What is Premature Ejaculation?
Premature Ejaculation, often referred to as PE, is the most common sexual dysfunction in men below 60 years old, estimated to affect around 30% of men irrespective of age. From a medical perspective, in order for a patient to be classified as suffering from premature ejaculation, he must exhibit the following:
- Ejaculation always or almost always occurs before or within one minute after penile penetration.
- Loss of control over ejaculation – inability to delay ejaculation before or after penetration
- Negative personal consequences and feelings, which might lead to avoidance of sexual activity
Any man that feels that he ejaculates too soon, preventing him and his partner from enjoying the sexual activity that they desire, can be considered to suffer from premature ejaculation. However, this presupposes that one is aware of what is considered a ‘normal duration’ for successful intercourse. This scenario is keenly subjective and every couple will have different preferences, but it is important to know that the average researched ejaculation time is 5 to 6 minutes after initial arousal and erection.
The great news is that with modern treatment options, the majority of our patients are able to successfully increase their ejaculation times irrespective of the underlying causes.
I am suffering from Premature Ejaculation, what should I do next?
If you are suffering from premature ejaculation then we advise you to book a consultation with one of our highly experienced doctors. The first step to successful treatment is a correct diagnosis of the underlying causes of premature ejaculation by your doctor.
Beyond that, our doctors will seek to do two things:
- Design the best therapy plan that will allow you to immediately improve your ejaculation time so as to continue normal sexual activities;
- Design a treatment procedure that will address the underlying causes of your issue.
Our doctor’s experience, treating over 10,000 PE patients, allows us to create highly personalised plans to help you.
Premature Ejaculation Frequently Asked Questions
What are the options for Premature Ejaculation Treatment?
Our Premature Ejaculation treatment protocols are based on the latest medical research, medical guidelines and our extensive clinical experience and we expect that most of our patients will be able to improve their ejaculation time.
Many doctors specializing in sexual dysfunction, find treating PE challenging because there is no specific treatment that can help all patients given the fact that the underlying mechanism for PE has not been clearly established.
For this reason, our treatment plan is personalized and multi-modal and the protocols will typically consist of a combination of the following:
- Counselling & Education
Patients suffering from premature ejaculation must be aware of key facts regarding their condition and in the cases of subjective and variable premature ejaculation, counselling and education are important elements of the treatment. For example, it is important that patients know that:
- 20%-30% of men complain of PE but based on an IELT of less than 2 min, the prevalence of pathological PE is unlikely to exceed 5% of the general population
- Average IELT is 5.4 min
- IELT decreases with age
- There are different types of PE, with different causes and treatment plans
- Treatment and control of risk factors in secondary acquired premature ejaculation
In patients with a clear diagnosis of secondary premature ejaculation, addressing the identified risk factors, such as erectile dysfunction, should be the first line of treatment.
- Behavioural Therapy:
There are various techniques that can be used to increase the ejaculatory control and improve ejaculation time including the Start-Stop or the Start –Stop-Squeeze Technique.
Patients can practice these techniques before sexual intercourse with the guidance of their doctor. This type of therapy is more likely to benefit patients suffering from secondary, variable and subjective premature ejaculation.
- Local anaesthetics
One of the prevailing theories for the underlying causes of premature ejaculation is genital over-sensitivity and applying local anaesthetics on the penis glans, will help some patients. Options include:
- Sprays; and
- Condoms with local anaesthetic
Appropriate use of the local anaesthetics is important so as to achieve optimum dosage and avoid complete numbing of the penis or of the partner’s genitals. Moreover, these should be avoided if the partner is pregnant.
- Oral Therapy
There are various drugs that can help with the treatment of premature ejaculation.
