Premature Ejaculation Therapy

Content written by Irwin Goldstein MD

Premature ejaculation (PE) primarily causes a problem for the partner because the man can still achieve satisfaction from ejaculation. The premature ejaculation can, however, cause humiliation and embarrassment because the man is not in control of the sexual event, and there is limited time for the partner to achieve orgasm and satisfaction. Studies have shown that women’s satisfaction during sexual activity increases linearly as IELT increases from one minute to ten minutes.

There are several treatments available for men with premature ejaculation who are distressed by this situation. Historically PE has been viewed as a psychologic condition. Sex therapy strategies and the squeeze technique were the first treatments considered.

Contemporary research, however, suggests that premature ejaculation reflects an alteration of central neurotransmitters, such that there is a lack of inhibition of this reflex during sexual stimulation. As such, contemporary strategies are designed to increase the inhibition of this ejaculatory reflex. One such strategy for PE involves use of topical anesthetic agents applied to the glans and skin of the penile shaft prior to sexual activity in order to reduce sensory input, used with a condom to prevent transfer of the anesthetic agent to the partner. If the condom is also being used for contraception, the material of the condom must be compatible with the anesthetic agent and not damaged by it.

Another pharmacologic strategy is the use of selective serotonin reuptake inhibitors (SSRI’s), currently government approved for the treatment of depression. A side effect of their use in men with depression is delayed ejaculation. Men with PE who took the drug on a daily basis significantly increased their IELT values, lessening their premature ejaculation symptoms and related distress. Intermittent use of SSRI’s, taken just prior to sexual activity, has been far less successful in management of premature ejaculation. The presumed hypothesis is that the neurotransmitter serotonin, a well-recognized inhibitory neurotransmitter for sexual activity, is increased in the brain with chronic dosing.

A third strategy is to use PDE5 inhibitors at a low dose on a daily basis, as recent studies have shown improvements in confidence, self-control and satisfaction in men with premature ejaculation. If conservative therapies were unsuccessful, an alternative treatment for PE is intracavernosal self-injection therapy. With this treatment strategy, although the man would ejaculate early, he would continue to have an erection, and thus be able to satisfy his partner. Under rare circumstances, in particular when premature ejaculation is indistinguishable from erectile dysfunction, the use of penile implantation has proven to be successful.

There are many options available so that a man who has premature ejaculation can identify the appropriate treatment for his situation.