Treat Premature Ejaculation Quickly and Simply!How can you treat premature ejaculation?How to treat premature ejaculation?Is it hard to find a good treatment for premature ejaculation?
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The issue of treatment is a challenging one,
especially if you're in a relationship where you are stressed by your partner's
dissatisfaction with your sexual performance. On the one hand, you want to get
effective treatment as fast as possible - on the other you certainly need a
treatment methodology which is going to work (which might imply, for example
with a professional sexual therapist, time and money commitments you are
unwilling or unable to make!). Even so some men in this position will search out a sexual therapist for one to one sessions, but the obvious disadvantage of this is that such sessions are potentially not only embarrassing but also expensive - ranging from $100 to $300 per hour. But do you really want to go through the experience of finding a sexual therapist, getting to know them, and then uncovering the most intimate secrets of your sex life in the consulting room? Probably not. It's this which leads me to examine the various treatment methods on hand, so that you can make some kind of informed judgment about what you want to try - and, more importantly, which treatment methods simply don't work, and are a waste of time and money. Broadly speaking, for rapid ejaculators, the treatment methods fall into two main groups: those which involve drugs, hypnosis or herbal potions and those which involve sexual therapy such as training the body to respond more slowly to sexual arousal and giving the man concerned some way to control his rapid progress towards ejaculation. Drugs, hypnosis and other "potions and lotions" in the treatment of premature ejaculationAt the moment, there aren't any oral drugs or topical lotions (to be applied to the penis) which are approved by the drugs licensing agencies such as the FDA in the USA for the management of premature ejaculation. At a conference of The Sexual Medicine Society of North America in June 2005, the various drug therapies which have been recommended by different authorities for the management of premature ejaculation were discussed and the established literature reviewed for information as to which drugs might be useful in the treatment of this condition. The drug group which one reads about extensively in connection with the treatment of PE is of course the SSRI family (selective serotonin reuptake inhibitors) administered for depression and other emotional conditions. Dr Gerald Brock, a prominent Canadian sexual health doctor and renowned urologist has made the observation that prescribing SSRIs for premature ejaculation treatment is now becoming more common in Canada. In the absence of specifically approved treatment methodologies and drugs approved for this purpose, SSRIs such as sertraline and paroxetine are now offered to patients as well as some non-SSRIs such as clomipramine. Many men do not seek treatment for this potentially embarrassing condition, and many others are not offered good treatment when they do.......so are prescription drugs an appropriate therapy anyway? SSRIs do have side effects in the treatment of premature ejaculationDr Brock has observed that SSRIs can be effective, but like many others working in the field points out the side effects. For one thing, they have long half-lives - a measure of how fast the drug decays in the body - and of course they are not designed for the treatment of premature ejaculation. The side-effects can include nausea and fatigue. Much worse, though, these drugs can apparently cause ejaculation failure and even complete impotence. The Annals of Pharmacotherapy has reported that citalopram withdrawal can actually cause premature ejaculation! Clearly, therefore, drug treatment is only part of the answer. Dr Brock states that a three-pronged approach is needed: this is a an important medical issue and needs careful treatment and the men who have it deserve to be taken seriously. This three pronged approach involves education, so any stigma attached to seeking treatment is removed; then the recognition that sexual therapies and psychotherapy can be effective in helping to cure the condition; and finally, the carefully considered administration of SSRI prescriptions, perhaps with psychological therapy. Needless to say the drug companies are working hard in finding a side-effect free drug to treat PE, though as yet they do not seem to have made much progress. Do drugs really help cure premature ejaculation - are they an effective treatment?Yet there are some experts who think drug therapy should be more widely used. An article in Current Opinion in Investigational Drugs called for increased use of SSRI therapy, on the grounds that its overview of these drugs had established that paroxetine was the most effective treatment for PE; they also observed that daily intake gives better ejaculation control (by which we mean delay between penetration and ejaculation) than treatment on an ad hoc