Premature Ejaculation Can Be Treated! 

Find out how right now - treatment for premature ejaculation which actually enables you to make love for longer.

Summary of Premature Ejaculation

Original article on the science of  PE can be found here

1 Introduction 

So we know that premature ejaculation is the most common sexual disorder or dysfunction amongst men in every country in the world, but it does seem to be challenging to treat. One of the reasons for this is that men get so caught up in their progress towards orgasm that it's hard for them to exert self-control at the point when they most need to do so in order stop themselves ejaculating too soon - which means before their partner is satisfied with the duration of intercourse. Furthermore, there isn't any kind of definition that's been universally accepted by doctors and psychologists, which means that even the frequency with which it occurs is open to question: estimates of the prevalence of premature ejaculation have ranged from between 5% and 75%. And lastly, as you probably are already well aware, there is no entirely satisfactory medical treatment for rapid ejaculation, although a drug called Dapoxetine is now licensed in some countries (but not in America!).

Doctors usually subscribe to a definition of premature ejaculation based on one of the major medical manuals such as the DSM-IV. This defines premature ejaculation as a condition marked by a man's climax occurring both persistently and frequently with minimal sexual stimulation, either before penetration, at the moment of penetration, or very soon after the man has penetrated the woman, and - crucially - before either the man or his partner wishes his ejaculation to take place.

Two key elements of this definition are that PE must cause either personal distress or difficulty within the relationship, and that the PE is not due to some side effect of a chemical substance. In a way, even now you can see how illogical this definition is, in that two couples who both experience the same time between lovemaking commencing and the man ejaculating, might or might not be defined as having a sexual dysfunction, depending on whether the man and his partner are distressed by it. It's hardly an objective definition if it can't distinguish between two couples in this way. 

Nonetheless, there are common factors in all definitions of PE: and it's certainly true that men who experience the condition are very well aware that they are rapid ejaculators. In essence, this dysfunction is a problem that prevents a man from delaying his ejaculation sufficiently for both partners to enjoy lovemaking in the way that they would wish to do so. But it's important when accepting this simplistic definition to remember that some couples have unrealistic expectations of the duration of lovemaking, expecting it to continue for 10, 15, or even 20 minutes; bear in mind that the average length of time for lovemaking across a wide range of populations is about 6 or 7 minutes; that is the standard against which you should be judging yourself if you're interested in what constitutes the average.  

One off the chief researchers in this field, Marcel Waldinger, was responsible for the concept of the "intravaginal ejaculatory latency time" (IELT), which is the time between penetration and the man's ejaculation. The median is 5.4 minutes, while the 0.5 percentile is defined by an IELT of around 0.9 minutes, and the 2.5 percentile is defined by an IELT of 1.3 minutes. And guess what? Men are regarded by many experts as having premature ejaculation if they "come" within one minute. Again, this is a highly inadequate definition because it ignores the distress that rapid ejaculation can cause either the man or his partner. Furthermore, most conventional pieces of research up until quite recently have failed to take some fairly significant facts into consideration: these include questions about how the man and his partner perceive a man's level of control over his orgasm and climax, the level of stress and relationship difficulties that this lack of control causes, and the level of the couple's overall sexual satisfaction. Clearly, objective measures based on time alone seem to be just as inadequate in forming a definition of PE as do those which only take account of the couple's distress because the man cannot last longer during lovemaking.

2 Non-medical treatment of PE 

For many years, PE was thought of as a purely psychological dysfunction, one that behavioral therapy and sexual psychotherapy could deal with effectively. The first formal treatment was proposed by the urologist Semans in 1956; he developed the stop-start technique, which was basically a behavioral training system that required the man's partner to masturbate him until immediately before the point of ejaculation, then pause until his arousal had dropped, then resume stimulation once more until he was again near the point of climax; repeating this cycle until the man had developed adequate voluntary control of ejaculation. 

This remains one of the most effective techniques for controlling PE, although it does require discipline on the part of both the man and his partner, and it does require them to engage in the training program with commitment. Masters and Johnson introduced a variation of this technique, which involved squeezing the penile shaft at the level of the frenulum when the man was about to ejaculate. In fact this is also an effective "treatment" in that the desire to ejaculate does dissipate when the penis is squeezed, and the man's erection does decline slightly; if the timing is correct, a man's urge to ejaculate is markedly reduced, and he can continue making love for much longer when he resumes sexual activity. 

