Premature Ejaculation (PE)

WHAT ARE THE SYMPTOMS OF PREMATURE EJACULATION (PE)?

The main symptom of Premature Ejaculation (PE) is not being able to delay ejaculation for more than three minutes after penetration. But premature ejaculation may occur prior to penetration as well. It may also occur during masturbation.

WHAT IS THE CAUSE OF PREMATURE EJACULATION (PE)?

There are many possible causes. It can occur as a result of both psychological problems, and physiological problems. The psychological problems can evolve from a variety of problems including stress, depression, poor body image, and a past history of sexual abuse. There are also a variety of physical reasons that can cause premature ejaculation including irregular hormone levels, irregular levels of brain chemicals, and swelling and infection of the prostate or urethra.

HOW IS PREMATURE EJACULATION (PE) DIAGNOSED?

The diagnosis of premature ejaculation can be made by taking a careful history. More extensive testing (blood test) can be done if the cause of PE is uncertain.

HOW IS PREMATURE EJACUATION (PE) TREATED?

1. Psychological therapy can be tried if a psychological cause is possible.

2. Behavior Modification: For example: practicing holding ejaculation for as long as possible, or masturbating 2 hours prior to having sex with a partner, or using condoms for sex.

3. Medications:

A. Anesthetic creams: benzocaine, lidocaine or prilocaine applied to the penis 10 to 15 minutes before sex [it may be necessary to put a condom over the penis so that your partner sex organ is not also anesthetized.]

B. Anesthetic cream: EMLA a combination of lidocaine and prilocaine.

4. Antidepressants. A side effect of certain antidepressants is delayed orgasm. For this reason, Selective Serotonin Reuptake Inhibitors (SSRIs) are used to treat premature ejaculation.

SSRIs include:
A. Paroxetine (Paxil, Pexeva, Brisdelle)
B. Escitalopram (Lexapro)
C. Citalopram (Celexa)
D. Sertraline (Zoloft)
E. Fluoxetine (Prozac).

5. Pain relievers.
A. Tramadol (Ultram, Conzip, Qdolo). Tramadol is NOT used in combination with an SSRI.

7. Phosphodiesterase-5 inhibitors.
A. Sildenafil (Viagra)
B. Tadalafil (Cialis, Adcirca)
C. Avanafil (Stendra)
D. Vardenafil

CAUTION:

1. All medication, including medication used for premature ejaculation, have a risk of side effects.

2. Possible Severe side effects are a severe skin rash, an anaphylactic allergic reaction (leading to the inability to breathe and subsequent death if not treated rapidly), and Clostridioides difficile infection (C. Diff.) of the colon.

3. Medications such as creams, lotions, and gels should be tested in small dosages in areas of the body that are not easily seen.

Consult “Epocrates.com” for each Specific Medication’s possible “Adverse Reactions.” Side effects are also referred to as “Adverse Reactions.” Epocrates.com will tell you both “common reactions” and “serious reactions.” You will have to create an account, but it is simple, fast, and free.