Premature ejaculation (PE), otherwise called rapid ejaculation or early ejaculation, is a common sexual issue that affects 20-30% of males. Among the men affected by this PE issue, nearly 10-20% of men complain of ejaculation within 1-2 minutes that has been lifelong. This article aims to discuss various treatment options for lifelong premature ejaculation. Before getting into this topic, let us first explain the significance of lifelong premature ejaculation.
According to the International Society for Sexual Medicine (ISSM) definition, lifelong Premature Ejaculation (PE) is defined as “a male sexual dysfunction characterized by ejaculation that always or nearly always occurs prior to or within about 1 minute of vaginal penetration and the inability to delay ejaculation on all or nearly all vaginal penetrations, which results in negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intimacy.”
Lifelong PE is one of the types of premature ejaculation that occurs all the time since your first sexual encounter. Psychological trauma surrounding sexual activity is the leading cause of lifelong PE. The major symptom of lifelong premature ejaculation is the inability to postpone ejaculation for more than a minute. It occurs in all sexual situations including masturbation.
The treatment options for lifelong PE include:
• Drug therapy
• Behavioral therapy
• Relationship counseling
• Combination therapy
The use of a condom containing numbing agents like benzocaine might reduce penis sensitivity, thereby helping in delaying ejaculation.
Topical anesthetic therapy includes lidocaine-prilocaine 5% cream or spray. According to the 2021 study, the application of the lidocaine cream on the penis region before covering it with a condom 20–30 minutes before sexual intercourse postponed ejaculation in patients with premature ejaculation. Similarly, the lidocaine spray delivers 7.5mg lidocaine and 2.5mg prilocaine. It acts quickly within 5 minutes and proves to be effective in improving ejaculation time and sexual satisfaction.
Serotonin can inhibit ejaculation. To increase the level of serotonin in the brain, doctors recommend tricyclic antidepressants (TCA) as well as selective serotonin reuptake inhibitors (SSRIs).
Depression occurs due to abnormal communications between nerve cells. The chemical called serotonin is a neurotransmitter used to deliver these communications. TCA works by stopping the reabsorption of serotonin. Hence, serotonin will get accumulated between the nerve cells of your brain without getting reabsorbed. Thus, serotonin in high levels will affect the sexual behavior and lead to a delayed ejaculation in men.
Clomipramine is the only effective TCA, but they are not commonly used due to the side effects like hot flush, nausea, erectile dysfunction, dry mouth, and cardiotoxicity.
Consumption of SSRIs every day can improve ejaculation delay, where the maximum delay is achieved after 1-2 weeks.
Treatment with certain SSRIs has several sexual side effects such as erectile dysfunction, inability to achieve orgasm, and decreased libido. For this reason, paroxetine, sertraline, fluoxetine, and escitalopram are used to help postpone ejaculation.
Paroxetine is considered a more effective SSRI than fluoxetine, citalopram, sertraline, fluoxetine, escitalopram, and fluvoxamine. However, it does not work on demand due to its slow onset of action of nearly 5 hours. Hence, paroxetine should be used every day, but there is a possibility of compliance issues due to its prolonged use.
Dapoxetine is the recently developed SSRI that can treat lifelong PE by absorbing quickly in one to three hours. Like other SSRIs, doctors recommend using dapoxetine with caution especially in patients with liver, kidney, or cardiac impairment.
Patients should consume 30mg of dapoxetine 30 minutes before sexual intercourse. It was well tolerated in males with premature ejaculation as well as comorbid erectile dysfunction treated with PDE-5 inhibitors.
Although the mode of action is unclear, tramadol is an effective on-demand option in treating premature ejaculation. The recommended dose of Tramadol is 25-62 mg that can improve ejaculatory control and offer more sexual satisfaction.
Doctors recommend tramadol as a standalone therapy. Due to the risk of serotonin syndrome (too much serotonin causes dangerous side effects due to extreme activity of nerves), tramadol should be administered with caution in combination with SSRIs.
The exact mode of action of PDE-5 inhibitors for premature ejaculation is not clear. A 2015 review study reported that PDE-5 inhibitors may improve premature ejaculation in patients with comorbid erectile dysfunction. Furthermore, it creates a perception of more control over ejaculation.
Behavioral therapy aims at the physical aspect of premature ejaculation, which includes the stop-start approach and pause-squeeze approach.
Discontinue sexual stimulation exactly before ejaculation, halt till the arousal level reduce, and restart. This technique is called the stop-start approach.
Start sexual activity including penis stimulation till you become ready to ejaculate. Once you are about to ejaculate, let you or your partner squeeze the penis to reduce the erection. This method helps you gain proper control followed by slow down.
In case your pelvic floor muscles are weaker, they might affect your ability to postpone ejaculation. Hence, practice kegel exercises (pelvic floor physical therapy) to help strengthen your pelvic floor muscles, as reported in the 2016 research study.
These behavioral interventions improve ejaculatory control by helping males with premature ejaculation to gain confidence in sexual performance, learn techniques to delay or control ejaculation, reduce performance anxiety, and come to terms with thoughts that hinder sexual function.
As PE occurs due to psychological reasons, you should undergo a counseling session with a sexual therapist. Counseling can be followed in combination with the above-listed techniques.
Premature ejaculation is quite normal among men, and the above treatments can help you manage this condition. To begin with, consult the doctor right away. After assessing your condition and medical history, they will recommend the most appropriate treatment that works for you.
So, don’t be shy with your doctor! Address this problem right away to enjoy your sexual life to the fullest!
Articles featured on Noah are for informational purposes only and should not be constituted as medical advice, diagnosis or treatment. If you have any medical questions or concerns, please talk to your healthcare provider. If you're looking for a healthcare provider, click here.