Premature Ejaculation

Premature ejaculation or PE is the commonest sexual dysfunction to affect men, and by extension women, in the world.

It is more common even than erectile dysfunction. And yet it is also the most neglected and least understood problem. Very often the management of PE is left to Dr. Google, and to the quacks and chancers who lurk therein. Men who suffer from PE are vulnerable to exploitation because, often, they do not know where to turn.

Definition of Premature Ejaculation

Immediately this is where the problems start. There is still no agreed definition for PE. Both the International Society for Sexual Medicine and the International Classification of Diseases have come up with definitions that seem to imply the use of a stop watch as a diagnostic tool!

The former says PE is ejaculating in less that one minute of commencing intercourse while the latter gives the man less than 15 seconds to qualify for a PE badge.

Using time alone as the single criteria for defining premature ejaculation seems to me to be missing the point. My working definition, for what its worth, is that premature ejaculation is: “The continuous inability to control the timing of ejaculation such that the sexual needs of either party engaged in sexual activity is not being met.”   

In practice, however, I believe a man has premature ejaculation when he tells me he has it, when he perceives the timing of his ejaculation is problematic.

In any case, I can tell you: If you are a doctor wondering about this malady, you are on a hiding to nothing if you think you can solve the man's problem by telling him he does not have one.

Management of Premature Ejaculation

There are only three things worthwhile in management of Premature Ejaculation and they are:

1. Behavior Modification: This requires practice and may benefit from the help of a sex counselor. Basically, it is about learning to recognize your point of no return when you know that if sexual stimulation continues beyond that point that you will ejaculate. At that precise point, you discontinue all stimulation and let things settle down before starting again. A lot of men tell me that they are unable to do this and I have to respect the validity of their point of view.
2. Topical Anesthetics: These come in creams or gels such as Emla or Promescent. Clinical studies have shown these to be effective. Exactly where the gel is applied is crucial and I can help you with this if you wish. If the numbing ointment does not work on its own then the additional use of a condom may be necessary. 
3. The SSRI group of drugs: These too are very effective in showing down ejaculation. They are not without side effects of course but often the benefit/risk ratio makes sense. I tend to reserve the use of SSRI in managing PE for those in whom the condition is so deeply ingrained as to be preventing a couple from starting a family.

If you suffer from the misery that PE can be and you are struggling to find some answers, then I would be delighted to try and help you.