More Information About Penile Sensitivity
Penile Hypersensitivity
Penile hypersensitivity has long been accepted to be one of the leading causes of premature ejaculation. The first publications documenting successful treatment for premature ejaculation by reducing penile hypersensitivity were released several decades ago. More recently, Xin et al in the September 1996 Journal of Urology studied the difference in penile sensitivity in 120 patients with premature ejaculation and 66 volunteers without premature ejaculation using an instrument that is able to determine vibratory thresholds called a biothesiometer. They found that penile sensitivity as determined by vibratory thresholds was much greater in men with premature ejaculation compared to volunteers without premature ejaculation. Also of interest was a lack of the normal age-dependent decrease in penile sensitivity in those patients with premature ejaculation.
In August 1997, Xin et al published a separate article in the Journal of Urology that measured penile sensitivity using a different device which measured somatosensory evoked potentials. This data was consistent with the earlier data in that men with premature ejaculation had significantly greater evoked potentials consistent with penile hypersensitivity in comparison to normal men.
Penile Sensitivity and Relationship to PE
In contrast to the previously mentioned studies, other published articles have questioned the role of penile hypersensitivity in the etiology of premature ejaculation. Rowland et al in 1993 studied 63 men and concluded that there appeared to be no role for hypersensitivity in the etiology of premature ejaculation. More recently, Salonia et al looked at sensory thresholds in 42 patients with lifelong PE and 41 controls. Both warm and cold sensation thresholds were similar between patients with PE and controls. In spite of the discrepancies in the literature related to penile hypersensitivity, most experts agree that penile hypersensitivity is one of the most important issues in patients with reduced ejaculatory latency.
Most of us are familiar with the anesthetic properties of local anesthetics such as lidocaine. When a physician injects lidocaine into the skin, a rapid reduction or elimination of skin sensitivity ensues. The reason why physicians historically have used injections to administer lidocaine has to do with the fact that a protective layer exists near the surface of the skin that prevents absorption of not only medications but numerous other things in our environment. Historically, this layer, called the stratum corneum, has prevented adequate absorption of lidocaine into the dermis, severely limiting the effectiveness of topical lidocaine. However, formulations containing a combination of different compounds have been created that have been shown to be effective in reducing sensitivity. These products have been tested and found to be effective in the treatment of premature ejaculation by reducing the intensity of the signal received by the brain from the penile skin during sexual activity.
Reduction of Penile Hypersensitivity
The American Urological Association includes a prescription, off-label topical anesthetic as an accepted treatment option for reducing penile hypersensitivity in their consensus panel on premature ejaculation published in 2004. A topical cream with enough absorption capability has been shown to be a safe, effective treatment for premature ejaculation in numerous published reports, with improvement in ejaculatory latency ranging from 4 – 6 minutes on average. Promescent is an over-the-counter topical lidocaine therapy that was developed and proven clinically to be equivalent to off-label prescription creams in the original university studies. Promescent comes in a metered dose spray that allows for markedly improved dosage reproducibility. An additional advantage to Promescent is that it has no prilocaine, and is therefore approved for use from 3 – 10 sprays for the treatment of penile hypersensitivity under FDA monograph 21 CFR 348.10 and can be purchased without a prescription.
