Premature ejaculation is very common, affecting up to 30% of men. Often, due to perceptions of shame and low self-esteem, men (and their partners) suffer in silence, and the stress of this only compounds the problem.
Unfortunately, there’s a lot of pushy and unscrupulous advertising for unproven and expensive medical treatments out there. What is the truth?
Premature ejaculation often has a strong psychological component. Sometimes there’s a genetic predisposition, and some medical conditions can contribute, although this is rare. Often, men also suffer from erectile dysfunction. This might be because then men might want to ejaculate early before the loss of the erection.
How do we manage these problems as a GP?
Firstly, do not feel at all ashamed or shy about bringing it up with your doctor. That’s easy to say, but genuinely we are used to discussing these problems and have no issue with it. We’re used to managing all sorts of problems which are embarrassing to our patients, but just part of the job for us. You’ll find once you’ve broached the subject the stress levels come down straight away as you realise things can be done to help, and you find your doctor listens and takes you seriously. If by any chance you don’t get that vibe, seriously think about getting another opinion – don’t give up!
What treatments are available?
Psychological counselling is often recommended if there are underlying stress, relationship or emotional issues to tackle.
Behavioural therapy can involve techniques such as pre-coital masturbation, “stop-start” or “squeeze” techniques. Your GP can refer you to psychologists with this expertise.
Local anaesthetic creams and sprays can be used on the penis; a condom needs to be used to prevent numbness for the female.
Several antidepressant in the SSRI class have the side effect of delayed ejaculation. Therefore they can be useful to treat ED. They do take some time to work and can have some side effects. Dapoxetine (“Priligy”) is a new SSRI which has been licensed specifically for the treatment of PE. It works much more quickly, needing to be taken 30 mins before intercourse. Side effects appear quite minimal.
Tramadol is a strong painkiller that seems to be quite effective. It has a risk of addiction so is not used first-line. It can also interact with other medications.
Viagra, Cialis, Levitra:
These drugs are used if there is concomittant Erectile Dysfunction – they are not effective for PE alone. They can be used in combination with SSRI’s.
In the end, the most succesul treatment is likely to be that which involves both partners, and may use a combination of psychological, behavioural and medication approaches. But we very often find that once a treatment has worked, the pressure comes off, and the problem tends to resolve itself. If you have concerns about PE or ED come in and discuss it with us – we would love to help.