Dealing With Premature Ejaculation

Study reported in European Urology (1) suggests that males who experience premature ejaculation try various sexual positions to control their symptoms along with other strategies such as masturbation, engaging in frequent sexual encounters and using interrupted sexual stimulation technique. However, only 9% of the affected population seek medical help for the resolution of symptoms.

Experts indicate that it is very important to look for suitable management options to address PE as poorly managed premature ejaculation not only affects your health but it may also complicate your relationships. Moreover, premature ejaculation can also lead to fertility issues, as it makes it difficult for couples to conceive.

How To Manage Premature Ejaculation With Therapy

The treatment options for premature ejaculation ranges from behavioral therapy, counseling, pharmacological agents (including oral medicines as well as topical anesthetic agents).

1. Behavioral Techniques:

This involves taking simple steps such as masturbating an hour or two before actual sexual intercourse, as it helps in delaying the ejaculation during vaginal sex.

Doctors may also recommend focusing on other types of sexual play for some time rather than engaging in sexual encounters to eliminate the source of anxiety (until other therapies deliver fruitful results).

2. The Pause-Squeeze Technique:

Doctor may also recommend pause-squeeze technique for you and your partner. It involves following simple steps:

• Sexual act should be started like usual, including stimulation of penis and vaginal intercourse until you feel that you are almost ready to ejaculate.
• Your partner will squeeze the end of your penis (area where head meets the shaft). Squeezing should be done for several seconds until the desire for ejaculation resolves.
• Wait for 30 seconds after the release of squeeze and go back to foreplay. Squeezing the penis makes it less erect but as sexual stimulation restarts, it again gains full erection.
• Let your partner repeat the squeezing process if you feel that you are again about to ejaculate.

By repeating this process you can successfully penetrate your partner without ejaculating prematurely. In addition, if you do this frequently, delaying the ejaculation becomes a habit and then there is no longer need for pause-squeeze technique.

3. Counseling:

Counseling or talk therapy involves talking about your relationship and experiences with a professional mental health provider. Counseling helps in reducing your anxiety and provide you with different coping techniques to alleviate your stress. Counseling is more effective when it is combined with pharmacological therapy.

Pharmacological Solutions For Premature Ejaculation

1. Topical Anesthetics:

In this strategy, anesthetic creams and sprays containing numbing agents (like Lidocaine and Prilocaine are applied on the penis just before the sexual encounter. This reduces the sensation and helps in delaying the ejaculation. Promescent (lidocaine) spray is available as an over-the-counter product.

Although, these anesthetic agents are well-tolerated and are quite effective but they may have some potential side effects such as negative changes in the sexual pleasure and transient loss of sensitivity. Sometimes, these side effects are also experienced by their female partners as well. Furthermore, lidocaine and prilocaine may cause allergic reactions in some susceptible subjects.

2. Oral Medications:

Several pharmacological agents are known to delay the orgasm via variety of mechanisms, but so far no drugs has been approved by FDA specifically for the treatment of premature ejaculation. Medications like analgesics, antidepressants and phosphodiesterase-5 inhibitors are usually prescribed to address premature ejaculation in some patients. Depending on the situation, these medications can be prescribed on occasional or daily use basis. In addition, these pharmacological agents can be prescribed in combination with other modalities of care (3).

3. Analgesics:

Tramadol (Ultram) is a commonly prescribed analgesic. Common side effects include delay in ejaculation. There are a few other unwanted side effects; such as nausea, headache and dizziness. It is usually prescribed when SSRIs (a type of antidepressant) are not effective enough for the resolution of PE symptoms.

4. Antidepressants:

Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Sarafem, Prozac), paroxetine (Paxil) and Sertraline (Zoloft) are frequently associated with serious side effects such as delay in achieving orgasm due to which they are fairly helpful in managing premature ejaculation (4). If SSRIs doesn’t improve your condition then another class of antidepressant, tricyclic antidepressant clomipramine (Anafranil) can be prescribed.  However, these medications have certain unwanted side effects, including nausea, drowsiness, dry mouth, and decrease in libido.

5. Phosphodiesterase-5 inhibitors:

These include Vardenafil (Staxyn, Levitra), Tadalafil (Adcirca, Cialis), Sildenafil (Revatio, Viagra). These drugs are mainly advised to manage the symptoms of erectile dysfunction but can also be used for premature ejaculation.  Headache, temporary visual changes, flushing of face and nasal congestion are some of the common unwanted side effects.

References

1. Porst, H., Montorsi, F., Rosen, R. C., Gaynor, L., Grupe, S., & Alexander, J. (2007). The Premature Ejaculation Prevalence and Attitudes (PEPA) survey: prevalence, comorbidities, and professional help-seeking. European Urology, 51(3), 816-824.

2. Althof, S. E., McMahon, C. G., Waldinger, M. D., Serefoglu, E. C., Shindel, A. W., Adaikan, P. G., … & Giraldi, A. (2014). An update of the International Society of Sexual Medicine’s guidelines for the diagnosis and treatment of premature ejaculation (PE). The journal of sexual medicine, 11(6), 1392-1422.

3. Bar-Or, D., Salottolo, K. M., Orlando, A., Winkler, J. V., & Tramadol ODT Study Group. (2012). A randomized double-blind, placebo-controlled multicenter study to evaluate the efficacy and safety of two doses of the tramadol orally disintegrating tablet for the treatment of premature ejaculation within less than 2 minutes. European urology, 61(4), 736-743.

4. Jern, P., Johansson, A., Piha, J., Westberg, L., & Santtila, P. (2015). Antidepressant treatment of premature ejaculation: discontinuation rates and prevalence of side effects for dapoxetine and paroxetine in a naturalistic setting. International journal of impotence research, 27(2), 75-80.