- Anti-depressant medication called SSRI inhibitors
Several antidepressants known to cause delayed ejaculation have been evaluated in the management of PE. These antidepressants include fluoxetine, paroxetine, and sertraline – and the tricyclic antidepressant clomipramine. Clinical studies indicate that paroxetine causes the most delay in IELT (8.8 fold) followed by escitalopram (4.9 fold), sertraline (4.1 fold) and fluoxetine (3.9 fold). An important element of using SSRI inhibitors is the dosing and whether these are taken on demand (i.e. before sexual intercourse) or on a daily basis.
On demand dosing avoids the side effects of daily intake that anti-depressants have and this is an important element that needs to be discussed with your doctor when determining your treatment protocol. In general, on demand dosing of SSRIs is less effective and the medication needs to be taken 4-6 hours before intercourse, which might make it difficult to plan in certain cases. In case of daily intake it must be remembered that the maximum effect of the medication will be after 2-3 weeks.
For this reason, we usually prescribe to patients that are candidates for SSRIs treatment, to start with daily intake for 4-6 weeks and then gradually move to on-demand dosing.
- Priligy (Dapoxitine)
Dapoxitine (commercial name Priligy) is a drug especially developed for treating PE and is the first line of treatment for most PE patients. Although it is an SSRI, the advantages of dapoxitine is that it works fast after intake and has a short duration of effect (1.5 hours, approximately half of the rest) meaning that patients are unlikely to suffer from severe side-effects that other SSRIs have and can also be taken shortly before sexual intercourse (1-2 hours).
- Uro-selective Alpha blockers
There is some evidence that daily dosing of Alpha blockers (such as Tamusolosin and Silodosin), used typically to treat LUTS, can improve ejaculation times. This type of medication is usually only prescribed to patients that do not benefit from Dapoxitine, SSRIs or other treatment modalities or patients that are also suffer from LUTS.
For patients suffering from premature ejaculation secondary to erectile dysfunction, then PDE5’s are likely to help with both. If after erectile dysfunction treatment, PE doesn’t improve then PDE5’s (or other ED treatment) would need to be complemented by other PE treatment options.
- Intra-cavernosal Injection Therapy
Men after ejaculation will loose their erection. For PE patients and their partner this can be very frustrating as it prevents them from enjoying penetrative intercourse. In very severe cases of PE such ante-portal ejaculation when other treatments have failed, injection therapy with alpostadil or similar erection inducing injections can allow patients to maintain their erection even after ejaculation and resume intercourse.
- Combination Therapy
Many PE patients will not respond to an isolated treatment modality and combination therapy will be required. Example of combination therapies include:
- Behavioural therapy + pharmacotherapy
- Topical therapy + SSRI
- Daily SSRI followed by on demand SSRI
- PDE5i + Topical therapy
- PDE5i + SSRI
For patients suffering from PE secondary to a genital issue such as tight frenulum, phimosis or balanoposthitis then surgical correction of the genital issue might improve their ejaculation time.
It is important to note that circumcision should not be routinely offered as a treatment for PE if the foreskin is healthy as this is unlikely to help.
- Other treatment options that have been suggested
If all the above treatment options fail to improve ejaculation time and this still causes significant distress to a patient, there are further more invasive or less proven treatment options that can be considered, these include:
- Hyaluronic acid glans augmentation
- Neuromodulation of the dorsal penile nerves
- Dorsal nerve neurotomy
- Tramadol oral medication
None of these treatment options should be offered routinely and only after extensive consultation with patients since their efficacy is not established and they are more invasive or have more severe side-effects.
What is the Cost of Premature Ejaculation Treatment?
Unfortunately, most insurance companies do not cover sexual dysfunction or male fertility consultations and most of our patients are self-paying. If your insurance company covers the cost of treatment or diagnostic tests, then we would be glad to assist you with the refund claim or claim directly from your insurance company on your behalf.
Surgical Treatment Costs
Surgical treatment costs will depend on the type of operation, the medical material used and the specific circumstances of each patient. Following your consultation and if you are a candidate for a surgical treatment, an all inclusive cost will be quoted (covering medical material, hospital fees, anaesthetist fees and surgeon’s fee and all the follow up consultations).