Treating Premature Ejaculation
What types of treatment are available for PE?
- Physical & Psychological Treatment
What kind of doctor takes care of PE?
Many different types of specialists are interested in sexual medicine and PE. The first resource would be the members of this society as they are all committed to excellence in sexual medicine and have a significant part of their practices devoted to this area. But if not possible, generally a urologist or a mental health professional (sex therapist, psychologist, psychiatrist) would be the primary specialists to go to for the treatment of PE.
Remember that psychologists cannot prescribe medications, so if a patient is interested in trying an SSRI medication, a physician will have to be further consulted (urologist, psychiatrist or even a family physician). Of note, the average family physician may not be familiar with the treatment of PE, but simply asking him/her is a good way to find this out. If he/she is not comfortable with the treatment of PE, then they can refer you to the local expert.
What medications are currently available for PE?
There are no FDA approved medications indicated for the treatment of PE, although, there currently are a number of treatments types used to manage PE.
The risks and benefits of all of the below treatment options should be discussed between the caregiver and the patient, as patient and partner satisfaction is the primary goal in the treatment of PE.
1. Desensitization treatments: these are aimed at reducing the sensitivity of the penis immediately before sexual relations. It is noteworthy to mention that there is no evidence that men with PE have any difference in penis sensitivity than men without PE. Although these techniques work for some men with mild PE, they can cause a reduction in sensitivity so that sexual satisfaction during intimacy is also reduced. Little research has been done on these techniques and their true benefit. Techniques that are employed by some men include:
A. Using condoms: the use of a single condom may reduce sensitivity enough to make a difference in ejaculatory control for some men. Using multiple condoms, however, reduces sensitivity, potentially to the point where the sensation during relations is less than satisfactory for men.
B. Using desensitization ointments: local anesthetics like lidocaine/prilocaine creams can be applied to the undersurface of the head of the penis (the glans) 30 minutes before sex. Desensitization ointments are best applied and then washed off 5-10 minutes before sexual relations, otherwise they will cause a numbing effect for the partner also. Some men use these creams underneath a condom.
C. Masturbating prior to intercourse: many men with PE, even those with primary (life-long) PE, have much better ejaculatory control if they have sexual relations a second time within a short period of time after the initial encounter. Some men use masturbation in the hours before anticipated intimacy as a means to improve ejaculatory control.
2. Non-FDA approved treatment options: a number of over-the-counter and prescription 'medications' have been used for PE:
A. Herbal therapies: there are currently no studies that show the effectiveness of herbal products (also known as nutriceuticals). Many of these products contain androgens (testosterone, DHEA and androstenedione) that may be inappropriate for some men to use. Furthermore, some herbal products used for male sexual health contain Viagra and Cialis, which is of concern to men taking nitroglycerin-containing medications, since taking these together can be deadly
B. PDE-5 inhibitors: medications such as Viagra®, Levitra® and Cialis® have been used by some men for PE. Studies suggest that they may help some men suffering from PE. Scientists are not sure why these medications would work in men with PE. However, it is generally believed that these medications can help men with PE who also have ED.
C. Antidepressant medications: Antidepressants have been used for the treatment of PE. Prozac®, Paxil® and Zoloft® have been used with some success for this condition. Although no antidepressants have been specifically used to treat PE, several weeks of treatment with some of these medications has been shown to help many men with PE. Several weeks of treatment is required for these medications to work. The drawbacks of these medications include the need for daily use (when men stop using them they return to having rapid ejaculation), the stigma that they are anti-depressant drugs (for example, airline pilots are not permitted to take these medications and fly) and side effects (drowsiness, nausea, dizziness, dry mouth and a range of sexual problems, such as decreased or increased sexual interest, ejaculation or orgasm problems, and impotence).
What types of psychological treatments are available?
Distraction techniques: distracting mental exercises during sex can be used to help PE (such as thinking of mundane things like baseball, work, etc.). These techniques are probably most useful for men with occasional PE or men who experience PE in the initial stages of a new sexual relationship. For men with long-standing PE, the consistent use of these techniques usually interferes with spontaneity and satisfaction.
Psychological Therapy: these treatments have been utilized for decades and are associated with success in many people. However, it is questionable for how long these treatments work. For example, for a man who has derived benefit from the techniques described, how long-lasting are the beneficial effects? It is estimated that 25% of men helped by such techniques retain the benefit for 2 years after starting the treatments.
PE can be both due to, and the cause of, psychological stress or other mental health and personal issues. Psychological treatments often involve counseling or sexual therapy that can include talking about relationships and experiences with a mental health professional and/or learning practical tools. By investigating relationships and individual issues that may be causing or compounding PE, mental health professionals can help find effective ways of coping with and solving problems that may be causing PE. For many couples affected by PE, working with a therapist together may produce the best results.
Some psychological therapies also focus on helping the individual find ways in which they can control ejaculation. Healthcare practitioners may provide instruction about distraction techniques, and "stop-start" and "squeeze" techniques that allow the patient to develop a sense of ejaculatory control.
The stop-start method works to help the individual identify ways of controlling their sexual stimulation and ejaculatory response. This method requires the man to engage in sexual stimulation, either with or without his partner, until he realizes that he is about to ejaculate. At this point he stops for about thirty seconds, reducing his urge to ejaculate, and then begins the sexual stimulation again. These steps are repeated until ejaculation is desired. In the final step of the sequence, stimulation is continued until a climax is achieved.
The squeeze method also involves sexual stimulation until just prior to the "point of no return". Once the man senses that he is about to ejaculate, his partner stops sexual stimulation and gently squeezes the tip or the base of the penis for several seconds. Further stimulation is withheld for 30 seconds and then resumed. The couple may choose to repeat the sequence as many times as they like, or continue stimulation until ejaculation is desired. These exercises have little benefit if conducted by the man himself and require the participation of partner.
How do I find a psychologist experienced in treating PE?
Talking with a primary care provider is a good place to start. He/she will be able to recommend psychologists experienced in treating PE. There are all kinds of psychologists, so seeing a sex psychologist (as opposed to an addiction, family therapy or depression specialist) is recommended. You can also use resources such as this website, AASECT (www.aasect.org) and SSTAR (www.sstarnet.org) to help find a sex psychologist near you.
Is psychological treatment for PE covered by insurance?
Treatment coverage by healthcare insurance varies from one insurance provider to the next, as well as from one plan to the next. It is best to contact the individual provider in order to determine if, and which, psychological treatments for PE are covered by insurance.
New medications are being developed to treat PE. The first is a quick acting drug taken one to four hours before sex, called Dapoxetine. In trials, Dapoxetine has been shown to effectively treat men with PE. The difference between this drug and SSRI medications is that it does not need to be taken every day and is not prescribed for depression. Dapoxetine is currently being reviewed by the FDA.