One of the criticisms that has been leveled at this technique is that the recidivism rate is rather high, and the effects not long-lasting. Our own interpretation of this information is that the men who undergo training to overcome PE are basically not motivated to maintain any improvement in the time for which they can make love. This isn't too surprising, because the power of the urge to come, and the feelings of satisfaction that the male climax produces are so intense that they can certainly seem much more compelling than the partner's less well-defined sexual satisfaction. 

In reality, about three quarters of the men who initially get some considerable benefit from these behavioral techniques find that after three years they are back to where they started. To reiterate, that's because there's no reason to suppose they had been following the training techniques between the initial training and the follow-up three years later; clearly, had they been doing so, they would not have been experiencing premature ejaculation. What is not known, however, is how frequently one would need to reinforce the new behavioral pattern to maintain a man's ability to voluntarily control his climax, and I don't believe any research has been done on the subject.

The physiological mechanism of ejaculation consists of a spinal reflex which is strongly modulated by higher centers in the brain and spinal cord -- in other words, it's basically like urination and defecation, in that control can be learned, and the degree of expression of that control can be strongly influenced by previous experiences and indeed by the context in which sex is taking place (for example, a man may have much more control when he's with a long-term partner than when he makes love to someone he's just met and/or who he finds extremely arousing.) 

Nonetheless, Marcel Waldinger has demonstrated that men who really do have a serious case of rapid ejaculation are to the far left of the normal distribution, and one interpretation of this may be that they have a genetically inherited trait which determines a physiological response in the brain, most likely something to do with serotonin receptor sensitivity. It's fair to say that this conclusion is not universally accepted, and it's also fair to say that while it does not present a clear treatment strategy, it has led to great deal of research on the possibility of modifying serotonin uptake in the brain with the use of SSRIs like Dapoxetine, as a treatment strategy for PE. Others would maintain that a combination of therapy including behavioral therapy based on the traditional methods described above, together with information, and psychotherapy designed to reduce performance anxiety and resolve any relationship issues that the man and his partner may be experiencing is a better approach to the treatment of PE.

3 Medical treatment of PE 

To say that although sex therapy is effective, it cannot be made available to the majority of men with this condition because it involves focused one to one effort, rather misses the point. If a man is sufficiently motivated to develop the ability to last longer during lovemaking, then such issues are an irrelevance; if he's not determined to make the effort required to develop greater staying power, then he's never going to seek out treatment of any kind. If you're a man looking for a solution to this problem, bear in mind that all medications available to treat it were originally developed for a quite different use -- more specifically, the treatment of depression. Although a compound known as Dapoxetine has now been licensed in some European countries, it too is based on an antidepressant formulation, and it is surely significant that it has not been licensed by the FDA in the United States.

The currently available and accepted treatment options that are not therapy based include agents that can be applied to the head of the penis to desensitize it, and the SSRI Dapoxetine.

Desensitizing drugs 

This is the original form of treatment for PE -- being described as long ago as 1943; the underlying presumption is that the man who reaches his climax too quickly has a hypersensitive penis, and therefore if it's desensitized with a suitable anesthetic, he's likely to be able to last longer in bed. However, recent research has failed to demonstrate any indication of penile hypersensitivity as a cause of rapid ejaculation, which in itself may not rule out this approach to treatment, except for the fact that desensitizing agents usually also reduce the sensations of pleasure which man can get during intercourse; so the added time becomes a highly questionable benefit, unless he simply wants to increase his self-esteem by demonstrating his sexual prowess to his partner. These compounds may cause female genital anesthesia, and they may also cause adverse skin reactions; and, like all interruptions to sex, the pause needed to apply the desensitizing agent to the head of the penis can be disruptive to the spontaneity of sex.

The most well-known agent that can be used in this way is a combination of lidocaine and prilocaine; this can be formulated as a cream which is applied to the head of the penis before intercourse. Does it work? Well, it's certainly widely available, and it's commonly used to treat the condition, but oddly enough there isn't a lot of research about how it impacts on the man and his partner. 

