Premature Ejaculation Treatment

What is premature ejaculation?

Premature ejaculation (PE) is a male sexual dysfunction characterized by ejaculation that always or nearly always occurs before or within 1 minute of penetration (lifelong PE) or a clinically significant and bothersome reduction in latency time, often to about 3 minutes or less (acquired PE), the inability to delay ejaculation on all or nearly all vaginal penetrations, and negative personal consequences, such as distress bother, frustration, and the avoidance of sexual intimacy (International Society of Sexual Medicine, 2014)

What are the causes of premature ejaculation?

Lifelong PE is known in some men, and neurobiological and genetic variations could contribute to the pathophysiology of lifelong PE.

Acquired PE is commonly due to sexual performance anxiety, psychological or relationship problems consistent with organic causes, occasionally prostatitis, hyperthyroidism, erectile dysfunction, and metabolic syndrome.

Learn more about Erectile Dysfuction Treatment in Thailand

1. Premature ejaculation, sexual performance anxiety, and psychological or relationship problems:

Several studies have suggested that anxiety activates the sympathetic nervous system and reduces the ejaculatory threshold due to an earlier emission phase of ejaculation.

2. Premature ejaculation and comorbid erectile dysfunction

Recent data demonstrate that as many as half of subjects with erectile dysfunction (ED) also experience premature Ejaculation. Issues with ED may require a high level of arousal to achieve an erection and intentionally rush intercourse to prevent early detumescence of the erection.

"Did you know that there's a new treatment for erectile dysfunction called Shockwave Therapy for Erectile Dysfunction?"

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3. Premature ejaculation and prostate disease

Several studies report premature ejaculation as the main sexual disorder of men with chronic prostatitis or chronic pelvic pain syndrome (CPPS), with a prevalence of 26% to 77%. Some have reported that antibiotic treatment in confirmed bacterial prostatitis in men with acquired PE improves ejaculatory control in 83.9% of subjects.

4. Premature ejaculation and hyperthyroidism

The 50% prevalence of PE in men with hyperthyroidism fell to 15% after treatment with thyroid hormone normalization.

How can premature ejaculation be treated?

1. Psychosexual therapy

The educational strategies are designed to inform men about the prevalence of PE in the general population, dispel myths about PE, and give them the confidence to try medical interventions and reduce performance anxiety.

2. Try the pause-squeeze or start-stop technique.

A well-known technique for delaying ejaculation, the “Start-Stop technique” stops genital penetration when about to ejaculate and stimulates new sexual arousal. It is a training for patients to recognize the feeling before reaching the climax (pre-orgasm), and the “Pause-Squeeze technique” when patients are about to ejaculate, stop inserting the penis and squeeze the frenulum for about 30 seconds until causing the penis to temporarily not harden. Inhibit ejaculation of sperm for the Pause-Squeeze technique was studied by Dr Keith H., who found that 64 per cent of the users of this technique were able to control ejaculation better when follow-up treatment in the next 3 years.

3. Topical local anaesthetic

The oldest known pharmacologic treatment for PE to diminish the sensitivity of the glans penis. Some data suggest it may be associated with significant possible transvaginal absorption, resulting in vaginal numbness and female anorgasmia unless a condom is used. —> Lidocaine-Prilocaine cream (EMLA) dosing; on-demand use 20-30 min before intercourse

4. Selective serotonin reuptake inhibitors (SSRIs)

PE can be treated with on-demand or daily dosing of off-label SSRIs: Dapoxetine (Priligy), Paroxetine, Sertraline, and Fluoxetine. But off label prescribing may present difficulties for physicians as the regulatory authorities strongly advise against prescribing for indications that medication is not approved. Also, some studies reported that some patients with depressive or anxiety disorder would slightly increase the risk of suicidal ideations in youth but not adults.

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5. Tramadol

Tramadol is a potent centrally-acting synthetic opioid analgesic. Even the mechanism of action of Tramadol is still unclear. Still, some data appear effective in treating PE but suggest that these findings should be interpreted with caution, risk of dependence, moderate-to-severe side effects, and serotonin syndrome, especially in combination with SSRIs.

—> dosing 25-50 mg 3-4 hours before intercourse

6. Phosphodiesterase type 5 inhibitors (PDE5Is)

ED pharmacotherapy alone (PDEI5Is; Sildenafil or Viagra and Tadalafil or Cialis) is recommended for Lifelong-PE or Acquired-PE in men with comorbid PE, but Off-label on-demand or daily dosing of PDE5Is is not recommended for PE treatment in men with normal erectile function.

Sildenafil or Viagra 25-100 mg; On-demand 30-60 min before intercourse —> Tadalafil or Cialis 10-20 mg; On-demand 30-60 min before intercourse

Circumcision and Premature Ejaculation

Some studies suggest a potential benefit of having circumcised to reduced premature ejaculation, others find no significant difference or increased risk among circumcised men.

Given the mixed evidence and the potential risks and ethical considerations associated with adult circumcision, it is crucial for men considering this procedure for PE to consult a healthcare professional and explore alternative treatment options.

Ultimately, the decision to undergo circumcision as a treatment for premature ejaculation should be based on a thorough understanding of the potential benefits and risks, assessing the individual's health risks, and considering personal preferences and values.

Ref:

- Campbell-Walsh Urology 12th Edition Review, (2020)

- Premature ejaculation, Tantiwongse K, Srithong S. Premature ejaculation. Chula Med J 2018

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