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Premature ejaculation


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What should I do if I have premature ejaculation?

If your ejaculation is earlier than desired (before or soon after penetration) with minimal stimulation and you have little control over it, you should consider seeking further advice from your GP

What are the facts about premature ejaculation?

  • Premature ejaculation is usually lifelong (it often dates back to the first sexual experience);
  • Rarely, premature ejaculation may develop in later life when it is often progressive;
  • We do not know accurately how common it is but between 1 in 3 & 1 in 5 men (20-30%) are thought to have premature ejaculation;
  • Less than a quarter of men with premature ejaculation actually seek medical advice for their condition; and
  • Premature ejaculation is often associated with erectile dysfunction (impotence) and with rapid loss of erection after ejaculation.

What should I expect when I visit my GP?

Your GP should work through a recommended scheme of assessment for men with troublesome premature ejaculation. This will normally include one or all of the following:

A full history

Your GP will enquire about lifestyle factors (e.g. your job, work pressures, smoking habits, alcohol intake and drug consumption and will take a detailed sexual history.  Your GP may also ask you to complete a premature ejaculation symptom questionnaire as an aid to further assessment and discussion of treatment options.  Download a premature ejaculation questionnaire

This will allow your GP to:

  • identify your needs & expectations;
  • help you & your partner share in decision-making; and
  • decide whether psychosexual counselling might be helpful.
 

A physical examination

A general physical examination will be directed to the suspected cause of your problem and may include an assessment of the development of your male sexual characteristics and to detect any abnormality of your genitals. Your blood pressure will normally be measured as part of this examination.

The pulses in your legs and nerve reflexes involving your legs, penis and anus (back passage) may also be tested. Rectal examination (pictured) may also be performed to assess the tone of your anal muscles and to feel your prostate gland, if there is a suspicion that you may have erectile dysfunction and low testosterone levels.

 

Additional tests

Specific tests are not usually needed but the following may be performed, depending on whether there is a suspicion of other problems:

a. General blood tests

The actual tests performed will be left to your GP's discretion. It is common to measure kidney function, liver function and cholesterol as well as checking your blood for anaemia or other problems. A blood sugar measurement may be performed to exclude diabetes

b. Routine urine tests

Your urine will normally be assessed by dipstick-testing to see whether it contains sugar which might indicate diabetes

c. Hormone measurements

Blood levels of testosterone, prolactin, FSH (follicle-stimulating hormone), LH (luteinising hormone) and thyroid hormones may be measured if you also have erectile dysfunction (impotence).

d. Other specific tests

Your GP may ask you to time the interval between penetration and ejaculation (the intravaginal ejaculation latency time, IELT) using a stopwatch. A latency time of less than 1 minute is regarded as abnormal.

 

What could have caused my premature ejaculation?

The cause of premature ejaculation is unknown; it appears unrelated to performance anxiety, hypersensitivity of the penis or nerve receptor sensitivity

Premature ejaculation may have a genetic tendency, running in some families.  It is also associated with prostate inflammation (prostatitis), thyroid disorders, emotional disorders and previous traumatic sexual experiences.

What treatments are available?

Psychosexual counselling, cognitive behavioural therapy (CBT) and other associated techniques form the cornerstone of managing this condition and may help men with less troublesome premature ejaculation but, in most men, the mainstay of long-term treatment is with drugs

Most patients can be managed in general practice without the need for urological referral. If you have troublesome erectile dysfuncton (impotence) as well, your GP may ask you to consult a urologist.

Psychosexual counselling

Behavioural strategies, listed below, are all effective:

  • the "stop-start" technique (developed by Semans);
  • the "squeeze" technique (pictured, developed by Masters & Johnson); and
  • the Kegel technique (learning to control the ejaculatory muscles).
 

Drugs

Selective serotonin release inhibitors (SSRIs)

These are powerful antidepressants but they also have a beneficial effect on premature ejaculation. They are used as first-line treatment for this condition and their effectiveness is often maintained for several years.

They are often taken daily and include drugs such as fluoxetone and paroxetine.

Dapoxetine (Priligy®, pictured) is the only SSRI licensed for use "on demand" (i.e. when needed) in premature ejaculation. It is normally available on the NHS, but local prescribing rules may restrict its use: you should, therefore, check with your GP or urologist whether it is available in your area. 

Common side-effects of SSRIs include fatigue, drowsiness, nausea, dry mouth, diarrhoea & excessive perspiration. These are often mild and usually settle after 2-3 weeks.

SSRIs are powerful drugs. You should only take them by getting a prescription from your GP & you should have a detailed discussion about the risks & benefits before starting treatment.

Other drugs which delay ejaculation

Drugs such as tramodol, terazosin and alfuzosin have been used, but their role is unclear and, at the moment, they are not recommended for clinical use in premature ejaculation.

If there is a suspicion that premature ejaculation is a result of, or is associated with, erectile dysfunction, it may be felt necessary to treat you with appropriate medications, either alone or in combination with therapy for premature ejaculation.

Viagra®, Cialis®, Levitra® or Spedra®, and self-administered penile injections

These may also be used to help premature ejaculation but their exact role is uncertain. They do, however, improve sexual confidence and reduce performance anxiety by producing better erections (if this is a problem).

Download a lealfet about Viagra, Cialis or Levitra
Download a leaflet about penile injections

 

Topical treatment

Local anaesthetic cream (lignocaine + prilocaine or SS-cream), applied 20 - 60 minutes before intercourse, can be useful but may numb the vagina unless used with a condom. It can occasionally cause irritation of the penile skin (or the partner's vagina) and may reduce the partner's sensation/pleasre too.

"Long love" condoms, containing the local anaesthetic benzocaine, are also available commercially and have proved useful in some patients.

 

Masturbation before intercourse

Other techniques that may benefit younger patients include masturbation before anticipated intercourse. This may result in desensitising the penis and a longer delay to ejaculation.

 

Although improvements are seen in 50-60% of men, they are not always maintained in the long term.  These techniques are best learned under the supervision of a psychosexual counsellor. They tend be used on their own in acquired premature ejaculation or when symptoms are mild. When symptoms are severe or lifelong, they are best used in conjunction with drugs.

More resources on Premature ejaculation

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