Premature Ejaculation

Definition

Premature ejaculation (ejaculation occurring sooner than the male or his partner would want) occurs in up to one third of adult men. Men may be reluctant to seek evaluation or treatment for this problem and consequently they and their partner may suffer frustration and anxiety which detracts from their sexual experience and their quality of life. In some men, premature ejaculation may be associated with erectile dysfunction.

Primary premature ejaculation indicates that the condition has been present from the onset of sexual activity. Secondary premature ejaculation denotes the onset after some period of satisfactory sexual activity without ejaculatory problems.

Signs and Symptoms

The diagnosis of premature ejaculation is based upon the perception of the male and his partner (who is assumed to be female for the purposes of this discussion). In extreme cases, ejaculation may occur before penetration. If orgasm and ejaculation in the male routinely occurs prior to the female partner being satisfied, then the diagnosis of premature ejaculation must be considered. However, failure of the female partner to attain orgasm may be a result of abnormal female sexual response.

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Evaluation

A careful history and physical exam is necessary to identify contributing factors. Frequency of premature ejaculation, any specific psychological factors or situations which might be associated with occurrence (such as anxiety or depression), erectile dysfunction, neurological disease, and medications provides important information that can guide investigation and treatment. In some cases, endocrine evaluation including serum testosterone levels may be helpful.

In cases of psychological abnormalities, further psychiatric or psychologic evaluations may be indicated.

Neurological studies of nerve function may be helpful including nerve conduction studies or somatosensory latency testing.

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Treatment

Premature ejaculation can be treated effectively with a combination of medication and psychological counseling with techniques to delay ejaculation.

Sexual Therapy:

Topical Desensitizing Cream:

Topical anesthetic cream or lotion can reduce the sensitivity of the penis thereby postponing male orgasm.

Medical Therapy:

Administration of oral selective serotonin reuptake inhibitors (SSRI) such as sertraline (Zoloft), paroxetine (Paxil) or fluoxetine (Prozac) has proven effective in delaying premature ejaculation. However, these medications are typically prescribed as anti-depressants, and are not specifically approved for the treatment of sexual dysfunction. Some tricyclic anti-depressants such as imipramine (Tofranil) also have SSRI effects.

Psychological Counseling:

Evaluation and treatment by a qualified psychiatrist, psychologist, or sex therapist may be indicated in certain circumstances.

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