basis. (This means of course that the drugs are permanently in the patient's body, which has implications for tolerance and raises concerns about possible side-effects.) A study reported in The Journal of Clinical Psychopharmacology concluded that the time between penetration and ejaculation could be extended from one minute or less to about two minutes in men who had received treatment with paroxetine, fluoxetine, and sertraline. In my opinion, the risks of drug treatment far outweigh the rewards for an improvement of such a short time - especially when more conventional sexual-therapy-based methods can effectively provide complete control. The problem seems to be that we are in a society where the drug treatment of PE potentially rewards the drug companies with massive profits and the patients with little effort. UroToday.com defines PE, quite correctly, as the
recurrent approach of orgasm and ejaculation with little or no sexual
stimulation, shortly before or after penetration and certainly before
the sexual partners wish for it to happen. The journal then observes
that while the established view is that PE is a psychological condition,
recent opinion suggests that disturbances of serotonergic
5-hydroxytrptamine (5-HT) neurotransmission might be a causative factor
- and hence drug therapies which target the 5-HT system might be an
effective treatment. Francisco Giuliano has studied the efficiency of
dapoxetine in the treatment of premature ejaculation and published his
results in the July 2007 European Urology Supplements. The studies which demonstrated the potential effectiveness of dapoxetine involved over 2600 men who were given between 30 and 60 mg of dapoxetine between one and three hours before sex. The average age of the men taking part in the drug treatment trial was forty years - surprisingly old, for I have always had the impression that men lose their tendency to premature ejaculation as they get older. It would therefore seem likely that these men were suffering from both long-standing and sever premature ejaculation. Indeed, almost two-thirds of the men reported life-long problems with premature ejaculation, and about a third of the men has developed premature ejaculation after a period of normal sexual relationships (i.e. satisfactory vaginal intercourse). The researchers measured the time between intromission and ejaculation and found that although a placebo did lead to an increase in the length of intercourse, it was nowhere near as significant as the increased length of intercourse with dapoxetine. At 30 mg dosage, intercourse increased from an average of 0.92 minutes to 2.78minutes. With 60 mg of dapoxetine, it increased from an average of 0.92 minutes to 3.32 minutes. This improvement was maintained over the twelve weeks of the study. Of course, the issue of side-effects always comes up: but the Dapoxetine produced relatively few side-effects, which included nausea and headache. Nausea occurred in 8.7% of men given 30 mg and 20.1% of men given 60 mg. Headaches occurred in 5.9% of the men given 30 mg and 6.8% of the men given 60 mg. Unfortunately 4% of men taking the lower dose had sufficiently severe effects to require the cessation of treatment, as did 10% of men given the higher dose. These are rather high figures for a drug which only produces a relatively short increase in vaginal intercourse duration. Giuliano F Eur Urol Supp. 6(13):780-6, July 2007 A drug developed for treatment of premature ejaculationThe New Scientist has reported the outcome of this study of the effectiveness of dapoxetine treatment on nearly 2000 men who were diagnosed with either moderate or sever premature ejaculation. Before taking the drug, these men had an average time before ejaculation of less than one minute after penetration. Again, they were given either a placebo "treatment" or 30 or 60 mg of dapoxetine, which was taken between one and three hours before intercourse. After twelve weeks of taking the drug treatment, the average time before ejaculation had gone up from less than a minute to 2.8 minutes for the lower dose and 3.3 minutes for the higher dose. Even better, the authors of the study suggested that the men's subjective view of how well they could control their ejaculation and how satisfied they were with sex had improved markedly, as had their partner's level of satisfaction. No license for drug treatment of premature ejaculationDapoxetine was developed for the treatment of premature ejaculation, but although the researchers have claimed it to be safe and effective, the FDA has not given it a license. The side effects include nausea, diarrhea, headaches and dizziness. And the other problem is this: according to Marcel Waldinger, a neuropsychiatrist at Leyenburg Hospital in The Hague, existing SSRIs have already found a place in the treatment regime for premature ejaculation, and work with greater efficiency. He says that the best way to treat premature ejaculation is by continual use of existing SSRIs. he observes that these drugs produce an increase in time between intromission and ejaculation of about nine times, while