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Premature Ejaculation - Description and Treatments

Premature ejaculation (PE) is considered the most common sexual dysfunction in men. The International Society of Sexual Medicine has defined PE 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, PE 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 PE irrespective of race, educational background, marital status or age. If one expands the definition of premature ejaculation to include any couple whom the female partner takes longer to reach orgasm than the male, estimates are that up to 90 million couples are affected by it.

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 PE by increasing serotonin levels in the brain. While effective in treating PE 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(r) and Zoloft(r)Priligy is the brand name for legally-available Dapoxetine.  Priligy is not FDA-approved in the United States.

Behavioral Therapy and Penile Injections

Behavioral therapy is also effective in some patients with PE, but long-term success with behavioral techniques has been limited. Penile injections of medication designed to cause prolonged erections are a successful form of therapy for some patients, and although there are rare side effects of pain, priapism or penile scarring, widespread acceptance has not occurred because there are simpler oral and topical therapies that most patients prefer over injection therapy.  

Sprays and Creams (Topical Anesthetics)

Treatment using topical anesthetics was first demonstrated decades ago. There have been numerous articles in well-respected medical journals showing that PE can be treated successfully with topical therapy. Topical therapy was endorsed for use 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 has become increasingly popular in the past several years and may become the standard treatment option for premature ejaculation patients in the future.

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