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Premature ejaculation is when you ejaculate too early during sex. It can happen to anyone for a range of reasons, but if it happens a lot it can cause stress and put strain on your relationship.
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Premature ejaculation: definition and prevalence. International Journal of Impotence Research, 18(S1), pp.S5–S13.
In short: ‘coming’ earlier than you’d like during sex. This can vary from person to person, and is really down to you and your partner to decide what you’re happy with. But the general feeling is that premature ejaculation can be defined by a short latency (time between starting and finishing sex), which you struggle to control and that causes distress.
There are two types:
But, as we said earlier, this is more a question of whether you feel like premature ejaculation is causing distress and is getting in the way of you and your partners’ sex life.
Pretty common. It’s pretty difficult to get accurate data on just how common, as the definition can often be loose or subjective, and many men ‘suffer in silence’ – so estimates can range from 4%-66% of men worldwide – though most studies indicate that the number is between 25%-40%
Whatever the exact number, most men will have at least one premature ejaculation at some point in their lives. Most of the time it’s not a concern, and often it will only happen once or twice.
It’s really only a problem if it happens with enough frequency to cause further distress, disrupt your relationship, or has happened consistently since you’ve been sexually active.
There are things you can try before seeking medical help. Some men find it useful to masturbate around one to two hours before sex, or to use condoms (or thicker ones if you already do) to lessen sensitivity. You can also take breaks, change position, or try to think about something a little less exciting.
Also, if you’re in a relationship, there are things you can do with your partner to help to extend your orgasms. The two main recommendations are the ‘squeeze’ technique, and the ‘stop and start’ technique. Both of which involve stopping intercourse when you are close to climaxing, and starting again when you feel comfortable. But these take a lot of practice, and might not always work.
Failing this, there are treatments you can take which have been shown to help you to delay ejaculations.
One of the most common treatments for premature ejaculation are drugs called SSRIs (selective serotonin reuptake inhibitors). These were originally designed as antidepressants, but an unintended side effect of these was that they delayed ejaculation.
This happens because serotonin manages the transportation of pleasure signals around the body, and SSRIs increase the activity of serotonin within a certain point of the nervous system, which leads to the user having greater control over their orgasms during sex.
Because of this, SSRIs started to be recommended to people who were struggling with premature ejaculations, but they have to be taken daily and there is often a delay of 1 to 2 weeks before you feel the effects. More recently, an “on demand” SSRI has been licensed with the sole intention to help people with premature ejaculation: Dapoxetine (or Priligy). This is the only drug marketed at helping to prevent premature ejaculations.
EMLA is another possible treatment. This is a topical anaesthetic cream which will reduce sensation when applied to the penis. You may need to use a condom when using EMLA, though, as the cream can transfer to your partner when engaging in sex or foreplay, which can cause numbing and a loss of sensation for them.
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Most of the time the cause is psychological. This can be anything from depression or stress, to performance anxiety (particularly with a new partner). These can often be the reasons for acquired premature ejaculation. And although it may feel as though the problem will last forever, it can often only result in you suffering from premature ejaculation temporarily, or until the root cause is resolved.
But it can also be caused by factors that will more likely mean lifelong premature ejaculation. This can be biological things, like having a higher-than-normal penis sensitivity, or psychological reasons.
Recommendations for the management of premature ejaculation: BASHH Special Interest Group for Sexual Dysfunction. International Journal of STD & AIDS, 17(1), pp.1–6.
Your best option for a premature ejaculation tablet will most likely be Dapoxetine (Priligy).
This is because it’s currently the only licensed treatment for premature ejaculation. Also, Priligy works “on demand”, so you can simply take it from 1 to 3 hours before sex, and be ‘good to go’ as and when you need to be. Though it’s recommended that you don’t take it more than once a day.
You can also take other SSRIs, which may help you to delay your ejaculation. SSRIs that are currently licensed as antidepressants include Paroxetine, Sertraline and Fluoxetine, and these could work, but are not recommended strictly for this purpose, so you would have to take them daily, and any usage of these would be “off label” (not licensed for use in this way, but can be prescribed if the clinician believes the treatment will work and the benefits outweigh the risks).
Lidocaine/ Prilocaine (the active ingredient in EMLA cream) works by reducing the strength of sensation to the applied area. So, when applied to the penis, you should feel a reduction in sexual sensation, allowing you to ‘go’ for longer.
It’s recommended that you pair this with the use of a condom. This is to help reduce the risk of your partner also experiencing numbing side effects if they do not want to.
Also, EMLA cream is a topical anaesthetic used in minor skin procedures, and wasn’t developed as a PE treatment. So when doctors prescribe this, it’s also off-label.
Aside from trying to learn how better to control your ejaculations – there aren’t any, really. Some people might claim that they have found a natural remedy to combat premature ejaculation but these are unlikely to be backed by strong scientific basis, and could end up being dangerous or doing more harm than good.
This is because some homeopathic medicines can have serious side effects, and as they aren’t generally prescribed by a medical professional, you won’t receive the health checks you need to make sure it’s safe for you to use. So it’s always best to consult a clinician to talk through whatever options are available, so you can be given the best, safest advice.
Comparison of the clinical efficacy and safety of the on-demand use of paroxetine, dapoxetine, sildenafil and combined dapoxetine with sildenafil in treatment of patients with premature ejaculation: A randomised placebo-controlled clinical trial. Andrologia, 50(1), p.e12829.
Priligy 30 mg film-coated tablets - Patient Information Leaflet (PIL) - (emc).
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Ejaculatory dysfunction as a cause of infertility. Reproductive Medicine and Biology, 11(1), pp.59–64.
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