The physician charged with the treatment of premature ejaculation (PE) has a range of options.
But before deciding the appropriate treatment, it is important to distinguish PE as a ‘complaint’ or as a ‘syndrome’.
Many years ago, scientists classified PE into ‘lifelong PE’ and ‘acquired PE’.
More recently, a new group of scientists have proposed further classifications, based on controlled clinical and epidemiological stopwatch experiments.
Two other PE syndromes were included, called ‘natural variable PE’ and ‘premature-like ejaculatory dysfunction’.
Basically, there are two forms of treatment for PE, medication or therapy.
Before deciding on the form of treatment the ‘Intravaginal ejaculation latency time’ (IELT) should be measured by the man’s partner, using a stop watch to time intercourse from the beginning of penetration to the point of his climax.
Only those men with a result of 1 to 1.5 minutes should require medication as a primary option, perhaps with therapy as well.
For other sufferers, the treatment should be based on patient reassurance and education, behavior therapy, and perhaps psychoeducation to find the causes of irregular early ejaculation.
Here are some of the many medications available.
Dapoxetine (Priligy) is a fast acting selective serotonin reuptake inhibitor (SSRI) created especially for the treatment of premature ejaculation, and is the only drug with specific regulatory approval for such a tratment. At present it is approved in several European countries, including Germany, Portugal, Finland, Sweden, and Austria.
Dapoxetine is currently awaiting approval of the U.S. Food and Drug Administration (FDA) after concluding the third phase of a study, which included contributions from 25 countries, including the United States.
Within this diverse population group, Dapoxetine significantly treated all aspects of PE, with few major side effects.
Tramadol (Ultram or Tramal) is an atypical oral analgesic, used for the treatment of mild pain and approved by the FDA. It is characterized atypical as it is similar to an opioid, as an agonist at the mu receptor, but also has the effect of an anti-depressant in that it increases levels of serotonin and norepinephrine.
Tramadol has very few side effects, has a low abuse potential, and increases (IELT) by a factor of four to twenty fold in more than 90% of cases.
Clomipramine (Anafranil) is commonly prescribed by physicians to treat PE. One of the drug’s properties is to help delay ejaculatory response. The Mayo Clinic have described this particular side effect as ‘Increased sexual ability, desire, drive, or performance.’
Desensitizing creams that can be applied to the tip and shaft of the penis can also be used to prevent PE. Such creams are applied on an ‘as required’ basis and have few adverse systemic side effects. But it should be explained to the patient that use of these creams may lead to insensitivity in the penis, and also a possible reduction of sensation for the sexual partner.