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Premature Ejaculation

What is Premature Ejaculation?

Premature ejaculation (PE) is a male sexual dysfunction characterized by ejaculation that always or nearly always occurs prior to or within about one minute of sexual penetration; and inability to delay ejaculation on all or nearly all sexual penetrations; and negative personal consequences, such as distress, bother, frustration and/or the avoidance of sexual intimacy.

What are the types of PE?

There are two subtypes of PE:

  • Lifelong PE symptoms have been present since first sexual intercourse.

  • Acquired PE symptoms develop after a period of normal ejaculatory function.

Anteportal ejaculation is the term for men who ejaculate before sexual penetration and is considered the most severe form of PE.

How common is it?

Premature ejaculation is the most common type of male sexual problem. The true prevalence of PE is difficult to assess as less than 10% of sufferers seek medical help. Based on patient self-report, PE affects 3% to 30% of men. PE is not just a problem of young, sexually inexperienced men, but can affect older men who have previously been normal, especially those with co-existing erection problems.

Most couples are quite surprised to know that the average duration of intercourse, from penetration to orgasm, is about 5 minutes. Some men may perceive that they have PE, when in reality, the period of time from sexual penetration to ejaculation is 5 minutes or longer.

If men who ejaculate after one minute of penetration are excluded, the prevalence of those with PE is probably less than 3%.

What are the causes?

There are no known causes found to date. Some men with erectile dysfunction (ED) ‘rush’ intercourse to prevent the loss of their erections. In these men, ED treatment may be helpful. Men with anxiety, either with sexual performance or with other issues, may have higher risks of PE.

Why is PE important?

A high level of distress is reported by both the man and his partner. It impacts on a couple’s satisfaction with intercourse and may cause emotional and relationship problems. The patient often feels a sense of lack of control. PE may serve as a barrier for single men to seek out and become involved in new relationships.

What is involved in the assessment?

A full sexual history is obtained. The time between penetration and ejaculation, and the ability to delay ejaculation is noted. The impact on a man’s emotions, quality of life and relationship are also ascertained.

The Premature Ejaculation Diagnostic Tool (PEDT) is a questionnaire used to help identify men with PE.

Download Premature Ejaculation Diagnostic Tool (PEDT) – PDF (50 Kb)

What are the treatment options?

The treatment options are sex therapy, drug therapy or a combination of both. Patients with erectile dysfunction should get that treated and optimised first. It is preferable but not mandatory, that the patient’s partner is also involved in making choices about treatment.

Sex therapy

Some patients may need to attend sessions with an experienced sex therapist. A range of techniques such as the ‘stop-start’ technique, or using a condom to decrease penile sensation, can be taught. Psychological and behavioural interventions can also be provided if needed.

Drug therapy

Drugs obtained through the Internet without a physician medical assessment or through other unregulated sources may be ineffective or dangerous. In Australia, such unregulated entities are rife and men should be aware of the potential health and financial risks associated with their programs.

There are two types of drug therapy recommended:

  • Topical anaesthetics:

    • These are numbing creams or gels that can be applied to the penis immediately before sex, to reduce penile sensitivity such that ejaculation can be delayed without the bothersome loss of pleasurable sexual sensation. Generally, the patient is asked to wear a condom once the cream or gel is applied, so that the numbness does not transfer to the partner.

  • Oral serotonergic drugs:

    • These medications affect the nerve signaling within the brain and the nervous system, resulting in delayed ejaculation. Examples of these drugs are dapoxetine, paroxetine and fluoxetine. They tend to be more effective if taken on a daily basis. Side effects include fatigue, nausea, diarrhea, perspiration, decreased sex drive, and erectile dysfunction.