Photo by @konrad_hop
One of the most challenging sexual problems in men’s health is ejaculatory dysfunction. Men can have all types of ejaculatory problems. Sometimes men ejaculate too early or too quickly. This is a condition called premature ejaculation, or PE. Sometimes men take too long to ejaculate or can’t ejaculate at all. These are termed delayed ejaculation and anejaculation, respectively. Certain men experience pain with ejaculation and some ejaculate backward (a condition called retrograde ejaculation). For whatever reason, my practice this summer seems to be dominated by premature ejaculators. So I thought I’d take a few minutes to discuss the facts and fiction about Premature Ejaculation.

First, let’s set the record straight on what constitutes a normal time to ejaculation. Men are often misguided when it comes to ejaculation and often overestimate what is normal. In a large observational study of men and their partners, half of the 1,500 men studied ejaculated in under 7.3 minutes (Patrick 2005). And the average time to ejaculation is under 10 minutes (Patrick 2005). Patients who see me often think they have a problem if they can’t last 15-20 minutes or more. But that’s just not realistic.

So how then do we characterize real Premature Ejaculation (PE)?

Definition.
PE is characterized by ejaculation which always or nearly always occurs prior to or within one minute of penetration or the inability to delay ejaculation on all or nearly all penetrations. To qualify as PE, the ejaculatory issue should cause negative or uncomfortable personal consequences such as distress, frustration and/or the avoidance of sexual intimacy (Althof 2014).

Prevalence and types.
Did you know that Premature Ejaculation is the most common male sexual dysfunction? Depending on the population, the prevalence has been reported as high as 30% (Carson 2006). Many incorrectly assume it’s a young man’s problem, but premature ejaculation can occur at any age (Rosen 2004).

PE comes in two primary types, congenital and acquired. That means, sometimes you’re born with it. And sometimes it’s Maybelline. I mean, sometimes it occurs later in life. Men with the congenital version have always had a problem controlling their ejaculation, even from their first attempts at masturbation. Men with the acquired kind experience a period of normalcy and suddenly or gradually develop an inability to delay time to ejaculation. Both types can be especially distressing and negatively impact a man’s self-esteem or cause relationship issues.

Treatment.
In my experience, guys are often embarrassed to discuss premature ejaculation with their doctors. And many don’t know that there are safe and effective treatments available to improve their ejaculatory control. Thanks to online platforms like hims that seems to be changing. Maybe that’s why this summer I’ve seen an influx of men talking to me about PE.

There are several ways to approach treating Premature Ejaculation. The first is to decrease penile sensitivity. This can involve applying a condom or using a topical anesthetic spray. hims offers this PE treatment option that you spray on 5-10 minutes before sex. These topical treatments can be useful for some patients, especially those with a regular partner. Younger patients and single men may find them cumbersome and sometimes report they interfere with intimacy or don’t allow for spontaneity with new partners. Thankfully there are other options.

A more commonly prescribed treatment for PE is a family of drugs known as selective serotonin reuptake inhibitors (SSRIs). You may have heard of these drugs before because they are also a common type of anti-depressant. One of the side effects of SSRIs is delayed ejaculation. So in patients with PE, we use this side effect to our advantage! These medications have been studied and used on-demand (just before sexual activity) and as daily treatments and both are effective. One of the more commonly prescribed on-demand options is sertraline, which can be used a few hours before sex with reasonable success. If you’re interested in reading more about this option, check this out.

If PE exists alongside erectile dysfunction (which commonly occurs), then phosphodiesterase-5 inhibitors (think Viagra, Cialis, etc.) can be helpful. Another commonly employed treatment is the use of the pain medication tramadol. This treatment is most often used on-demand and essentially dampens the brain’s processing of the genital stimulation that leads to PE. Additional treatments, including Botox injections, are under study as we speak. Some non-medical approaches that can be helpful in PE include pelvic floor physical therapy, sex therapy, psychotherapy, and cognitive-behavioral therapy.

All this is to say, if you’re having problems ejaculating seek help. Do some research, just be careful what you read. hims is a great place to start. And if you’re interested in trying one of the many treatments they offer for sexual dysfunction, talk to your doctor about whether that option is right for you. We are here to help!


Citations

Althof SE, McMahon CG, Waldinger MD, Serefoglu EC, Shindel AW, Adaikan PG, Becher E, Dean J, Giuliano F, Hellstrom WJ, Giraldi A, Glina S, Incrocci L, Jannini E, McCabe M, Parish S, Rowland D, Segraves RT, Sharlip I, Torres LO. An update of the International Society of Sexual Medicine’s guidelines for the diagnosis and treatment of premature ejaculation (PE). J Sex Med. 2014 Jun;11(6):1392-422.

Patrick DL, Althof SE, Pryor JL, Rosen R, Rowland DL, Ho KF, McNulty P, Rothman M, Jamieson C. Premature ejaculation: an observational study of men and their partners. J Sex Med. 2005 May;2(3):358-67.

Carson C, Gunn K. Premature ejaculation: definition and prevalence. Int J Impot Res. 2006 Sep-Oct;18 Suppl 1:S5-13. Review.

Rosen RC et al (2004) The Premature Ejaculation Prevalence and Attitudes (PEPA) Survey: A Multi-National Survey. J. Sex Med 1 (Supp 1): 57-58