dapoxetine only increases the time by a factor of three. According to Waldinger, one also has to ask about the motives of the drug companies in developing a drug specifically to treat PE. Waldinger has studied the time that men last between penetration and ejaculation on average: his findings make interesting reading. The study was carried out in 2005 and he discovered that - in the general population - not just among men seeking treatment or cure for premature ejaculation - the average length of intercourse was just 5.4 minutes in The Netherlands, the UK, the US and Spain. In Turkey the average tie to ejaculation was 3.7 minutes. So where does this leave us? Men who identify as having premature ejaculation, and who seek treatment for it, may actually be in the normal range of sexual activity for men in their general population. This does not mean that treatment should be denied, for as we have seen, the definition of premature ejaculation these days is tailored specifically to include a factor of the man's subjective satisfaction (or lack thereof) with his sexual performance. But the danger is that the drug companies create a pathology out of a normal condition so that they can sell drugs to deal with it. And most men will sometimes experience a rapid ejaculation - it is normal. This of course brings back into play the difficulty of definition: PE has been described as the most common male sexual problem, affecting between a fifth and a third of all men. But what does that mean, if it is so common? Isn't it then a "normal" condition? Waldinger concludes by observing that he believes only men who have experienced lifelong PE should receive drugs. As he (in my opinion correctly) observes, lifelong PE is a much rarer problem, and probably only affects 1% to 5% of men. New Scientist 8 September 2006 and The Lancet (volume 368, p 929) More scientific reviews of drug treatment of premature ejaculationWhat follows is a summary of treatment of premature ejaculation adapted from Medscape. SSRIs have been administered to increase ejaculatory delay; because they are associated with inability to ejaculate and erectile dysfunction. Unfortunately, continual administration of SSRIs is linked to dry mouth, nausea, drowsiness, and reduced libido. Dapoxetine hydrochloride (DPX) has been studied and indeed has undergone Phase III trials. DPX is a serotonin transport inhibitor (STI) which has a pharmokinetic profile suitable for "on-demand" usage in the treatment of PE. Unlike other oral agents, DPX works quickly and is effective from the first dose. [Editor: as previously mentioned, FDA approval has not yet been forthcoming.] The worst side-effects of SSRIs is that they not only cause decreased libido but they can cause erectile dysfunction. Another category of drugs which have been studied as possible candidates for the management of premature ejaculation are Phosphodiesterase-5 (PDE-5) inhibitors. The somewhat tenuous connection with premature ejaculation is their ability to prolong erections. It's been established that PDE-5 inhibitors are useful in the treatment of men who have premature ejaculation secondary to erectile dysfunction, and that they can be used in association with other drugs such as SSRIs. Anesthetic substances which can be administered to the surface of the penis have been tested in the treatment of premature ejaculation. [Editor: though some studies have shown an increase in ejaculatory delay times, evidence from my own experience with men who have premature ejaculation is that these creams, whether administered to the surface of the penis or contained in a condom, do not have much impact on premature ejaculation, but they do remove sensation, thereby making sex even less satisfactory for both partners.] Clomipramine: at 25 - 50 mg per day increases sexual latency from 1 minute to 3 to 6 minutes Fluoxeline: at 5 - 60 mg per day increases sexual latency from 1 minute to 2 to 9 minutes Paroxeline: at 20 - 40 mg increases sexual latency from 1 minute to 3 to 10 minutes Sertraline: at 25 - 100 mg increases sexual latency from 1 minute to 3 to 6 minutes The higher the dose, the longer the ejaculatory delay. But at high does, there are unpleasant psychotropic side-effects. These drugs stay in the body for a long time, and they cannot be given on-demand. As soon as the drugs are reduced, the premature ejaculation returns. The summary of this treatment regime, therefore, is that it is "woefully inadequate". Obviously the ideal drug for the treatment of premature ejaculation is going to interfere with the signal from the brain to the penis in a way that allows on-demand treatment (i.e. you take it just before sex), be fast-acting with a short half-life, and deal with the specific serotonin receptors that deal with ejaculation. It's worth making the observation at this point that the behavioral therapies are effective but they do require a co-operative partner. The simple fact is that premature ejaculation is underdiagnosed and undertreated. None of the current drug treatments are FDA-approved.
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