About Premature Ejaculation
Premature ejaculation (PE), is a medical condition that is tough to define. Essentially, a man or a couple can suffer from PE if one or both is unhappy with how rapidly the man ejaculates. For some couples, PE can occur 30 seconds into vaginal penetration. For others, PE may extend out to five or ten minutes. As long as one of the partners is dissatisfied, PE is a problem.
How does it happen?
A guy doesn’t have much control over how quickly he ejaculates. Ejaculation is mostly an event of the autonomic nervous system, the part of our nervous system we can’t fully control. Heartbeat, digestion, sweating are all examples of autonomic nervous system controls. Therefore, when a man gets a signal to ejaculate, the point of no return, he’s going to go. The most sensitive part of the penis is the area around the frenulum, the skin flap on the underside of the penis just below the urethral meatus (pee hole). There is a spinal cord pathway that connects there and rapidly sends signals to the ejaculation center of the spinal cord. Ejaculation is also hormonal. Serotonin, dopamine, prolactin, testosterone and oxytocin are all hormones that play a role in ejaculation.
30 sec
the amount of time that premature ejaculation can occur for some couples.
SSRIs
(Serotonin Reuptake Inhibitors) are used to postpone ejaculation.
Signs and Symptoms of Premature Ejaculation
ejaculation 30 seconds into penetration
for some 5-10 minutes
dissatisfaction
by one or both of partners
Erectile Dysfunction
necesitates quicker ejaculation to avoid losing erection
Treatment Options for Premature Ejaculation
What’s a guy to do? Treatment for PE centers around behavioral, neurologic and hormonal modifications.
Behavioral modifications have been tried for centuries. The premise is to not concentrate on the sexual act but let one’s mind wander to less erotic topics. This doesn’t work and can distract a guy to the point where he may become disengaged in the coupling; that defeats the purpose. Other behavioral techniques include the “stop and start” – basically interrupting intercourse to decrease stimulation to the penis in hopes of cooling the nerves down. Add to this technique “the squeeze,” where the guy, or partner, withdraws the erect penis prior to climax and squeezes the head of the penis to reset the nerve fibers. Lastly, “the pre-game” move is to masturbate earlier in the day of a sexual encounter to “empty the tank” in hopes of decreasing stimulation later. Results are mixed on these behavioral techniques, but for many men they are a reasonable first step to try. A more modern approach to these ancient techniques is the Myhixel© Device – a battery powered, vibrating penile sleeve connected to a phone app that works on slowly training the man to last longer with pre-programmed protocols. This can be purchased directly from the company or through Amazon.
Medical treatment for PE takes a variety of forms. The simplest thing to do is to temporarily desensitize the head of the penis. Topical numbing sprays and creams are available over the counter. They all work by gently numbing the sensitive areas of the penis so the nerves don’t fire so fast and the guy can prolong intercourse. He has to wash off the agent prior to intercourse or wear a condom to make sure he doesn’t desensitize his partner. Many men who suffer from PE also simultaneously have some degree of erectile dysfunction, which causes them to need to ejaculate faster to avoid losing the erection. The first step for many men is thus ED treatment, and studies do show improvement in men with PE treated with impotence drugs like sildenafil (Viagra) or tadalafil (Cialis). A doctor may also suggest a pill to block serotonin, one of the hormones important in ejaculation. These pills are in the class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). They’ve been around for over 20 years, are relatively safe, but are not FDA approved for PE. It is therefore up to you and your doctor to make the call to use this class of drugs off label. Most treatment regimens require daily use to be most effective. For a man having sex frequently, that’s probably not a big deal but compliance can be an issue with less sexually active men. There are also other agents such as Tramadol, a low dose opiate, to be used on demand, but given all the possible issues surrounding opiate use, we generally do not favor the use of these medications for this condition.
Don’t be afraid to seek treatment for PE. It is a very common condition, probably the most common sexual dysfunction out there. Your Men’s Clinic provider will be understanding and likely have an effective treatment that will please you and your partner.