Premature Ejaculation

Premature Ejaculation, or PE, is a very common problem. It is estimated that around 20% of men between 18 and 59 suffer from PE.

Definition: Premature ejaculation is ejaculation that occurs sooner than desired, either before or shortly after penetration, causing distress to either one or both partners.

The exact cause of PE is not known. There is some evidence that it results from a slight imbalance in the brain neurochemistry. 

Treatment options include behavoiral modification techniques, agents to decrease sensitivity of the penis, and pharmacologic agent (drugs).

Behavioral treatments such as the "squeeze technique," the "start-stop" methon, and the valsalva manuever are well described. 

Methods to decrease penis sensitivity such as wearing condoms or applying topical anesthetics have been shown to be effective for some men. Promescent is a topical agent available over the counter which has recently been released. 

One effective treatment strategy uses the side effects of a class of antidepressant called the SSRI's (selective serotonin reuptake inhibitors). These medications cause a delay in ejaculation and orgasm by raising the threshhold of stimulation needed to reach orgasm.  These medications (fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and clomipramine (Anafranil) are used "off label" because they have never been FDA approved specifically for the treatment of PE. They can be used on an "as needed" basis or as a daily dose. The doses used on PE are usually significantly lower than doses used to treat depression.