Premature Ejaculation - Overview And Treatment Options
Premature ejaculation (PE), which is also known as early or rapid ejaculation, is defined according to three essential criteria: (1) loss of control; (2) brief ejaculatory latency (reaching ejaculation in two minutes or less); and (3) psychological distress in the patient and/or partner. PE is a fairly common issue in men, with the Mayo Clinic stating that as many as one-third of men report that they experience this problem at some time in their lives. Approximately 30% with PE have concurrent erectile dysfunction, which usually results in early ejaculation without a full erection.
PREMATURE EJACULATION - COMMON FACTORS
PE involves a complex interaction of biological and psychological factors. Several causes may contribute to premature ejaculation, including:
PSYCHOLOGICAL CAUSES
Psychological factors that may play a role include:
Anxiety about initiating or maintaining an erection may lead to a pattern of rushing to ejaculate out of fear of losing an erection
Performance anxiety or worrying about premature ejaculation
Early sexual experiences or history of sexual abuse - perhaps unprocessed feelings around sex
High levels of general life stressors or anxiety
Poor communications with your partner or anxiety about satisfying them sexually
BIOLOGICAL CAUSES
Several biological factors may contribute to PE, including:
Imbalance or abnormal levels of brain chemicals (aka neurotransmitters)
Abnormal hormone levels, i.e. low testosterone levels
Inflammation or infection of the prostate or urethra
Inherited traits
TREATMENT OPTIONS FOR PREMATURE EJACULATION
There are several options when it comes to treating PE. Some patients experience ED concurrently with PE, and these cases may best be addressed simultaneously using a comprehensive approach.
Phosphodiesterase (PDE) inhibitors - PDE inhibitors (i.e. Viagra or Cialis) may also be effective for the treatment of men with PE and coexisting ED. Two meta-analyses have assessed the efficacy of PDE5 inhibitors for premature ejaculation, finding that both SSRIs and PDE5 inhibitors are more effective than placebo.
SSRIs - paroxetine, sertraline, fluoxetine, citalopram, and escitalopram are some of the medications used to address premature ejaculation. It is recommended that these are started at the lowest dose and titrated up as needed at three- to four-week intervals. The majority of patients begin to see the full therapeutic effect of SSRIs after two to three weeks of therapy. It’s important to note that symptoms will likely return if treatment is stopped. Some men are also able to take an SSRI circumstantially on the day of sexual activity. A meta-analysis suggested that Paxil may be the most effective as it can delay ejaculation by up to nine minutes.
Tramadol - this analgesic has some activity at opioid receptors but also inhibits reuptake of norepinephrine and serotonin. Tramadol is occasionally used if SSRIs are poorly tolerated or ineffective. However, this medication should be used with extreme caution as there is a potential risk of side effects and addiction associated with opioids.
Topical anesthetics may also be effective in treating premature ejaculation. Multicenter trials featuring an aerosolized, lidocaine-prilocaine spray have reported enhanced ejaculatory control, ejaculatory latency, and sexual satisfaction when applied topically to the glans penis five minutes before intercourse. Another potentially beneficial treatment is the topical application of alprostadil cream to the penile meatus before intercourse may also be beneficial.
Behavioral therapies - squeeze therapy, start/stop techniques, and distracted thinking are strategies that can be employed to delay orgasm. Wearing a condom may also decrease sensitivity and help delay ejaculation.
OTHER EJACULATORY DISORDERS
Retrograde ejaculation - the ability to ejaculate, but no semen is emitted because it enters the bladder instead of flowing through the penis.
Anejaculation (aka anorgasmia) - the inability to achieve orgasm or ejaculation.
Delayed ejaculation - an extended period is needed to reach orgasm and ejaculate.
Common contributors to the aforementioned ejaculatory disorders include medications (especially SSRIs, prostate medications like Flomax, and certain blood pressure medications), lower urinary tract symptoms or BPH (enlarged prostate), or prostate surgeries. Hormone conditions such as low thyroid or low testosterone have also been associated with ejaculatory problems. These issues can be discussed with a doctor familiar with ejaculatory disorders.
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