Premature Ejaculation

Premature ejaculation (PE) is a male sexual dysfunction characterized by ejaculation which almost always occurs within approximately one to two minutes of vaginal penetration and this results in distress for the male.  There are 3 common themes in patients with premature ejaculations:

1.      They have a rapid ejaculation usually less than one minute (Realize that the average ejaculatory time in most men in 5.4 minutes).

2.      These men feel that they have a lack of self-control about their timing of ejaculation.

3.      They experience distress and interpersonal difficulty which can also lead to frustration and avoidance of sexual intimacy.

Roughly 30% of men suffer from premature ejaculation yet very few men seek treatment.  The prevalence of premature ejaculation varies among countries and different ethnic groups. For example the prevalence of PE in Asian countries tends to be higher while the prevalence in European countries tends to be lower.  This may be due to cultural difference and different attitudes and beliefs towards sex.

When diagnosing PE one must keep in mind the difference between lifelong PE and PE that was acquired later on in life.  Usually lifelong PE is much more difficult to treat.  There are believed to be 4 main causes for PE: biological factors, neurobiological factors, genetic causes, and psychological factors.  Biological factors include a increased sensitivity of the head of the penis, inflammation of the prostate, chronic pelvic pain, thyroid problems, and certain drugs.  Neurobiological factors include problems with neurotransmitters in the brain, such as with seratononin.  There is now data to suggest that there may be a genetic component to PE.  Finally psychological factors play a large role in the development of PE.  These psychological factors are more common in acquired PE than lifelong PE.  These factors include history of sexual abuse, impaired self body image, depression, performance anxiety, and problems with the relationship when it comes to intimacy.   All 4 factors need to be considered when evaluating men with PE.

The surprising fact is that very few patients with PE actually seek help.  In fact only 9% of men with PE actually seek medical attention for their condition.  The reason why most men do not seek treatment is because they are embarrassed or do not believe treatment will help.  A recent study found that 91.5% of patients who did seek treatment for PE felt that the treatment was not effective.  Furthermore, many physicians are also uncomfortable discussing PE with their patients.   A recent survey found that 81.9% of patients had to initiate the conversation of PE because their physician would not initiate the discussion on PE.

While several treatment options exist for men with PE, the use of local anesthetics to diminish the sensitivity of the penis is one of the oldest and well proven treatments for PE.  Another commonly used therapy is anti-depressants.   These are used off-label as they are not FDA approved to treat PE. While antidepressants are effective in treating PE, they need to be taken every day or at least 4-6 hours prior to intercourse.  Antidepressants are also associated with systemic side effects such as reduced sexual desire, nausea, headache, dry mouth and weight gain.  For these reasons, and to avoid the stigma of taking an antidepressant, many men chose not to take antidepressants to treat PE.  Finally there is psychological counseling, or sex therapy, which is very effective in treating PE.  This therapy focuses on teaching the man techniques, such as the squeeze technique or the start-stop technique, so that he can prolong his ejaculation.  The goal of psychological counseling is to increase the man’s confidence, lower his performance anxiety, increase communication with his partner, and to help resolve any interpersonal problems that may have caused the PE.   While sex therapy is effective, it requires a time commitment and dedication which many men find difficult to do.