Premature ejaculation Sexual Therapy

The are medical treatments for PE. SSRI (Selective – Serotonin – Reuptake – Inhibitors) are the most common one. Dapoxetine is approved for this use in men between 18 and 64 years, others are used „off label“, meaning they are not officially approved for PE. There are contraindications such as heart disease and other conditions, it can also interfere with other medications, so it is essential that it is prescribed and monitored by a GP or Urologist.

SSRI cause the levels of the neurotransmitter serotonin (a signal giver) in the brain to increase and are usually used as antidepressants or to treat obsessive – compulsive disorders or post traumatic stress syndromes.

The unwanted adverse effects they can have: loss of desire, erectile dysfunction and delayed ejaculation or anejaculation (no ejaculation at all), are used to delay the so called IELT (intravaginal ejaculatory latency time) on purpose in men with PE. This is also valid if intercourse is not with a vagina but anus or other body opening.

There have been large studies where 3 groups of men with PE got placebo (a pill with no active ingredient) or a lower (30mg) or higher dose (60mg) of Dapoxetine (Priligy) for 12 weeks. The geometric mean IELT was 0.8 minute before and 1.3 minutes after 12 weeks of taking placebo, 2.0 minutes with the lower dose (group 2), and 2.3 minutes with the higher dose (group 3).

The effect can be different in every individual, so some men gained more and some gained less time than that.

Almost one third of the men said they had gained better control over ejaculation in group 2 and 3 (1 out of 10 in the placebo group). Nearly 25%, 1 out of 4 men reported good or very good satisfaction in the placebo group, about 40% in the other two groups.

There were adverse effects reported by one third of the men in the placebo group (!!!), about half in group 2 and two thirds in group 3. The most common complains were nausea and dizziness.

This means in summary that treating PE with Dapoxetine is showing a longer IELT from just under 1 minute to 2 to 2,3 minutes which one third or more found beneficial. One forth saw an improvement without having been administered the drug. The rate of general adverse events was high, also in people who didn’t get the drug.

If this treatment is a desirable perspective for a man with PE is an individual decision. I have found that many do not find this very attractive, as it means that you are likely having to take a drug for life. If you stop, the effect is reversible.

Another medical treatment is the use of anaesthetic creams, gels or sprays containing f.ex. lidocaine, aiming to numb the skin of the penis a bit so the man feels less. There are studies showing that it can prolong the IELT, in a rather small study, some of the participants even reached average IELTs in combined use with a condom.

It is also a matter of preference if a man wants to numb his penis and prepare it with a cream or spray 20 – 30 min before intercourse.

Aside from drugs, there are well meant self – help advices like: „think about something that will turn you off“ or „masturbate a couple of hours before intercourse“ „interrupt stimulation and take breaks before you come (may be difficult to do if you come before penetration or very shortly after)“, „squeeze your glans penis hard“ , „try to contract your pelvic floor to hold back“ or wear a thick condom or several condoms.

Some of this may work for some men, I have not heard too many positive comments about this though. It doesn’t seem to lead to a satisfactory sex experience for many. Contracting your pelvic floor may even lead to the opposite result.

If you have read the text above (or even followed the link to the article) describing some of the causes of PE like a hyperarousal of the sympathetic autonomous nerve system, arousal patterns using hight muscular tension and little body self – perception, you may have already guessed that it is worthwhile to assess and evaluate the individual causes in more depth and find individual solutions, be it by learning to perceive and regulate yourself better, using different breathing techniques and movement instead of high static muscular tension and expanding your arousal mode, or resolving underlying conflicts in a relationship.

Therapy can mean to identify negative vicious cycles and influences and finding solutions. This often involves working through and with the body in sessions (always dressed and not with sexual arousal) and practicing yourself in-between sessions.

This may take weeks or months, so you need to be patient, do the exercises and talk about your experiences in the sessions so that the process can be built up step by step and change can slowly occur. The way your arousal system is conditioned at the beginning of therapy has been a data – motorway to the brain for decades, so it is important to realize that change will take time and consistency with practice to be able to establish improvement and new data – motorways.

Please contact me by email or phone for your first appointment.