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Premature Ejaculation

 

International Andrology Treatment Protocol

Our Premature Ejaculation treatment processes are based on the latest medical research, medical guidelines and our extensive clinical experience and we expect that a majority of our patients will improve their ejaculation time.

Many doctors specialising in sexual dysfunction, find treating premature ejaculation challenging because there is no one specific treatment that can help all patients given the fact that the underlying mechanism for premature ejaculation has not been clearly established and that psychological factors play a large role.

For this reason, our treatment plan is personalised and multi-optional and the plan will typically consist of a combination of the following:

  1. Counselling & education

Patients suffering from premature ejaculation must be aware of key facts regarding their condition and in the cases of subjective and variable premature ejaculation, counselling and education are important elements in this treatment. For example, it is important that patients understand the following:

  • While 20%-30% of men complain of premature ejaculation based on an IELT of less than 2 min, the prevalence of pathological premature ejaculation is unlikely to exceed 5% of the general population
  • Average IELT is 5.4 min
  • IELT decreases with age
  • There are different types of premature ejaculation
    with different causes and treatment plans
  1. Treatment and control of risk factors in secondary acquired premature ejaculation

In patients with a clear diagnosis of secondary premature ejaculation, addressing the identified risk factors, such as erectile dysfunction, should be the first line of treatment.

  1. Behavioural Therapy:

There are various techniques that can be used to increase the ejaculatory control and improve ejaculation time including the Start –Stop-Squeeze Technique (with or without the assistance of a Medical Vibrator).

Patients can practice these techniques before sexual intercourse with the guidance of their doctor. This type of therapy is more likely to benefit patients suffering from secondary, variable and subjective premature ejaculation.

  1. Local anaesthetics

One of the prevailing theories for the underlying causes of premature ejaculation is genital over-sensitivity and applying local anaesthetics on the penis glans, will help some patients. These include:

  • Creams
  • Sprays
  • Condoms with local anaesthetic

Appropriate use of the local anaesthetics is important so as to achieve optimum dosage and avoid complete numbing of the penis or of the partner’s genitals. Moreover, these should be avoided if the partner is pregnant.

  1. Oral Therapy
  • Priligy (Dapoxitine)

Priligy (aka Dapoxitine) has been especially developed for treating premature ejaculation and is the first stage of treatment for most premature ejaculation patients. Although it is an S SRI, the advantages of dapoxitine is that it works quickly and has a shorter duration of effect (1.5 hours) meaning that patients are unlikely to suffer from severe side-effects that other SSRIs can create and can also be taken shortly before sexual intercourse (1-2 hours).

  • Anti-depressant medication – SSRI inhibitors

Several antidepressants known to cause delayed ejaculation have been evaluated for the management of premature ejaculation. These antidepressants include Fluoxetine, Paroxetine, and Sertraline – and the tricyclic antidepressant Clomipramine. Clinical studies indicate that paroxetine causes the most delay in IELT (8.8 fold) followed by Escitalopram (4.9 fold), Sertraline (4.1 fold) and Fluoxetine (3.9 fold). An important element in using SSRI inhibitors is the dosing and whether these are taken on demand (i.e. before sexual intercourse) or on a daily basis.

On demand dosing avoids the side effects of daily intake that anti-depressants have and this is an important element that needs to be discussed with your doctor when determining your treatment plan. In general, on demand dosing of SSRIs is less effective and the medication needs to be taken 4-6 hours before intercourse. In case of daily dosing it must be remembered that the maximum effect of the medication will be after 2-3 weeks.

For this reason we usually prescribe to patients that SSRIs treatment beginning with daily dosing over 4-6 weeks and then gradually move to on-demand dosing.

  • Uro-selective Alpha blockers

There is some evidence that daily dosing of Alpha blockers (such as Tamusolosin and Silodosin), used typically to treat LUTS, can improve premature ejaculation times. This type of medication is usually only prescribed to patients that do not benefit from Dapoxitine, SSRIs or other treatment modalities or patients that are also suffer from LUTS.

  • PDE5i’s

For patients suffering from premature ejaculation secondary to erectile dysfunction, then PDE5’s are likely to help with both. If after erectile dysfunction treatment, your premature ejaculation symptoms do not improve then PDE5’s (or other premature ejaculation treatment) would need to be combined with other premature ejaculation treatment options.

  1. Intra-cavernosal Injection Therapy

A majority of men after ejaculation will rapidly lose their erection. For premature ejaculation patients and their partners this can be very frustrating as it prevents them from enjoying extended penetrative intercourse. In very severe cases of premature ejaculation, such as ante-portal ejaculation, when other treatments have failed, injection therapy with Alpostadil or similar erection inducing injections can help patients maintain their erection even after ejaculation and resume intercourse.

This treatment option is unlikely to be pleasurable for patients themselves but might improve a partner’s sexual satisfaction and in some cases, help patients to better control their ejaculation.

  1. Combination Therapy

Many premature ejaculation
patients will not respond to an isolated treatment modality and combination therapy will be required. Example of combination therapies include:

  • Behavioural therapy + pharmacotherapy
  • Topical therapy + SSRI
  • Daily SSRI followed by on demand SSRI
  • PDE5i + Topical therapy
  • PDE5i + SSRI
  1. Surgery

For patients suffering from premature ejaculation secondary to a genital issue such as tight Frenulum, Phimosis or Balanoposthitis then surgical correction of the genital issue might improve their ejaculation time.

Other treatment options are being researched

If all the above treatment options fail to improve ejaculation time and this issue still causes significant distress to you, there are more invasive and less proven treatment options that can be considered. These include:

  • Hyaluronic Acid Glans Augmentation
  • Neuromodulation of the dorsal penile nerves
  • Dorsal nerve neurotomy
  • Tramadol oral medication

None of these treatment options are offered routinely and only after extensive consultation with patients will they be considered as they may be more invasive or lead to more severe side-effects.

I am suffering from Premature Ejaculation, what should I do next?

If you are suffering from premature ejaculation then we advise you to book a consultation with one of our highly experienced doctors. The first step to successful treatment is a correct diagnosis of the underlying causes of premature ejaculation by your doctor.
Beyond that, our doctors will seek to do two things:

  • Design the best therapy plan that will allow you to immediately improve your ejaculation time so as to continue normal sexual activities;
  • Design a treatment procedure that will address the underlying causes of your issue.

Our doctor’s experience, treating over 10,000 PE patients, allows us to create highly personalised plans to help you.

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