Premature Ejaculation

For an issue that one out of three men say they experience at some point in their lives, premature ejaculation (PE) is often steeped in unnecessary embarrassment. The fact is, this common complaint is typically not a cause for concern unless it’s happening nearly every time you engage in intercourse. Below we explain some of the symptoms to look for before coming in to see us about this issue, as well as how it is diagnosed and treated.

What Is Premature Ejaculation?

First, what exactly are we talking about here? Premature ejaculation happens when a man has an orgasm and ejaculates before he wants or is ready. Obviously, this can present problems in intimate sexual relationships, especially if a man cannot figure out the root cause of the issue. If it happens frequently enough, it could result in a medical diagnosis.

So why does this problem even happen to begin with? Well, there are a couple of reasons. For one, psychological issues can be primary factors in prematurely ejaculating. Stress — whether within the relationship or completely unrelated to it — can be a huge contributor to the issue. Nervousness or pressure, as well as ongoing depression, anxiety, or other mental health issues, can all cause PE as well.

But there are biological reasons for the issue that mean proneness to it can happen in certain men, and occasionally there are other physical problems at play that could mean a more serious medical diagnosis. 

Types

There are two phases to ejaculation: emission takes place when sperm moves to the prostate from the testicles, producing the semen. Expulsion happens when semen exits the penis due to muscle contraction that forces it out. 

There are two main categories doctors use to diagnose PE and discuss treatment options: 

Primary premature ejaculation — sometimes referred to as “lifelong” — is the diagnosis given when a man has always experienced this problem or has never had a significant portion of time pass where he has been able to engage in sex without prematurely ejaculating.

Secondary premature ejaculation — or “acquired” premature ejaculation — is the diagnosis when a man has developed the issue only recently, but has had normal patterns of control over orgasm and ejaculation during intercourse in the past.

Symptoms

Patients reporting ongoing problems with premature ejaculation typically present symptoms including:

• Routine, ongoing patterns of uncontrolled ejaculation and the inability to stop it from happening
• Routinely ejaculating within one minute of initial penetration
• Decreased interest in sex or decreased sexual pleasure overall due to fear of premature ejaculation
• Inability to connect intimately with a sexual partner, or avoidance of a partner, due to guilt, frustration, or shame surrounding premature ejaculation
• Depression or low self esteem as a result of the issue

It is important to keep in mind that the criteria for ejaculation to be considered “premature” can vary from person to person, or from couple to couple. It is up to you and your partner to decide whether you both are satisfied or dissatisfied with the time it takes for orgasm and ejaculation to occur.

Tests and Treatment Options

If premature ejaculation is something you have been dealing with for some time, and has not gone away on its own, it may be time to schedule an appointment with a specialist. Urologists are uniquely qualified to quickly diagnose the issue and provide tailored treatment options. 

We start with a physical exam, a review of your medical history, and a series of questions to get more information about the issue and to rule out any more serious health problems. It is important to be as honest as possible during your appointment, especially when discussing any impact premature ejaculation might be having on your relationships or mental and emotional health. 

Lab tests are typically not necessary for patients presenting PE symptoms, but may be ordered if another issue is found during the examination. 

Once we determine that the issue is not related to another erectile dysfunction (ED) issue, we create a treatment plan to address the underlying cause. This could consist of behavioral methods that aim to increase your control over ejaculation, psychological therapy to address any relational problems and increase your confidence, or medications to help slow ejaculation. Often, the treatment plan will be a combination of methods to support the various contributing factors.

 

Medications

There are currently no FDA-approved drugs to treat premature ejaculation. However, several types of FDA-approved medications for other conditions or ailments can help men with a PE diagnosis.

SSRIs, or selective serotonin reuptake inhibitors — typically known as antidepressants — can help delay orgasm during intercourse.

Some anaesthetic creams can help “numb” the penis and might be prescribed to be applied before sex. Numbing sprays are another option for penis desensitization, which can help with PE.

If premature ejaculation is negatively affecting your sexual relationships or you find yourself avoiding intimacy with a partner due to an ongoing struggle with the issue, give us a call. We can get you in to see one of our specialists and find a treatment option that works for you.

Pelvic Floor Physical Therapy

We believe strongly that PFPT can help men achieve longer time to ejaculation with better control of their pelvic floor. The pelvic floor muscles are those which surround the urethra and prostate and contract during orgasm. Mens’ pelvic floors can learn how to trigger too quickly and PFPT can help men to have more control over this process. Success with PFPT can remove the need for medications or topical numbing agents.

Medications

• Promescent is essentially a 2% prilocaine spray applied to the penis 10 minutes prior to intercourse. This particular treatment generally does not affect the female partner and can be purchased from our office
• Tramadol, although commonly used as a pain medication, can be prescribed in an off label manner and can help men delay ejaculation for up to 4 minutes.
• SSRI medications such as Paxol or Zoloft are long known to cause delayed ejaculation which is a bothersome side effect for men without premature ejaculation, but is a useful treatment for men with premature ejaculation. These medications can be given daily for allowing for more spontaneous intercourse or can be taken 2 hours prior to intercourse if used as an on demand medication.