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Erectile Dysfunction (ED)

Premature Ejaculation: Causes and Treatment

Premature ejaculation is the most common male sexual dysfunction affecting men and their partners. Approximately 20-30% of the male population may have symptoms at any one time, but the condition remains largely untreated.

Currently, only 1-12% of males who tell their doctors they have problems with premature ejaculation receive treatment. This is due to a number of factors including:

Premature ejaculation is commonly thought of as a lack of control over ejaculation, but it also includes the resulting:

Treatment

Treatment of premature ejaculation can include medications, exercises done by couples, psychotherapy. For the most effective treatment, coaching, which is a combination of these treatments, seems to be the most effective.

Medication

There is no currently FDA-approved treatment for PE.

Oral Medication-SSRI (Selective Serotonin Reuptake Inhibitor)

Most clinicians commence therapy with an oral SSRI. These drugs can be used on an as-needed basis, taken a few hours before planned sexual activity, or on a daily basis. Most men prefer the daily regimen instead of the as-needed basis because it does not interfere with the spontaneity of sexual activities. Which SSRI to use for PE treatment remains unclear. Dapoxetine has been proposed for FDA approval for PE, but has not been approved by the FDA. It is important to note that the FDA has issued a "black-box" warning for SSRI drugs with respect to suicide.

Topical Creams and Aerosols

Topical anesthetic spray and cream therapy, such as the topical eutectic mixture for premature ejaculation (TEMPE), for PE is under study. Most men who have used these treatments considered the spray and the cream easy to use, while mild to moderate local numbness occurred in some individuals. Topical treatment with TEMPE resulted in better ejaculatory control and improved quality of life. Lidocaine cream and a variety of other agents have been used for PE with limited success.

Therapy

Psychotherapy is an integral part of treating premature ejaculation. Working with a counselor helps couples:

A counselor may address the following topics and help patients with:

Coaching

Coaching combines medical and psychological treatment for premature ejaculation. It is different from psychotherapy alone. It is more directive and involves giving advice, and providing patients with educational materials and techniques. The goals of coaching are:

In addition, as men are taken off medications used to treat premature ejaculation, continued work with a coach may reinforce the progress made and uncover new techniques for continuing improvement.

What You Can Do - Talk to Your Doctor

The most effective way to treat premature ejaculation is under the care of a doctor.

Specialists who treat premature ejaculation include: 

Finding a specialist

It is often difficult to find a specialist in your area who treats premature ejaculation, particularly one who treats both the physical and emotional sides of the problem. For an accredited professional in your area, these sites may help:

What your doctor needs to know

In order to get the best treatment possible, be prepared for the initial appointment. The following is a list of some information that you should know for your appointment that will help your doctor to find your best path of treatment.

Portions of this article were originally reviewed by Allen Seftel, MD, formerly of Case Western Reserve University, and published on NetWellness with permission.

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Last Reviewed: Jul 03, 2010

Stanley E Althof, PhD Stanley E Althof, PhD
Professor of Urology
School of Medicine
Case Western Reserve University

Ahmad  Hamidinia, MD Ahmad Hamidinia, MD
Formerly, Professor of Clinical Surgery
College of Medicine
University of Cincinnati