HOW CAN premature ejaculation (PE) be treated or its effects minimised? I will divide treatment into three categories. These are: 1) manoeuvres that can be carried out immediately by the man to minimise PE and its effects; 2) drug treatment prescribed by a health professional; 3) behavioural therapy to permanently cure the problem.
DRUG TREATMENT
A number of drugs may be prescribed by the doctor to immediately break the cycle of PE by delaying ejaculation thereby restoring confidence and diminishing anxiety.
Drug treatment unfortunately will not produce a permanent cure but will be effective for as long as the man is taking the medication. Therefore, if a permanent cure is desired, simultaneous behavioural therapy should take place which is laborious and requires a high degree of motivation and commitment but produces durability of cure.
The classes of drugs used include antidepressants (utilising a side-effect of these drugs), topically applied local anaesthetic creams (desensitising agents), anti-anxiety drugs and alpha-1 blockers.
Antidepressants are by far the most successful class of drugs to be used. The tricyclic antidepressant clomipramine (Anafranil - the 'bomb', on the street) is the most potent drug used for treating PE and is taken eight hours prior to intercourse. Its main limitation is the side effects which include, drowsiness, yawning, insomnia, tremulousness and decreased sexual desire to name a few.
Selective serotonin reuptake inhibitors (SSRIs) such as Sertraline (Zoloft), Paroxetine (Paxil), and fluoxetine (Prozac) are generally all effective in delaying ejaculation and tend to have less side effects than clomipramine but may still significantly reduce sexual desire and potency. These can all be taken on an as-needed or on-demand basis eight hours prior to sexual activity.
Other useful medications include anxiolytics (anxiety reducing drugs) such as xanax and frisium or alpha-1 blockers used in treating non-cancerous prostate enlargement (BPH) such as Tamsulosin (Flomax) and terazosin (Hytrin). These are all off-the-label uses of these drugs.
Desensitising creams are particularly useful and work quite well in delaying ejaculation. EMLA cream or Retardin are two pharmaceutical preparations available. There is also a desensitising spray which is available without prescription.
BEHAVIOUR THERAPY
To permanently cure PE some relearning has to take place. This is achieved through behaviour therapy. Briefly, this involves using a number of techniques which are not mutually exclusive, including Masters and Johnson start-stop method, the squeeze technique, breathing exercises, Kegel (pelvic floor muscle) exercises, changing sexual positions and masturbatory exercises.
Common to all of these is the importance of the man recognising the sensations in his genitals as the 'point of ejaculatory inevitability' approaches. These sensations are best appreciated and the point identified during masturbation by focusing on the changing sensations in the genitals and elsewhere as sexual tension rises and ejaculation approaches. Having learnt to recognise this point, adjustments can then be made during masturbation, mutual stimulation or sexual intercourse either by stopping, squeezing the penis, contracting the pelvic floor muscles, deep breathing or a combination of all of the above to prevent ejaculation occurring.
It is recommended that success is achieved with masturbation for at least 15 minutes before moving on to partner exercises. For those men who have severe PE, that is, ejaculation occurs before or during penetration, it is suggested that the man should first learn to become accustomed to the sensations of vaginal containment in the woman-on-top position without becoming extremely aroused and without thrusting until this stage is successfully negotiated. These exercises require a high degree of motivation and commitment and a loving, supportive partner definitely helps. Positive results should not be expected until after three to six months of doing the exercises.
In summary, PE is a very common problem which causes sexual frustration and may result in relational problems if not remedied. A combination of drug and behaviour therapy can effect a lasting cure and therefore men and their partners need no longer suffer in silence from this condition.
(Part one appeared September 25, 2002)
- Dr. William D. Aiken,
consultant urologist, University Hospital of the West Indies.
