Premature Ejaculation - Description and Treatments

Premature ejaculation is considered the most common sexual dysfunction in men. The international society of sexual medicine has defined premature ejaculation as a male sexual dysfunction characterized by ejaculation which always or nearly always occurs prior to or within about one minute of vaginal penetration; an 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. Using this strict definition, premature ejaculation is thought to effect 30 million men in the United States. In his frequently referenced article from the February 10, 1999 Journal of the American Medical Association, Edward Laumann demonstrated that when compared to erectile dysfunction, premature ejaculation effects two to three times as many men. It is also interesting to note that the article showed that a similar number of men were bothered by premature ejaculation irrespective of race, educational background, marital status or age. If one expands the definition of premature ejaculation to include any couple where the female partner takes longer to reach orgasm than the male, estimates are that up to 90 million couples are affected by premature ejaculation.

Selective Serotonin Reuptake Inhibitors (SSRI)

Common treatment options for premature ejaculation include selective serotonin reuptake inhibitors, topical anesthetics, behavioral therapy and even penile injection of medication designed to allow men to maintain an erection after ejaculation. The most common treatment for premature ejaculation at the present time is the use of selective serotonin reuptake inhibitors (SSRIs). These medications, which are used to treat depression, improve premature ejaculation by increasing serotonin levels in the brain. While effective in treating premature ejaculation in some patients, SSRIs are limited by their numerous side effects and their need to be taken daily to reach maximum efficacy.

Dapoxetine is a faster-acting SSRI designed to minimize the side effects of other anti-depressants such as paxil and zoloft. Priligy is the brand name for legally-available dapoxetine.  Priligy is not FDA-approved in the USA.

Behavioral Therapy and Penile Injections

Behavioral therapy is also effective in some patients with premature ejaculation, but long-term success with behavioral techniques for premature ejaculation has been limited. Although penile injections of medication designed to cause prolonged erections are a successful form of therapy for patients with premature ejaculation, widespread acceptance has not occurred due to pain from the injections and the potential for significant side effects such as priapism (a painful prolonged erection) and penile scarring.

Sprays and Creams (Topical Anesthetics)

The treatment of premature ejaculation with topical anesthetics was first demonstrated decades ago. There have been numerous articles in well-respected medical journals showing that premature ejaculation can be treated successfully with topical therapy. Topical therapy was endorsed for use in premature ejaculation by the American Urological Association consensus panel in 2004. Unlike selective seretonin uptake inhibitors, topical therapy has almost no side effects and can be taken on an as-needed (prior to intercourse) basis. The improvement with most topical therapies for premature ejaculation has been from 3 to 8 minutes in most studies. Topical therapy for premature ejaculation has become increasingly popular in the past several years and may become the standard treatment option for premature ejaculation patients in the future.