(PE) or rapid ejaculation is the most common sexual
dysfunction in men. It is also known as rapid ejaculation, premature climax, or
can cause significant distress to a man and his partner
and it is not a condition that has recently been identified, yet, there is
ambiguity in the clinical definition of premature ejaculation. This has made it
difficult for researchers to try out new and effective drugs and for doctors to
effectively identify and treat PE patients.
there is no universally accepted definition of PE as yet, for better diagnosis
and treatment, researchers have divided PE into four categories, namely:
Lifelong PE, •
Acquired PE, •
Natural variable PE, •
Premature-like ejaculatory dysfunction.
categorization, experts feel, will determine the first choice of treatment.
Premature ejaculation treatment
premature ejaculation happens once in a while, you may not require any
treatment. Treatment options include:
one or two hours prior to sexual intercourse to delay
for a period of time to
remove performance pressure and anxiety.
Using behavioral techniques such as squeeze technique
in which the penis
is stimulated to the point of ejaculation; then, squeezing the point in the
penis where the glans meets the shaft and holding it until the urge to
ejaculate passes. This should be followed by releasing the squeeze and
continuing with the foreplay. The process can be repeated as necessary.
such as consulting a
psychologist or psychiatrist to identify emotional disturbance underlying PE or
for strategies to reduce performance anxiety.
- Although the FDA does not
specifically approve of any medications for PE, the following drugs can help
treat premature ejaculation.
- SSRI such as
Prozac, Zoloft, Paxil; and tricyclic anti-depressants such as Anafranil.
Phosphodiesterase inhibitors, such as sildenafil (Viagra
), vardenafil (Levitra), and tadalafil (Cialis). These are used alone or in combination with
Topical anesthetic creams containing
or prilocaine. The
cream is wiped off before the intercourse.
An SSRI, dapoxetine, was developed
specifically to treat this condition. It may be effective when taken one to
three hours before sexual intercourse. Researchers found that it may be
effective at the very first dose itself in some men, whereas daily dose may be
required in others. Its adverse effects are similar to those of other SSRIs.
Dapoxetine (Sustinex) has been approved in a number of countries including India.
Unfortunately, this is
the only drug that has been developed successfully till date.
2009, the International Society for Sexual Medicine (ISSM) convened a select
panel of experts to develop an evidence-based set of guidelines, including
assessments and treatment, for patients suffering from lifelong premature
ejaculation (PE). The panel recognized the continually evolving nature of
clinical research and recommended a subsequent guideline review and revision
every fourth year. In view of that, the ISSM organized a second
multidisciplinary panel of experts in April 2013, which met for two days in
lack of an evidence-based definition for acquired premature ejaculation
promotes errors of classification, resulting in poorly defined study
populations and less reliable and harder-to-interpret data that are difficult
to generalize to patients," said Ege Can Serefoglu, MD, FECSM, of the Bagcilar
Training & Research Hospital, Istanbul, Turkey. Dr. Serefoglu is one of the
experts in the second panel.
The second committee
proposed a unified definition of lifelong and acquired premature ejaculation
that is characterized by:
Ejaculation that always or nearly always occurs prior to or within about 1
minute of vaginal penetration from the first sexual experience (lifelong) or a
clinically significant and bothersome reduction in latency time, often to about
3 minutes or less (acquired);
The inability to delay ejaculation on all or nearly all vaginal penetrations;
Negative personal consequences, such as distress, bother, frustration, and/or
the avoidance of sexual intimacy.
definition of lifelong and acquired premature ejaculation will reduce errors of
diagnosis and classification by providing the clinician with a discriminating
diagnostic tool,' said Dr. Serefoglu. 'It should form the basis for both the
office diagnosis of premature ejaculation and the design of observational and
interventional clinical trials,' he added.
The committee also
conducted and published a study, led by Stanley Althof, PhD, of Case Western
Reserve University School of Medicine in West Palm Beach, Florida, to provide
clearly worded, practical, evidenced-based recommendations for the diagnosis
and treatment of premature ejaculation for family practice clinicians and
sexual medicine experts.