety, hypersensitivity of the penis or nerve receptor sensitivity.

• genetic tendency
• prostate inflammation (prostatitis)
• thyroid disorders
• emotional disorders and previous traumatic sexual experiences.
• erectile dysfunction and with rapid loss of erection after ejaculation

Diagnosis

• A full history enquiring about lifestyle factors (e.g. job, work pressures, smoking habits, alcohol intake and drug consumption and
• Detailed sexual history
• Premature ejaculation symptom questionnaire
• Timing interval between penetration and ejaculation (the intravaginal ejaculation latency time, IELT) using a stopwatch. A latency time of less than 1 minute is regarded as abnormal.
• A physical examination to assess the development of male sexual characteristics and to detect any abnormality of your penis or genitals. Rectal examination is normally performed to assess the tone of your anal muscles and to feel your prostate gland.
• Routine urine tests to see whether it contains sugar which might indicate diabetes
• Hormone measurements. Blood levels of testosterone, prolactin, FSH (follicle-stimulating hormone), LH (luteinizing hormone) and thyroid hormones may be measured if the patient also has erectile dysfunction (impotence)

Treatments Options

• Psychosexual counseling may help men with less troublesome premature ejaculation
• Medications, the mainstay of long-term treatment for most men
• Selective serotonin uptake inhibitors (SSRIs) (e.g. paroxetine, fluoxetine, fluvoxamine, sertraline, clomipramine) are powerful antidepressants but they also have a beneficial effect on premature ejaculation. They are, therefore, used as first-line treatment for this condition and their effectiveness is often maintained for several years. Common side-effects of SSRIs include fatigue, drowsiness, nausea, dry mouth, diarrhea & excessive perspiration although these are often mild and usually settle after 2-3 weeks
• Other drugs which delay ejaculation (e.g. tramadol, terazosin, alfuzosin) have been used but their role is unclear and, at the moment, they are not recommended for clinical use in premature ejaculation.
• PDE5 inhibitors (Viagra®, Cialis®, Levitra®) have also been used to help premature ejaculation but their exact role is uncertain; they do, however, improve sexual confidence and reduce performance anxiety by producing better erections (if this is a problem).
• Self-administered penile injections
• Local anaesthetic cream (lignocaine + prilocaine or SS-cream), applied 20 - 60 minutes before intercourse, can be useful but may numb the vagina unless used with a condom and can occasionally cause irritation of the penile skin.
• "Long love" condoms, containing the local anaesthetic benzocaine, are also available commercially and have proved useful in some patients.
• Psychosexual counseling
  Behavioural strategies, including the "stop-start" technique (developed by Semans), the "squeeze" technique (developed by Masters & Johnson) or the Kegel technique (learning to control the ejaculatory muscles) are also effective. Improvements are seen in 50-60% of patients but may not be maintained in the long term. These techniques are best learnt under the supervision of a psychosexual counselor. They can be used alone in acquired premature ejaculation and when symptoms are mild but, when problems are severe or lifelong, are most useful when used in conjunction with drugs.