• PREMATURE EJACULATION

    MORE THAN JUST ‘START-STOP’

ABOUT PREMATURE EJACULATION

Types of PE

Premature Ejaculation (PE) is either:

  • Lifelong (Primary) PE means that you have had the problem from the get-go.
  • Acquired (Secondary) PE means that you have previously had control over ejaculation.

Both lifelong and acquired each affect around 5% of men.

Primary PE is usually more ‘severe’ than secondary PE.

Lifelong PE

Lifelong PE has a measurable effect on quality of life. The author finds it surprising that men with primary PE may not seek for help for many years. Once you realise that Lifelong PE is not a primary pyschological issue then you are more likely to stop beating yourself up about something over which you have little control.

First line treatment for Lifelong PE is pharmacological therapy and not psychological therapy. In other words, the problem is not psychological. The cause of Lifelong PE is frankly not known. However, evidence points towards genetically predisposed dysfunction of the serotonin (5-HT) receptor.

Acquired PE

The most common cause of acquired PE appears to be a combination of erectile dysfunction (ED) with peformance anxiety.

Perhaps you notice that your erections aren’t as strong as you’d like. You might try to rush to avoid embarrassment. In other words, you will naturally speed up ejaculation to make sure that you don’t miss the boat! This heightened sense of performance is a form of anxiety. The trouble with perfomance anxiety is that it contributes to the problem it is trying to stop!

Physical causes of PE are less common, but include:

  • Chronic Prostate inflammation (Chronic Prostatitis). Pointers include painful ejaculation, pelvic pain, and/or pain on passing urine.
  • Thyroid hormone disorder

Diagnosis of PE

The time interval between vaginal penetration and ejaculation is the ‘latency time.’

The latency time provide some guidance as to what is normal although you are unlikely to want to start a stop watch.

The International Society for Sexual Medicine (ISSM) require the latency time for lifelong PE to be around or under 1 minute. The latency time for acquired PE is 3 minutes or less.

The other requirements for a diagnosis of PE would appear to be self-evident:

  • ‘The inability to delay ejaculation on all or nearly all vaginal penetrations,’ and
  • ‘Negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intimacy.

The author rarely finds the diagnosis of PE difficult. On occasion, a guy will be concerned about PE but report a good 3-5 minutes or longer before ejaculation occurs.

Two other types of PE are worth a mention. ‘Subjective PE’ describes the feeling of PE with a normal latency time. However, the latency time of 1 minute and 3 minutes in the definitions are arbitrary, and some men with subjective PE do seek treatment to prolong time to ejaculation.

‘Variable PE,’ describes inconsistent ejaculatory latency time that includes time in the normal range. This type of PE is likely to be acquired.

Do I need treatment?

Doctors are guided by level of patient concern.

Men with PE often report:

  • low satisfaction with their sexual relationship
  • low satisfaction with sexual intercourse
  • less frequent intercourse
  • low self-confidence
  • mental distress, anxiety, embarrassment, depression

The Premature Ejaculation Prevalence and Attitudes survey found that ‘Only 9.0% of men with PE reported having consulted a physician for the condition.’

We encourage you to seek help if PE is causing issues in your life. The best known ‘PE Score’ is The Premature Ejaculation Diagnostic Tool (PEDT) Questionnaire which is a useful guide as to whether you are experiencing significant PE. Take the test now.

TREATMENT OF PE

Treatment of PE is classified as behavioural, psychological and pharmaceutical. Doctors treating PE generally find that behavioural treatments are ineffective, particularly for primary ED.

Behavioural treatments

Many behavioural treatments for PE do not work that well. The upside, so to speak,  is that the only side effect is embarrassment. Behavioural techniques require support from your partner and are most suitable for couples in a long term relationship.

Masturbating before sexual intercourse is the epitomy of natural behavioural treatment for PE,  making use of the body’s natural latency between two consecutive ejaculations.

You can try to learn how ‘keep a lid’ on the level of sexual arousal required to ejaculate. Essentially, you tune into your body and learn to recognist the signs of increased sexual arousal that occur before ejaculation.

The best known behavioural treatments are:

  • The ‘stop-start’ technique  where your partner stimulates you until you are ready to ejaculate, at which point stimuation stops.
  • The ‘squeeze’ technique where your partner squeezes the ‘glans’ or tip of the penis just before ejaculation.

Cycles are repeated classically repeat three times, after which time you proceed to ejaculation.

Ejaculation becomes unstoppable at point X in the process of ejaculation. Both the ‘stop start’ and the ‘squeeze’ methods are designed to increase your awareness of the feelings you experience before point X.  The methods can help you to recognise those feelings with a view to reducing the ‘stimulus-response.’

Medication for PE

Medication is the first-line treatment for lifelong PE.

Local anaesthetic is definitely worth a mention – although not really what we mean by pharmaceutical treatment. You can buy low-strength ‘numbing cream’ from the pharmacy but you are likely to need full strength version of lidocaine to work properly.

Oral ‘SSRI’ medication is the the go-to for PE Treatments. Tablets are either taken every day, or an hour or two before sex (‘on demand’ therapy).

On-demand branded products are available from any pharmacy but are expensive. Compounding pharmacies can make ‘almost anything’ (not quite, but you get the idea), often at a cheaper price.

Daily medication can be a win-win for guys who have both PE and suffer from a mood disorder.

The author finds that most men with PE also suffer from perfomance anxiety. The all-in-one combination of an SSRI with Viagra-like medication is often the treatment of choice.

What can I expect at the clinic?

Virtual consulting means that expert help is just a phone call away.

Your first appointment allows for a full assessment of the issues. The outcome will typically include a prescription that you source from a range of standard or compounding pharmacies. We make a point in separating the ‘sale’ of a pharmaceutical product from its supply. In other words, there is no conflict of interest. We offer to forward a script directly to a cost-effective compounding pharmacy that provides next day delivery.

Scripts are provided with a repeat prescription – typically enough for 60 ejaculations.

WRITTEN BY: Richard Beatty
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