Premature Ejaculation

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Diagnosis

A diagnosis of premature ejaculation involves a detailed sexual history, medical history (including over-the-counter, prescription, and recreational drug use), and a physical examination. In men who experience premature ejaculation with erectile dysfunction (impotence), blood tests may be performed to detect abnormal hormone (e.g., testosterone) levels.

A mental health professional or sexual therapist often can help make the diagnosis. A sexual history includes information about early sexual experiences, information about past and present sexual relationships, and the circumstances when the condition first started.

Information about religious values and upbringing also may be important. In many cases, it is helpful to include the patient's sexual partner in the diagnostic process.

Treatment

Treatment for premature ejaculation may include sexual therapy, counseling, medication, or a combination of these methods. Getting enough exercise and sleep, and eating a healthy diet are also important.

Couples may be instructed to avoid sexual relations for a period of time to reduce anxiety. In some cases, ejaculating (e.g., through masturbation) an hour or two before sexual intercourse allows the man to control ejaculation longer during sex.

Sexual therapy may involve a technique called the squeeze method, which can help the man learn to delay ejaculation. Using this method, the couple discontinues penile stimulation when the man feels ready to ejaculate and squeezes the area of the organ where the head (glans) meets the shaft until the urge to ejaculate passes. After waiting about 30 seconds, the couple resumes stimulation and repeats the process as many times as necessary to achieve satisfying sexual intercourse.

Counseling or psychotherapy can help patients and their partners resolve conflicts and personal issues (e.g., resentment, stress, anxiety) that can contribute to premature ejaculation. In many cases, counseling is more effective when couples attend together.

Medications that may be used in men who experience premature ejaculation include topical anesthetic creams (e.g., lidocaine, prilocaine) and certain antidepressants (e.g., selective serotonin reuptake inhibitors [SSRIs]). Topical anesthetics can be used to reduce sensation in the penis. Men who have had a previous reaction to topical anesthetics should not use them, and the cream must be removed prior to sexual intercourse to prevent genital numbness in the partner.

Antidepressants are not approved by the Food and Drug Administration (FDA) to treat premature ejaculation; however, many studies have shown that they are safe and effective. These medications include selective serotonin reuptake inhibitors (SSRIs), such as the following:

• Dapoxetine
• Fluoxetine (Prozac®, Serafem®)
• Paroxetine (Paxil®)
• Sertraline (Zoloft®)

SSRIs may cause nausea, weight loss, headache, and sun sensitivity. Patients taking these medications for premature ejaculation usually see results in 3–6 weeks. If SSRIs are ineffective, a tricyclic antidepressant, such as clomipramine (Anafranil®), may be prescribed.

Side effects of tricyclic antidepressants include the following:

• Blurred vision
• Changes in appetite
• Decreased libido
• Dizziness
• Dry mouth
• Hypertension
• Impaired concentration
• Increased heart rate
• Nausea
• Nervousness

Premature Ejaculation, Diagnosis, Treatment reprinted with permission from urologychannel.com
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