Premature ejaculation is a relatively common phenomenon with some estimates showing that up to 35% of all men are affected by it. The main challenge when helping patients suffering from PE is defining the problem (How soon is too soon?) and setting realistic milestones in the treatment (No one is meant to last for hours).
How do we define Premature Ejaculation? How fast is too fast?
Sexual intercourse is an intimate affair, hence I find that asking a patient how many minutes they can sustain the intercourse to be a very awkward question. Most of us do not set a timer for every activity let alone those of the bedroom. This is the primary reason why international guidelines have moved away from defining PE just on how long someone can sustain intercourse. The current guidelines define PE as:
- Time elapsed between penetration to ejaculation is LESS than 1 minute
- Unable to delay ejaculation on all or nearly all penetrations – loss of control over the ejaculation
- Negative emotional distress suffered by patient and or partner due to the condition
So what is normal?
I usually start my consultations by presenting key statistics about PE from international studies to my patients as I find it helps to reassure them by demonstrating what is normal. With the prevalence of adult films, some patients can have rather unrealistic expectations – much like how just by watching John Wick take down 20 evil henchmen in a movie does not make you a champion martial artist, basing your timing on adult film actors can be equally unrealistic.
So let’s talk numbers:
- Average duration of intercourse – 4 -7 minutes
- Average number of penile thrusts before ejaculation – 8 – 15
- Average amount of time penis spends in partner – 5.4 minutes
Once we have established that there is premature ejaculation, the next time is to determine if there is any underlying cause for the condition.
What causes Premature Ejaculation?
- Erectile Dysfunction (ED)
Ejaculation is considered a reflex, like how you close your eyes automatically when a fast moving object approaches your face. There is a complex interaction of neurotransmitters and nerves that regulate this reflex. Any condition that affects the nerves involved in this interact can damage this reflex.
The most common condition that is found in cases of PE is ED. Many times, men find that they are unable to sustain the erection and hence the ejaulatory reflex is activated too early. Like a truck that moving a heavy load up a steep hill, if the truck does not have enough power, it will be forced to release its load. Similarly, if your erections are not strong enough to sustain the sexual intercourse, ejaculation will come about once the erection is lost. So treating the ED with medications, ESWT or PRP injections will also improve the PE.
There are also what I like to call “structural” issues that lead to the nerves in the area not being effective players in the ejaculatory reflex.
- Tight Foreskin
The foreskin is an important component in providing sexual pleasure during intercourse by gliding over the head of the penis. However, if the foreskin is too tight (phimosis) then that can lead pain during sexual intercourse. If you are in pain during intercourse is it more likely that the ejaculation reflex will be initiated as your body tries to prevent further pain.
- Tight Frenulum
There are also instances when the foreskin glides well but the frenulum (the piece of skin that anchors the foreskin to the penis) is too tight. This can likewise cause pain during intercourse leading to early ejaculation.
There are simple procedure a doctor is able to perform for you to solve these structural issues. I discuss them more in my other blog post on Frenulectomy and Circumcsion.
What else can be done? – Medicines for Premature Ejaculation
There is only one medicine that is specifically designed to treat Premature Ejaculation. This medicine is called Priligy and its active ingredient is Dapoxetine. It belongs to a class of medicines known as Selective Serotonin Re-Uptake Inhibitors or SSRIs for short. Most Doctors will start their patients at 30mg however, the dose can be increased to 60mg. Priligy is directed at enhancing the response of the neurotransmitters involved in ejaculation. Priligy is used as an “on demand”. That means it is not taken regularly and only taken before sexual intercourse. Although the medicine is supposed to take effect in as fast as 30 minutes, I advise my patients to wait 1 to 4 hours. The closer to 4 hours they get, the better the medicine works. It is also important that you take it on an empty stomach. Because the effect of this medication increases the more you use it (what is called a cumulative effect), I advise my patients to try at least 6 doses before deciding if it works for them.
There are no other medicines specifically designed to treat Premature Ejaculation. However, some Doctors prescribe medicines that are used to treat something else but are also known to help with Premature Ejaculation (known commonly as off-label prescribing).
One example is Lexapro (Escitalopram). This medicine falls into the same class of medicines as Priligy (i.e. SSRIs). Lexapro is used to treat depression and anxiety. But it also helps patients who suffer from Premature Ejaculation prolong their ejaculation time. Instead of taking only when required like Priligy, Lexapro is instead taken daily. Other SSRIs have also been used off-label to treat premature ejaculation.
Another example is Tramadol. Tramadol is a commonly prescribed opiod painkiller. However, it is also know to help people with Premature Ejaculation. It is taken on-demand like Priligy.
All 3 of these medicines can cause nausea as a side effect.
In Conclusion.....
In conclusion, PE is a rather common issue but one that can be very difficult to define.Therefore is first most important that your doctor works with you to accurately diagnose and guage the severity of your condition. This will allow for a more targeted approach in the treatment and longer lasting results.
Have a question on Premature Ejaculation? Put it in the comments section below and I’ll get back to you soon as I can.