A reliable 2002 study which involved placebo controlled, randomized testing of this compound showed that all men experienced penile numbness and loss of erection after 45 minutes; this probably just demonstrates that you shouldn't keep it on your penis for that long, because a second reliably conducted study demonstrated that the cream could provide an almost six-fold increase in the time between penetration and ejaculation, and that eleven out of sixteen men in the study reported "very good" or "excellent" satisfaction with sex. Conversely, almost one man in five had some adverse effects, including penile numbness or even retarded ejaculation, and/or irritation of the skin of the penis.

More recently, a lidocaine-prilocaine mixture has been developed that can be applied as a metered spray to head of the penis. It delivers 7.5 mg of lidocaine and a third of that amount of prilocaine in each application; one of the qualities that the makers claim for it is that it is able to penetrate tissue easily, and therefore its anesthetic effect begins more rapidly than the cream formulation referred to above. 

Many of the products that use desensitizing anesthetic preparations require the use of a condom to cover the man's penis and contain the desensitizing agent, thereby preventing it reaching his partner's vagina; this spray, however, penetrates skin so rapidly that the condom is not required, and it appears to have only a minimal effect on his partner's vagina. And it isn't as effective as the cream, producing only a three or four minute increase in the time for which the man can make love, but it is much better tolerated than the cream, is easier to apply, needing only three squirts of the spray 15 minutes before sex begins, and there's no need to wash it off. In addition, almost no men experienced the side effect of delayed ejaculation or complete inability to ejaculate in the two studies referred to in the original article from which this review is taken.

The next product that's widely available is a compound called SS cream® (made by the Cheil Jedan Corporation, Seoul, Korea), which is applied to the glans of the penis sixty minutes before sex begins and is then washed off before the man penetrates his partner. It's made up of a  combination of as many as nine botanically derived compounds, which have both anesthetic and vasodilatory qualities.  The scientific research on the effectiveness of this product, which is currently only available in Korea, is somewhat questionable, but it does seem to demonstrate that up to 90% of men who use it obtain as much as an eight fold increase in the IELT. Unfortunately there was considerable irritation of the glans in 19% of the men who tried the product. The product has since been reformulated, but data is not available on the effectiveness of this new product.

The next product which is under development is a combination of local anesthetic, dyclonine, and vasodilator, alprostadil. Applied to the end of the penis in the region of the urethral meatus between five and twenty minutes before sex begins, the makers claim that this produces a synergistic effect and increases IELT, but there is no evidence for or against its efficiency.

Tricyclic  antidepressants

At one stage the tricyclic antidepressant clomipramine was investigated as a treatment for PE, but it's fair to say that this has been a false hope. Clomipramine was first written up as a possible treatment for PE in 1973. It certainly does have an impact on IELT, increasing it by between four and five times, which is a similar improvement to that achievable with the use of sertraline and fluoxetine. However, at the dose required to achieve a delay in ejaculation, nausea is a common side effect - and it lasts beyond the day on which the medication is taken, through to the day afterwards.

There's some evidence to suggest that men who could initially last for at least a minute before coming, and whose pre-existing level of satisfaction with sex was as high as 5 or more on a 7 point scale received more benefit from taking clomipramine "on demand" rather than on a daily basis; but this approach to curing PE has not gained wide acceptance, because of the side  effects.

SSRIs

The other main agents which can be taken orally for the "treatment" of PE consist of SSRIs, that is to say, selective serotonin reuptake inhibitors. SSRIs are not approved by any regulatory body in the United States for the treatment of PE, and its usefulness in addressing the condition seems somewhat variable, depending on which report one reads, which research conducted the investigation, and which SSRI is under discussion

Other helpful sources of information on the subject of rapid ejaculation

Premature ejaculation is said to occur when a man reaches orgasm during sexual intercourse before he or his partner wishes to achieve climax.

Round one third of men experience the frustration of premature or rapid ejaculation. Happily it can be successfully treated. Therapist Paula Hall explains how.

Premature ejaculation (PE) means reaching orgasm too quickly, and it's probably the most common sexual problem. In a survey of thousands of British men, around one in ten often or sometimes had this trouble.

People ask what is the most common question received by this column. By a long way, it is: "How do I solve my rapid ejaculation problem?" So we look at ways to cure an issue that plagues many men.

As you may expect, PE is much more common in younger men - there's a marked tendency for IELT to improve with age. Men generally get better ejaculation control as they grow older.

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Anxiety and premature ejaculation

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