Premature Ejaculation

    This is a common problem, and may affect 20-30% of men. Some men have always had it from the time they became sexually active (primary premature ejaculation), and in others it may develop suddenly (secondary premature ejaculation). It can have major effects on relationships and emotional wellbeing. Men with premature ejaculation describe a number of issues, including a poor feeling of ejaculatory control, poor sexual satisfaction, and personal and relationship distress.

    It is difficult to precisely define premature ejaculation, but the World Health Organisation gives the following definition:

    Inability to delay ejaculation sufficient to enjoy lovemaking, and/or ejaculation before or soon after the beginning of intercourse.

    The cause of premature ejaculation is not known, but it may be associated with the following:

    • Psychological problems (including stress, sexual performance anxiety, and low self-confidence)
    • Hormonal (hyperthyroidism, increased leptin). These possible associations have not been proven.
    • There are possibly some drugs that may promote premature ejaculation.

    Treatments for premature ejaculation:

    Care is required with potential treatments. Many men can benefit from psychosexual counseling by a trained counselor.

    The following treatments may help, but are ‘off-label’ for premature ejaculation. Side effects are common. They are mentioned here purely for educational interest and treatment with these agents is not necessarily recommended.

    • Topical local anaesthetic preparations. These creams can be used ‘on-demand’ and may be effective for some men. They reduce penile sensitivity, and may help to delay ejaculation.
    • Antidepressants known as Selective serotonin re-uptake inhibitors (SSRIs). These need to be taken on a regular basis, and can be associated with quite marked side effects.
    • PDE-5 inhibitors. These are the class of drugs that are used for erectile dysfunction (impotence). There is some evidence that they can produce a delay to ejaculation, although clinical evidence suggests that they don’t actually delay ejaculation, but just give men more confidence and a feeling of control over ejaculation.

    A newer SSRI called dapoxetine, which can be taken ‘on-demand’ rather than regularly. A formulation of this drug has an indication for premature ejaculation in Australia. Again, there are side effects with this drug and these should be discussed at length with your doctor.

    Summary of premature ejaculation

    Below is an infographic from the Institute for the Study of Urologic Diseases, and this may help to summarise premature ejaculation:

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