What can be done with PE
Premature Ejaculation (PE) was initially seen as a psychological problem and for decades was only treated with behavioural and cognitive therapies. Subsequently, pharmacological treatments such as prescription drugs and topical preparations have become available.
PE, both chronic (Lifelong) or Acquired, is often a condition of organic/neurobiological etiology that can be treated. If the PE is caused by another disease (for instance by a non-diagnosed chronic prostatitis), the treatment of that disease will have positive effects also on PE. Even for treatment of the Lifelong form of PE there are different options the doctor could prescribe. In any case, a doctor’s consultation is strongly recommended for a correct diagnosis and treatment.
Here are some of the treatments generally known for men with PE symptoms, that include a range of cognitive/behavioural approaches (e.g., special positions during sex, interrupted stimulation), topical desensitising agents, and prescription drugs.
Behavioural and cognitive therapy. These are psychological and physical techniques aimed at training men to recognise pre-ejaculatory signs and to improve their control over ejaculation.
- The most often used behavioral techniques are the “stop-start” technique (first introduced by Dr. J. Semans in 1956) and the “squeeze” technique (described by Masters and Johnson, 1970). Several modifications of these techniques are available, but after initial success rates of 50-60%, clinical experience shows that they often fail to provide long term improvements. Instead of the “stop-start” technique, which can be unsatisfactory for the female partner, it is better for men to learn how to modulate and reduce the level of arousal and excitement by doing slow, sensual movements while breathing deeply and slowly. The goal is to keep the level of arousal below the ejaculation threshold, while maintaining a good erection. These breathing control techniques seem to have a calming effect and, at that moment, seem to really work. But clinical experience and scientific studies suggests that improvements achieved with these methods are generally not maintained on a long term.
- Masturbation before sexual intercourse is a technique used by many younger men. Following masturbation, the penis can be desensitised, possibly resulting in greater ejaculatory delay after the recovery period. In a different approach, the man learns to recognise the signs of increased sexual arousal and how to keep his level of sexual excitement below the intensity that finally triggers the ejaculatory reflex. Such self-help techniques, while partially effective in the short term, may actually exacerbate rather than alleviate PE, as they deliberately ignore or dampen the sexual sensations that need to be controlled in order to improve the condition. Furthermore, bad masturbation practice, i.e. a non-stop rush to climax, can further impede the development of ejaculation control mechanisms.
In general, there is no controlled research to support the efficacy of behavioural techniques.
Pharmacological treatment. Different oral treatments have been successfully used under medical prescription following PE diagnosis.
Topical creams or sprays containing anaesthetic compounds such as lidocaine and prilocaine, that desensitise the penis and thus help delaying ejaculation, provided moderate success-rates in smaller studies. But these topical anaesthetic medications are often difficult to dose and may therefore cause numbness of the glans/penis resulting in a loss of erection and/or ejaculation if they are overdosed. There is also the possibility of transferring the anaesthetic compound to the partner, thus reducing pleasurable sensations resulting in anorgasmia.
Other methods. Other self-help techniques, including double condoms or condoms containing anaesthetics (“delay” condoms), which produce a slight numbing effect, while partially effective in the short term, may ultimately exacerbate rather than alleviate PE, as they deliberately ignore or dampen the sexual sensations that need to be controlled in order to improve the condition.
Avoid self-medication. It is important to note that men with PE should avoid attempts of self-medication, as they involve many risks, such as using an inadequate or ineffective remedy. Above all, they should avoid trying to obtain a drug on the internet from unauthorised companies/agencies. It is important to remember that the safest and most reliable treatments are those prescribed by a doctor and bought from an authorized pharmacist who is well known to the prescribing doctor and trusted or from an authorised and certified online Pharmacy. See more about the risk of counterfeit medicines
- Althof SE et al. J Sex Med. 2010;7(9):2947-2969.
- Atikeler MK, Gecit I, Senol FA. Andrologia 2002;34(6):356-359.
- Broderick GA. J Sex Med 2006;3(4):295-302.
- Buvat J. J Sex Med 2011;8(suppl 4):316–327.
- Donatucci CF. J Sex Med. 2006;3(Suppl 4):303-308.
- EAU Guidelines on ED and PE 2012.
- El-Nashaar A, Shamloul R. J Sex Med. 2007;4(2):491-496.
- Gallo L, Perdonà S, Gallo A. J Sex Med. 2010;7(3):1269-1276.
- Giuliano F et al. BJU International 2008;102 (6):668-675.
- Giuliano F, Clement P. Eur Urol 2006;50 (3):454-466.
- Graziottin A, Althof S. J Sex Med 2011;8 Suppl 4:304-309.
- Halvorsen JG et al. J Am Board Fam Pract 1992;5:51-612.
- Jannini EA et al. Sessuologia Medica. Trattato di psicosessuologia e medicina della sessualità. Elsevier Masson Ed. 2007
- Jannini EA, Lombardo F, Lenzi A. Int J Androl 2005;28 Suppl 2:40-45.
- Jannini EA, Porst H. J Sex Med 2011;8 Suppl 4:301-303.
- Jannini EA, Simonelli C, Lenzi A. J Endocrinol Invest 2002;25(11):1006-1019.
- Laumann EO, Paik A, Rosen RC. JAMA. 1999; 281 (6) :537-544.
- Limoncin E, Tomassetti M, Gravina GL et al. J Urol 2012 Nov 6. Epub ahead of print.
- Lindau ST, Schumm LP, Laumann EO et al. NEngl J Med 2007;357:762–74.
- Masters WH, Johnson VE. Human sexual inadequacy. Boston: Little Brown; 1970:92–115.
- McCarty EJ. Core Evidence 2012;7:1-14.
- McMahon CG et al. J Sex Med 2008;5:1590–1606.
- McMahon CG et al. J Sex Med 2011;8:524-539.
- McMahon CG, Jannini E, Waldinger M, Rowland D. J Sex Med 2013;10(1):204-229.
- Montorsi F. J Sex Med 2005;suppl 1:8, ABS PS-3-1.
- Porst H et al. Eur Urol 2007;51(3):816-824.
- Porst H. “Premature Ejaculation”. In: Porst H, Reisman Y (eds):The ESSM Syllabus of Sexual Medicine.Medix Publishers,Amsterdam 2012; pp 547-595.
- Revicki V et al. Health and Quality of Life Outcomes 2008;6:33.
- Rosenberg MT, Sadovsky R. Identification and diagnosis of premature ejaculation. Int J Clin Pract. 2007;61(6):903-908.
- Screponi E, Carosa E, Di Stasi SM et al. Urology 2001;58(2):198-202.
- Shabsigh R, Rowland D. J Sex Med 2007;4 (5):1468-1478.
- Sotomayor M. J Sex Med 2005;2(2):110-114.
- Waldinger MD. Premature Ejaculation Definition and Drug Treatment. Drugs 2007;67 (4):547-568.
- World Health Organisation. ICD-10;1992. p. 355–356.
- www.eaasm.eu "The Counterfeiting Superhighway" report