SERVICEPremature Ejaculation (PE)

Premature Ejaculation (PE) occurs in men when semen leave the body (ejaculate) sooner than wanted during sex. The criteria for PE is when ejaculation always or nearly always occurs prior to or within about 1 minute of after penetration for primary/life-long PE and 3 minutes for secondary/acquired PE

Type of Premature Ejaculation: PE has two main types

1.  Lifelong (primary) PE:

Patients almost always ejaculate in a very short time with every sexual partner, since the first time of sexual activity. In these patients, the intravaginal ejaculation latency time (IELT) always or nearly always is about 1 minute or less. Some patients ejaculate during the foreplay before the sexual intercourse even begins. 

2. Acquired (secondary) PE:

This type of patient might have underlying medical conditions that need to be investigated, both physical and psychological e.g., stress, sexual performance anxiety, psychiatric disease, erectile dysfunction, prostatitis, hyperthyroidism, and recreational drug use.

Symptoms begin later in life after patients have been having normal ejaculation throughout their lives. The onset could be either abrupt or sudden. In this type of PE, it is always crucial to find true underlying causes.

Premature Ejaculation Treatment

1. Behavior modification technique:

• Start-Stop technique: Stop sexual arousal and penetration just before the orgasm. After that is achieved, then you can start sexual arousal again. The purpose is to train you to notice pre-orgasm feelings so that you can better control ejaculation.
• Pause-Squeeze technique: While reaching pre-orgasm, stop penetration and use your fingers to squeeze the frenulum for about 30 seconds until your penis is flaccid and ejaculation is stopped.

2. Consultation with a sex therapist: Sexual behavior and psychological therapy are precise, with no harm, and no complication solutions. It also gives couples chances to talk more openly about sex. Problems are there are few sex therapists. You also have to invest time and money in the process, cooperation from your couple is also needed, and it’s not an instant solution.   

3. Medication:

3.1 Selective Serotonin Re-Uptake Inhibitor (SSRI): Dapoxetine (Priligy) can be taken occasionally before having intercourse, while other SSRIs have to be taken daily, e.g. paroxetine 10 – 40 mg, sertraline 50 – 200 mg, fluoxetine 20 – 40 mg. However, there could be side effects like fatigue, nausea, vomiting, diarrhea, and diaphoresis. These side effects occur mostly in the first week, and subside in 2-3 weeks after. Sexual side effects like decreased sexual desire (libido) and erectile dysfunction are rare, especially in those without a history of depression.

3.2 Phosphodiesterase-5 Inhibitors (PDE5i): Premature ejaculation and erectile dysfunction are related, especially in acquired type PE. Some PE patients also have erectile dysfunction due to sexual performance anxiety, meanwhile some ED patients also rush to ejaculate because they worry that they cannot keep the erection longer. Studies shows that about half of ED patient also have concurrent PE, thus PDE5i drugs have also been used in the attempt to treat PE, e.g. Vardenafil, Tadalafil, and Sildenafil.   

4. Topical Local Anesthetic: Lidocaine and  Prilocaine are available in both cream and spray. Condoms with topical local anesthetic are also available.

5. Pelvic floor rehabilitation: The purpose of these methods is to strengthen the pelvic floor muscles, so that patients can control the ejaculation better and also delay it. However, currently there is still no standardized protocol for pelvic floor rehabilization.

6. Surgery & Procedures 

6.1 Hyaluronic Acid (HA) Injection: Hyaluronic acid  will be injected into the penis. Based on the assumption that premature ejaculation results from hypersensitivity, thus HA injection would create more space in the lamina propria layer of the penis, resulting in creation of a barrier between stimulus and receptor. Currently, there is no globally standardized HA injection protocol for penile enlargement and PE treatment, most medical practitioners would begin the procedure by using topical anesthetic cream (in adjunct with local anesthetic injection, if patients can not tolerate the pain). HA will be injected subcutaneously in the area between 1 ⁄ 3 from the glans penis to corona sulcus, fan and multiple puncture are frequently used techniques.    

6.2 Selective Dorsal Neurotomy (SDN) and Cryoablation of Dorsal Penile Nerve: Dorsal penile nerve is main afferent somatosensory pathway of the penis, thus the target for PE treatment. The nerve will be cut in those who need a surgical treatment and those who have penile hypersensitivity.

Effect of Premature Ejaculation

To Men:

  Men with PE often feel anxious about relationships, some even avoid all intimate relationships. This could even affect their spouse, make them feel that something is not fulfilling, resulting in lack of intimacy and even marriage problems.

To Women:

Women who have a partner with PE might have very little to none sexual pleasure, and often worry about relationships. Some even feel angry and offended, because of the misunderstanding that a guy is selfish (be the only one who gains pleasure from sexual activity).   

In conclusion, premature ejaculation is common. It could impair sexual activity, resulting in relationship problems and quality of life of patients and their partners. With medical knowledge and technology that is always developing, there is evidence that treatments are efficient and safe. However, it should be under physician closely supervision.