Controlling premature ejaculation: effective treatments & a new treatment

Experts estimate that as many as 30 percent of men regularly suffer from premature ejaculation (PE), and many more have experienced the disorder at some point in their lives. Yet, only 12 percent of men who report PE consult a physician, according to one study.

Premature ejaculation has remained somewhat of a medical enigma. Although many believe the condition originates in the brain, researchers have yet to pinpoint definitively a single psychological or biological cause. Premature ejaculation preventive measures are few. And, because determining what constitutes premature ejaculation is difficult, the medical community has yet to reach a consensus on a definition for it.

Perhaps one of the most significant confounding factors in understanding premature ejaculation is that patients--and sometimes their physicians--are hesitant to discuss it.

"It's usually not the first thing they talk about when they come in," said Julian Gordon, M.D., a urologist with The Cleveland Clinic's Glickman Urological Institute. "We need to encourage patients to talk with their physician, because there are some fairly effective modalities of treatment that we have available."

Diagnosing the Problem
Most experts acknowledge the following common premature ejaculation symptoms: lack of ejaculatory control or ejaculating sooner than desired, a man's inability to satisfy his and/or his partner's needs, and emotional distress among either partner. Premature ejaculation has no age boundaries, but it tends to peak in men between 18 and 30 years old and in men older than 45 or 50, according to Dr. Gordon.

Premature ejaculation is classified either as primary--the problem has occurred for as long as you've been sexually active--or secondary--the problem developed later, after you've had successful sexual relationships without ejaculatory problems.

Doctors rely on a thorough medical and sexual history to determine the origins of the problem. Your doctor will ask personal questions about your sexual history and have you talk about the nature of your premature ejaculation. Your doctor also will do a medical history to evaluate your overall health and identify potential physiological causes. Premature ejaculation may be related to erectile dysfunction (ED), and treating erectile dysfunction may improve the ejaculation problem. In rare cases, drug and alcohol use may contribute to premature ejaculation.

Finding a Solution
To begin treatment, Dr. Gordon typically recommends simple behavioural interventions: relaxation methods, mental distractions to help lessen arousal, or pelvic floor exercises, which tighten the pelvic muscles and can inhibit stimulation and improve premature ejaculation symptoms. Treatment may progress to other approaches, such as the "stop-start" or "squeeze" techniques, in which the couple engage in sexual activity, stop just before ejaculation, and resume. Patients with mental health problems or significant conflicts with their partners that compound their PE may be referred to a psychologist or sex therapist for counselling.

Topical creams or sprays containing the numbing agents’ lidocaine and prilocaine, as well as herbal remedies, can reduce penile sensitivity. However, if you don't wear a condom or fail to thoroughly wash off the cream, you run the risk of making your partner numb, as well.

If behavioural techniques fail to resolve the problem, your doctor may prescribe an antidepressant selective serotonin reuptake inhibitor (SSRI) such as fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft), or the tricyclic antidepressant clomipramine (Anafranil). Many experts recommend that patients start with daily doses and, later, take them as needed hours before anticipated sexual activity. Although these drugs are not indicated for treating premature ejaculation, doctors prescribe them--in lower doses and often in conjunction with behavioural therapy--because they carry delayed ejaculation as a side effect. Dapoxetine, a new SSRI designed specifically to treat premature ejaculation, remains under review by the U.S. Food and Drug Administration.

Speak Out
Regardless of the treatment method, communication with your partner and your doctor is the key to resolving premature ejaculation problems. Get your partner involved in your treatment, including visits to your physician.

And, if premature ejaculation is bothering you, don't be afraid to mention it to your doctor, and do so early in your visit so that you have adequate time for discussion. "And don't take no for an answer," Dr. Gordon said. "If your family doctor doesn't feel comfortable talking about it, ask for a referral or seek out a specialist who has a particular interest in sexual dysfunction."

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