Premature Ejaculation

My answer to this question is written from the perspective of a Christian physician using a combination of my own experience with patients and the American Urologic Association’s guideline on the topic of premature ejaculation (PE).

There has yet to be universally accepted definition of PE. But simply stated it is ejaculation that occurs sooner than one or both spouses desire. It is primarily a problem of voluntary control over the timing of ejaculation, and the current treatments include behavior modification, decreasing the sensation of the penis, and certain medications known to delay ejaculation as a side effect (i.e., an “off label” use of a medication for its side effect rather than its primary effect).

Behavior modification is a fancy term for the couple working through the problem by being considerate to one another and, yes, practice. This may be done with the assistance of a professional psychologist or not. I have found the three most important factors are that the husband be attentive to his wife in bringing her to arousal (i.e., not focus on himself); that the husband not be “pre-stimulated” before making love to his wife by viewing things that cause him to already be aroused; and that the husband teach his wife what actions are too intense for him to put off ejaculation. If it is vaginal penetration that creates the “problem” then the solution is both having his spouse better aroused so that the duration of actual intercourse will be satisfying for both and, again, “practice” so that his body becomes familiar enough with hers and the process of intercourse so it may be “trained” to prolong the process. All of this presupposes a couple that is comfortable and committed to their relationship and do not have any major issues that have been unresolved. Problems that are being ignored or “swept under the rug” will often negatively impact the ability to have satisfactory intercourse because sexual intimacy is just that–we are communicating with our spouse with our body and the body will not “lie”!

An adjunctive solution is the use of medication, ideally as only a temporary help until the couple are doing well enough on their own. The use of these medications must be obtained from and supervised by your attending physician.

One can apply EMLA cream to the head of the penis about 20-30 minutes prior to penetration to decrease its sensitivity or one can use an SSRI (selective serotonin reuptake inhibitor) orally for its known side effect of delaying ejaculation.

EMLA cream is a mixture of short-acting and long-acting topical anesthetics (lidocaine and prilocaine). One must not put it on too long before or the penis may become so numb as to cause loss of erection. One must also use it sparingly or some residual cream may numb the spouse’s vaginal wall.

The SSRIs that have been used successfully for this problem are:

Fluoxetine (Prozac, Sarafem) 5-20 mg/day

Paroxetine (Paxil) 10-40 mg day or

20 mg 3-4 hrs before relations

Sertraline (Zoloft) 25-200 mg/day or

50 mg 4-8 hrs before relations

Typically the physician prescribes the lowest dose first and gradually increases it as needed. And most suggest “situational” dosing just before intercourse rather than having the person on the medication all the time.

One nonselective SRI has also been used:

Clomipramine (Anafranil) 25-50 mg/day or 25 mg 4-24 hrs before relations

As with all medications adverse reactions may occur (e.g., dry mouth, drowsiness, reduced libido) and these medications cannot be taken with certain other medications (anticonvulsants, benzodiazepines, cimetidine, tricyclic antidepressants, antipsychotic agents, tolbutamide, antiarrhythmics, and warfarin). Again your physician will be your guide.

Dr. Greg Polito