Bergen Urological Associates, PA

Premature Ejaculation

Premature ejaculation (PE) is defined as persistent or recurrent ejaculation with minimal sexual stimulation with climax occurring before, upon, or shortly after vaginal penetration, prior to a person’s desire to do so, over which the sufferer has little voluntary control, which causes the sufferer and /or partner bother and distress.

This is the most common male sexual dysfunction, occurring in up to 30% of the male population, and affecting men of all ages, ethnicities, and socio-economic groups. PE can be devastating, causing extreme embarrassment, frustration and loss of self-confidence for males, and negatively affecting their relationships with their partners. The basis of PE is can be psychological and/or biological-- with guilt, fear, and performance anxiety, but also genetics and certain medical disorders playing possible roles in its occurrence.

PE may be classified as either primary (lifelong) or secondary (acquired). Primary PE applies to men who have had the problem since becoming sexually active and is thought to have a strong biological component. Psychological or situational stressors may contribute to secondary PE, but it is also associated with erectile dysfunction, prostatitis and urethritis.

Our society’s cultural emphasis on ejaculation as the focal point of sexual intercourse tends to exacerbate the performance anxiety that can initiate the problem. The occurrence of PE has social and psychological consequences that tend to perpetuate the problem as fear of and mental preoccupation with PE can actually induce the unwanted ejaculation, creating an unfortunate vicious cycle. But males experiencing PE need to know that various types of help are available and that there is no need to suffer in silence. Treatments are varied, consisting of behavior modification techniques, physical and pharmacological interventions, and sexual counseling.

One method of attempting to prolong the time prior to ejaculation is to employ mental diversionary tactics—that is, filling your mind with thoughts other than ejaculating in order to prevent doing so. Baseball, work, counting backwards, etc., are examples of such thoughts. Unfortunately, these "de-erotization" techniques are rarely effective and diminish the pleasure of sexual activity and intimacy.

A more successful means of preventing PE is the stop-start method originated by Dr. Semans. This technique requires you to develop an enhanced awareness of the feelings and sensations surrounding the time leading up to ejaculation; by achieving such familiarity, you can learn to accurately predict when ejaculation will occur and how to gain control before the "point of no return". Recognizing imminent ejaculation and responding by slowing the pace of pelvic thrusting as well as varying the angle and depth of vaginal penetration may allow time for the feeling to dissipate. If slowing the tempo is not sufficient to prevent the occurrence of premature ejaculation, you may need to stop thrusting completely while maintaining penetration in order for the urgency to go away. Once the sensation to ejaculate subsides, pelvic thrusting may be resumed.

Another option is the squeeze technique originated by Masters and Johnson. As ejaculation approaches, the penis is withdrawn from the vagina and the head of the penis is squeezed until the feeling of ejaculation passes, after which intercourse is resumed. The male or his partner may apply the squeeze.

Decreasing penile sensitivity can be helpful in the management of PE. There are various means of accomplishing this, including the use of extra thick condoms, topical creams that desensitize the penis, and increasing the frequency of ejaculation, since PE tends to be more pronounced after prolonged periods of sexual abstinence. By masturbating prior to engaging in sexual intercourse, the ejaculatory latency period can be increased. Local anesthetics including Lidocaine (2.5%) or Lidocaine and Prilocaine (EMLA cream) applied 20-30 minutes prior to intercourse will diminish the sensitivity of the penis.

Medications are available that can substantially delay ejaculation. The familiar PDE5 inhibitors (Viagra, Levitra and Cialis) that are commonly used for erectile dysfunction, may have a significant role in the treatment of PE in men with acquired PE secondary to erectile dysfunction.

Anti-depressants of the SSRI class (selective serotonin reuptake inhibitors) have been clearly demonstrated to delay ejaculation. These medications can have undesirable side effects such as decreased libido, sleepiness, insomnia, headache, nausea and dry mouth. You are generally started on a low dose for two weeks with an increase in dose if necessary for the next two weeks. Once an effective dosage is achieved, you can use the medication on a situational basis, 3-4 hours prior to sexual intercourse. The most commonly used medications are:

Anafranil (Clomipramine) 25-50 mg
Paxil (Paroxetine) 20-40 mg
Zoloft (Sertraline) 25-100mg
X (Fluoxetine) 5-60mg
A new medication, Dapoxetine (30/60 mg), is currently in investigational trials.

Insofar as most cases of PE have an underlying psychological basis, it may be beneficial to seek the aid of a sexual therapist who can help manage the problem with counseling sessions. This can be done in conjunction with some of the aforementioned techniques in order to bring about a quicker resolution.

Andrew Siegel, M.D.
January 2007

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Bergen Urological Associates


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