BOOK AN APPOINTMENT
The initial consultation will last for about two hours in order to properly diagnose the condition and formulate a treatment recommendation.
WHAT IS PREMATURE EJACULATION
Premature ejaculation occurs when a man ejaculates sooner during sexual intercourse than he or his partner would like. Premature ejaculation is a common sexual complaint. Estimates vary, but as many as 1 out of 3 men say they experience this problem at some time. As long as it happens infrequently, it’s not cause for concern.
Most men with this problem won’t have always had it – they’ll have previously ejaculated normally. This may be referred to as ‘secondary’ premature ejaculation.
It’s less common for the man to have always experienced premature ejaculation (since becoming sexually active) – this is known as ‘primary’ or lifelong premature ejaculation. It affects around one in 50 men in England. In most cases of lifelong premature ejaculation:
there is an inability to delay ejaculation during sex every time or most times.
the condition causes feelings of shame or frustration and impacts on quality of life, causing the man to avoid sexual intimacy.
CAUSES OF PREMATURE EJACULATION
Premature Ejaculation is usually caused by a combination of an oversensitive glans penis (or head of the penis), and nervousness or performance anxiety during lovemaking. Fear of not being able to satisfy a sexual partner, which is common, often stems from previous experiences of premature ejaculation.
The potential causes of PE include:
Hormonal imbalances Thyroid issues Neurotransmitter abnormalities Abnormal reflex activity of the ejaculatory system
Inflammation and infection of the prostate or urethra Genetic abnormalities
WHAT ARE THE TREATMENT OPTIONS
Intracavernous Pharmacotherapy (ICP)
ICP involves painless injection of a small amount of a pre-determined combination of vasodilators into the spongy tissue of the penis, using an auto-applicator. The vasodilators, each of which is FDA-approved, are known as papaverine, phentolamine, atropine and prostaglandine E1. The induced erection will occur within several minutes of application and feels perfectly natural. The only difference is that it will not go down immediately after ejaculation.
The prescribed combination is individually formulated to allow the erection to last approximately 30-60 minutes, regardless of the man’s state of mind or the occurrence of ejaculation.
Antidepressant medicines are sometimes used to treat premature ejaculation. These medicines include clomipramine (Anafranil) and dapoxetine (Priligy). They are used because one of their side effects is inhibited orgasm, which helps delay ejaculation. Tramadol (Ultram) is a medicine that has been used for many years to control pain. It can be used to delay ejaculation.
There are also creams, gels, and a spray that may be used to treat premature ejaculation by reducing sensation. These medicines are applied to the penis before sex. They include lidocaine and lidocaine-prilocaine. But some of these medicines can also affect a man’s sex partner by reducing sensation for the partner.
Anesthetic Gel, Spray or Cream
The use of local anesthetic products (like lidocaine, prilocaine and combination) has been widely marketed. The goal is to numb the head of the penis and reduce the penile sensation, thereby reducing the likelihood of uncontrolled ejaculation. This option attempts to address the hypersensitivity aspect of Premature Ejaculation.
In practice, the effect is minimal, inconsistent and temporary at best, because the use of anesthetic fails to address the psychological or the habitual aspect of Premature Ejaculation.Furthermore, numbing the penis does not allow one to get used to the real sensation of lovemaking. It would be virtually impossible for a man to learn to control his ejaculation if he was not aware of the real sensation. The use of local anesthetic is further limited by its own anesthetic effect, which reduces the sensation on the penis and vagina, detracting from the pleasure for both partners.
Start & Stop Technique, Squeeze Technique
The “Start and Stop” technique essentially involves trying to retard ejaculation by either withdrawing the penis or stopping the motion just before the “point of no return”. The “squeeze” technique involves having the partner squeeze the head of the penis, again just before the “point of no return”.
These techniques require consistency, patience and unwavering support from the partner. Once ejaculation occurs, prematurely as it often would during the initial phase of the practice, the erection is lost, making it impossible to continue. The initial failure can be embarrassing to the man and discouraging to his partner. These techniques however can be effective with proper guidance from a qualified Sex Therapist. They seem to have limited success otherwise.
Central Nervous System (CNS)
The most commonly used CNS suppressants are Selective Serotonin Reuptake Inhibitors (SSRIs) such as sertraline, paroxetine, fluoxetine. The main purpose of these drugs is to restore a neurotransmitter imbalance in the brain involving serotonin level. A byproduct of these drugs is an inhibitory effect on ejaculation.
These drugs are not indicated for the treatment of premature ejaculation, although they are occasionally employed as off-label use. Chronic therapy is required; but its usefulness is limited by a number of neuropsychiatric side effects such as nausea, dry mouth, dry eyes, drowsiness, reduced libido and Erectile Dysfunction. Isolated cases of more serious complications, such as mania and withdrawal symptoms, and potential drug interactions also have been associated with the use of SSRIs. Opioids and cocaine are known to delay male orgasm. They are obviously not intended for use for this purpose.
APPOINTMENT STEPS
DIAGNOSIS & EVALUATION
The process begins with a thorough evaluation of your medical history, and may include up to 3-4 diagnostics tests, including blood work, blood flow and nerve supply analysis.
TREATMENT RECOMMENDATION
Erectile dysfunction may cause or exacerbate psychological problems such as poor motivation, feelings of inadequacy, frustration, denial and low self-esteem, and may ultimately lead to depression.
