Premature Ejaculation: Complicated Yet Very Treatable

Most experts in sexual medicine believe that the most common male sexual dysfunction is premature ejaculation (PE). Everyone knows what we mean when we use the term: the man involved experiences an orgasm sooner than desired. However, trying to define PE for scientific purposes is not as easy. How should one define the presence of a clinically early ejaculation: from time of penetration, after some number of thrusts, in relation to the partner's orgasm or to personal satisfaction? All these variables have strengths and weaknesses, but there is agreement that treatment for PE should aim to improve patient and partner satisfaction.

PE may occur in isolation or together with erectile dysfunction (ED). In many cases one condition can lead easily to the other. There is consensus in the sexual medicine field that when both conditions are present the patient's ED should be treated first, and there is also evidence that they may be treated together with a combination of a PDE5 inhibitor like Viagra, and a low dose of an SSRI antidepressant such as Paxil. Recent data also suggest that a PDE5 alone may be used as first-line therapy for PE.

Fortunately for men suffering from PE, there are many therapeutic approaches that work. All have benefits and all have some risks. Behavioral approaches such as the "squeeze technique" and the "stop-and-start method" have been demonstrated to be effective since Masters and Johnson. The main drawbacks of these approaches are that they tend to be relatively time-consuming and that they tend to "wear off," requiring reapplication. Topical anesthetics such as lidocaine/prilocaine cream may also be rubbed on the penis to reduce its sensitivity; however, care must be taken not to anesthetize the partner's genitals!

At the moment, the preferred pharmacological treatment for PE involves SSRI antidepressants such as Paxil, Zoloft, and Prozac. Doses are lower than the doses used to treat depression, but side effects are very similar and include nausea, drowsiness, dry mouth, and reduced libido. Keep in mind that drug treatments do not confer any long-lasting benefits and must continue to be used to be effective. In addition, new drugs that are candidates for PE treatment are currently in Phase III trials and may be on the market within a year or so.

It's said that all men experience premature ejaculation at one time or another. Now, those men who have it chronically may choose from among numerous effective treatments.