Premature ejaculation is the commonest form of sexual dysfunction in men. It is an inability to control ejaculation sufficiently to permit both partners to enjoy sexual intercourse. It may result in ejaculation shortly after penetration or, in severe cases, before penetration. Around 20% to 25% of surveyed adult men in modern industrialized nations have reported that premature ejaculation is associated with distress.
Premature ejaculation is commoner in younger men with increasing sexual experience and anxiety plays an important role in hurrying ejaculation in some men.
Treatment of premature ejaculation (PE)
The current European Association of Urology (EAU) guidelines for the management of PE have suggested the use of pharmacotherapy as first-line treatment. This includes either the short-acting dapoxetine or other off-label antidepressants such as daily selective serotonin reuptake inhibitors (SSRIs).
Tramadol and topical local anesthetics might be used as weak alternatives to SSRIs. Phosphodiesterase-5 inhibitors should be used only in men with concomitant ED.
Behavioural therapy should also be used with pharmacotherapy. There are two types of behavioural therapy: psychotherapy and physical techniques.
Psychotherapy uses counselling to identify and correct any interpersonal problems which may be contributing to PE.
Physical therapies includes a variety of exercises to increase slowly the degree of genital stimulation over time, which allows the male to gain control over his ejaculation. This includes ‘stop-start’, ‘squeeze ’, sensate focuses, and pelvic floor muscle rehabilitation.