Premature Ejaculation Treatment

Archive for September, 2007

What treatments are available?

There are several treatment choices for premature
ejaculation: psychological therapy, behavioral therapy,
and medications. Be sure to discuss these treatments
with your doctor and together decide which of the
following options is best for you:

• Psychological therapy addresses feelings a man may
have about sexuality and sexual relationships.

• Behavioral therapy makes use of exercises to help
a man develop tolerance to stimulation and, as a
result, delay ejaculation.

• Medical therapy includes oral medications that can
cause a delay in the time it takes from the beginning
of sexual stimulation until ejaculation occurs. These
oral medications are the same medications that are
commonly used to treat depression. But in men with
premature ejaculation, they are used to improve
the problem of premature ejaculation, not to treat
depression. In addition, topical anesthetic creams
may be used to increase the time it takes from the
beginning of sexual stimulation until ejaculation
occurs.

Psychological therapy

Psychological therapy can be used as the only
treatment or can be used together with medical
therapy or behavioral therapy. The focus of
psychological therapy is to help you to identify
psychological difficulties that may contribute to the
premature ejaculation and/or to solve problems in
your relationships that may have added to the cause
of premature ejaculation. This therapy can also
help couples to talk about problems with intimacy
that occurred after premature ejaculation began.
Psychological therapy can also help a man learn to be
less anxious about his sexual performance and have
greater sexual confidence. Typically, a man will receive
specific advice on how to enhance his and his partner’s
sexual satisfaction.

Behavioral therapy-

Behavioral therapy can play a key part in the usual
treatment of premature ejaculation. Certain sexual
maneuvers can be effective; however, they may not
always provide a lasting solution to the problem. Also,
they rely heavily on the cooperation of the partner,
which in some cases, may be a problem.
With the squeeze method, an exercise developed by
Masters and Johnson, the partner stimulates the man’s
penis until he is close to ejaculation. At the point when
he is about to ejaculate, the partner squeezes the penis
hard enough to make him partially lose his erection.
The goal of this technique is to teach the man to
become aware of the sensations leading up to orgasm,and then
begin to control and delay his orgasm on his
own.

With the stop-start method, the partner stimulates
the man’s penis until just before ejaculation. The
partner should then stop all stimulation until the urge
to ejaculate subsides. As the man regains control, he
instructs the partner to begin stimulating his penis
again. This procedure is repeated three times before
allowing the man to ejaculate on the fourth time. The
couple repeats this exercise three times a week, until
the man has gained good control.

Medical therapies

Although not approved by the U.S. Food and Drug
Administration (FDA) for this purpose, pills used for
depression and anesthetic creams have been shown to
delay ejaculation in men with premature ejaculation.
Medications are a relatively new form of treatment for
premature ejaculation. Doctors first noticed that men
and women who were taking drugs for the treatment
of depression (antidepressants) also had delayed
orgasms. Doctors then began to use these drugs “offlabel”
(this implies using a medication for a different
illness than what it was originally manufactured for) to
treat premature ejaculation. These medications include
antidepressants that affect serotonin such as fluoxetine
(Prozac®, Sarafem®), paroxetine (Paxil®), sertraline
(Zoloft®), and clomipramine (Anafranil®).

If one medication fails to work, a second one is usually
recommended. If the second one fails, trying a third
medication is not likely to be beneficial. An alternative
is to combine medication with behavioral therapy and/
or creams.

For use in premature ejaculation, the doses of
antidepressants are usually lower than those
recommended for the treatment of depression.
Though side effects are not inevitable, when they do
occur, the most common side effects of antidepressants
include nausea, dry mouth, drowsiness, erectile
dysfunction and reduced desire for sexual activity.

These drugs can be taken either every day or
only taken before sexual activity. Your doctor will
decide how you should take the medication based
on the frequency of intercourse and the effect that
they produce for you. The best time for taking the
antidepressant medications before sexual activity
has not been established, but most doctors will
recommend from two to six hours depending on the
medication. Because premature ejaculation can recur
when the medication is not taken, you most likely will
need to take it on a continuing basis.

Local anesthetic creams can be used to treat
premature ejaculation. These creams are applied to
the head of the penis about 20 to 30 minutes before
intercourse to lessen the sensitivity. Prior to sexual
intercourse, a condom (if used) may be removed and
the penis washed clean of any remaining cream. A
loss of erection can occur if the anesthetic cream
is left on the penis for a longer period of time than
recommended. Also, the anesthetic cream should not
be left on the exposed penis during vaginal intercourse
since it may cause vaginal numbness.

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