Premature Ejaculation (PE)
PE is thought to affect over 36 million men and is the most common sexual complaint of men under 50 years of age. It is defined as uncontrolled, unwanted ejaculation occurring less than 5 minutes after initial stimulation, or within 2 minutes of insertion. It should be stressed that it is subjective as it depends on the mutual satisfaction of both partners. Nevertheless, it can be a very distressing event, resulting in severe disruption to the relationships (or difficulty in forming them) and low self-esteem.
The cause of ED is unknown, but is likely to involve both physical and behavioural components. The following have been suggested;
Hyperactivity of pelvic floor muscles.
Neurotransmitter (serotonin) problems.
Unsatisfactory early sexual experiences.
Prostate or urethral inflammation or infection.
Urinary tract infection.
Withdrawal from opiates or some antipsychotic drugs.
Rarely, nerve damage from trauma or surgery.
A full history to taken to account any factors suggested above. Erectile dysfunction may co-exist. Often, reassurance can be given about expectations and performance. Examination, to include blood pressure and urine testing.
Blood tests are not usually necessary, but might include full blood/biochemistry, thyroid function and testosterone levels.
Advice about sexual practice, condom usage, positional variations.
Counselling by appropriately qualified practitioner.
Use of anaesthetic creams (EMLA).
Use of serotonin reuptake inhibitors (Paroxetine; off-licence use).
Follow-up is important and regular attendance would be encouraged to discuss progress or ongoing problems.