What is premature ejaculation?

Some studies have shown that 30 out of every 100 men feel that they are ejaculating too rapidly.

Men with premature ejaculation find that their ejaculations always or nearly always occur too rapidly within a minute or so of vaginal penetration. They have difficulty delaying this ejaculation in most instances of vaginal penetration. This causes them and their partners significant distress and frustration. It can then lead to avoidance of sexual intimacy.

What are the criteria used to define premature ejaculation?

If couples define sex as the time period between penetration and ejaculation (also known as the latency period), then it might last just a few minutes when there is an issue of premature ejaculation.

But if they include foreplay and other sexual activities such as massage and oral sex etc, the experience can last for a much longer period.

If the individuals are satisfied with the duration of vaginal penetrative sex, even if it lasts for just over a few minutes, then the couple does not have an issue as they are both satisfied with that duration of penetrative sex and it does not cause them distress or frustration.

However, in a couple setting where penetrative vaginal sex mostly occurs under a few minutes (eg 2-3 mins), and one or both partners are unsatisfied, bothered and negatively affected by this, then this can be classified as premature ejaculation.

It is helpful to have realistic expectations – typically, the normal time to ejaculation is between 5 to 7 mins.

What causes premature ejaculation?

Premature ejaculation can be classified as acquired or lifelong.

Men can acquire the condition at some point in their life, such as after a significant event or change.

It can also be a lifelong issue, where they struggle with having very short duration of vaginal penetrative sex from the first time they engage in penile-vaginal sex.

What are the treatment options?

Once a diagnosis is made, premature ejaculation is usually treated with behavioural therapy, medication, or a combination of both.

Behavioural therapy

There is increasing data showing that behavioural therapy can be more effective than medication to manage premature ejaculation. Behavioural psychotherapy is a longer term commitment to resolve this problem. Many men, however, are looking for a quicker strategy to fix premature ejaculation – for example, for that night they are going to have sexual intercourse. In these cases, medication and creams can allow for an interim solution to premature ejaculation.

Medication

There are two types of medications that are commonly prescribed to treat premature ejaculation:

Oral drugs

Dapoxetine, now commonly branded as Priligy, was actually initially manufactured to be an antidepressant. By pure serendipity, it was discovered to have the ability to elongate the duration of vaginal penetrative sex. Men with premature ejaculation can now use this medication 1 to 3 hours before intended sexual intercourse on an on-demand basis to allow them to enjoy a longer, more satisfactory time at vaginal penetrative sex.

Tramadol, a commonly used painkiller, is another medication that is gaining more traction and evidence in treating premature ejaculation. It is however an “off label” – meaning this drug has not formally been approved for use for premature ejaculation. We still need more information on the safety with long-term use of tramadol and the most effective dose required to manage premature ejaculation.

Topical anaesthetics

Numbing creams are another way to treat premature ejaculation on an on-demand basis. These topical anaesthetic creams can be applied to the head of the penis approximately an hour before sex. This reduces the sensitivity to touch stimulus such that it does not create a rapid arousal response that causes ejaculation to happen undesirably early.

Do drugs like Viagra help to manage premature ejaculation?

Yes! Common drugs for erectile dysfunction like Cialis, Viagra and Levitra can actually alleviate some of the problems with premature ejaculation. As these drugs provide men with stronger vigour of erection, they also reduce what many men call ”performance anxiety”. Since anxiety is often a concern for men with premature ejaculation, a man using drugs like Viagra, Cialis and Levitra then find that not only are their erections stronger, they may also ‘last longer’.