MALE PATIENTS

What is premature ejaculation?
Premature ejaculation is defined as ejaculation occurring sooner than desired by the man or his partner and causing distress to the couple. It is usually caused by sexual inexperience, anxiety, and other psychologic factors instead of disease. It can be treated successfully with topical anesthetics, sex therapy, tricyclic antidepressants, and selective serotonin reuptake inhibitors.

How quick is premature ejaculation?
It is quite common for men to worry about whether or not they last long enough during sex and often people are unsure about how long sex lasts for the average couple. Studies show that this varies, but evidence suggests that, on average, sex lasts between six and eight minutes. 

What matters, is whether you and your partner are both happy with your sex life. However, if you normally ejaculate within one minute of sex, doctors would consider this to be premature ejaculation. 

Who does PE affect?
Premature ejaculation is the most common type of ejaculation problem. Reports suggest that one in three men suffer from premature ejaculation. In reality the numbers are probably higher though, because frequently men prefer not to discuss premature ejaculation as part of a survey. 

Causes of premature ejaculation
The causes of premature ejaculation are unclear, but they are often thought to be psychological and/or neurological. They can include: stress, anxiety, depression, relationship problems, or a traumatic sexual experience in the past. It can also be caused by biological factors.

Causes of primary premature ejaculation
If someone has experienced premature ejaculation for their whole life, doctors call this primary premature ejaculation.If you experience primary premature ejaculation, there can also be biological reasons why it happens. You may have a particularly sensitive penis. This can be caused by changes in the usual pattern of nerve signals in men who experience erectile dysfunction. Doctors also think that some cases of premature ejaculation can be linked to low levels of a hormone called prolactin. Prolactin usually has the effect of dampening arousal, which in turn delays ejaculation.  

Psychological causes
More often than not though, there are psychological reasons why primary premature ejaculation occurs. It can stem from early sexual experiences. Some doctors believe that premature ejaculation can be linked to a type of conditioning, where a man has become accustomed to ejaculating quite quickly when masturbating as a teenager for example. 

It can also be linked to upbringing. If you’ve had a very stern upbringing or if you’ve been taught that sex is wrong or a sin, it can be hard to let go of these thoughts as you age, which can result in problems relaxing into sex. Similarly, a traumatic sexual experience, such as abuse, can result in ejaculation problems.  

Causes of secondary premature ejaculation
If you had a history of normal ejaculation, but then later started having problems, this is called secondary premature ejaculation. The causes of this can also be biological. These include diabetes, multiple sclerosis, under-active thyroid, prostate disease and high blood pressure, along with taking recreational drugs and drinking too much alcohol. Usually though, the causes are psychological and include stress, depression, or being worried about performing sexually (for example, if you’ve had trouble with premature ejaculation in the past you might be worried about it happening again, or if you get a new partner you might feel self conscious).

Statistics on Premature Ejaculation 
People often think that premature ejaculation is only an issue faced by young men and that it happens less frequently as men age. In fact, studies show that this is not true. Premature ejaculation is a problem that is consistent across ages. An American study found that 30% of men aged between adolescence and 59 years of age reported that they had experienced premature ejaculation at least once in the previous year. It also affects 28% of men aged 65-74 and 22% of men aged 75-85.

Which treatment options are there?
It isn’t possible to cure premature ejaculation, but there are medications available that exist to treat it temporarily.

Priligy
Priligy is an oral medication. It contains the active ingredient dapoxetine and is newly licensed in the UK. Men who normally ejaculate after about 1-2 minutes of sex, find that it helps them to last longer.

Priligy works by raising your serotonin levels temporarily. It is a type of anti depressant (also sometimes known as a selective serotonin reuptake inhibitor or SSRI). You take it 1-3 hours before you have sex and it lasts for a couple of hours afterwards. Studies show that priligy is effective at increasing the length of time from when the penis enters the vagina to ejaculation.

EMLA
EMLA cream is a topical cream that is rubbed onto the penis to numb sensation and, in turn, slow down ejaculation. The cream contains two local anaesthetics: lidocaine and prilocaine. You put it on about a quarter of an hour before having sex. Once your penis feels numb, wash the cream off so that it doesn’t also reduce sensation for your partner.

Alternative Treatment Options
You can also consider mental techniques, alternative therapies, numbing condoms, psychological therapy, and anti-depressants.

Numbing condoms come with a numbing lubricant inside them to reduce sensation for the man and help him to control ejaculation. You need to put them on 30-60 seconds before you have sex so that the lube has time to work.

You can buy topical creams from sex shops to make you last longer. These don’t work as well as the medically prescribed creams, like EMLA, so are maybe not the best if you suffer from premature ejaculation, but you might like to try them to see if they work for you.

Which mental techniques are there?
There are also mental techniques that you can try. Some self-help techniques include masturbation a couple of hours before sex, taking a break during sex, thinking about something dull, using thick condoms so you can feel less, and taking a big breath in when you feel like you are about to ejaculate – to stop the ejaculatory reflex.

How can therapy help?
Psychological therapy can often cure your PE, but you need to be open to discussing your feelings for it to work. Often therapists also recommend that you stop having sex for a short while and explore other forms of pleasure with your partner, like massage or showing affection.

Another option, if you are in a relationship, is couples therapy. This will help you to consider whether there are things that are affecting your relationship negatively and allow you to work through any issues with your partner. They can also teach you ways to train your body out of the habit of premature ejaculation. The two most common ways are the ‘squeeze’ and ‘stop-go’ techniques. You’ll need to practice them for them to work for you, even though they sound very simple.

What is the "squeeze" technique?
In the ‘squeeze’ technique, the woman masturbates the man until he feels that he is almost ready to ejaculate, then stops and squeezes the head of his penis for between 10 and 20 seconds. She lets go, waits for a further half a minute, then starts to masturbate him again. They repeat this process a few times before ejaculation. ‘Stop-go’ works similarly, but the woman doesn’t squeeze the penis, instead the couple have sex, stopping and starting as required.

Which side effects can occur?
Because numbing condoms and topical creams (either from a sex shop or on prescription e.g. EMLA cream) are designed to reduce sensation to help you control ejaculation, they can also reduce your enjoyment of sex.

• EMLA cream can cause some short term skin irritation, such as redness, swelling or paleness where the cream was applied. 

• Priligy’s most common side effects are dry mouth, headache, dizziness and nausea.

• The SSRI’s, paroxetine, sertraline and fluoxetine do unfortunately have several mild, common side effects, including feeling tired and nauseous, vomiting and diarrhoea and excessive sweating. Normally these side effects improve after a few weeks.

Always read the patient information leaflet for the full list of possible side effects.

Always take this medicine exactly as your doctor has told you. Check with your doctor or pharmacist if you are not sure.