Premature Ejaculation (PE) is a sexual dysfunction during the orgasm phase that consists in the difficulty or impossibility of exercising a reasonable control over the ejaculatory reflex, generating anticipatory anxiety, guilt and a feeling of tremendous frustration.
PE is considered the most common sexual disorder in men.
The psychotherapeutic success rate is greater than 90%.
There is no specific cause, as it is the result of a combination of several different factors.
Lack of knowledge on how to control and/or the presence of anxiety can prevent the clear perception of the premonitory sensations of orgasm, which are the essential signals to achieve ejaculatory continence.
Other factors are the presence of sexual performance anxiety, fear of failure, hostility and a passive-aggressive behavior style.
Sexual quality also has an influence. As ejaculatory control is poor, the patient spends less time on erotic games, so sexual intercourse becomes increasingly monotonous and oriented towards penetrative sex.
The treatment of PE is complex and must be multidisciplinary involving doctors and sexologists. It is important to individualize the treatment to optimize the results in each patient.
From a strictly pharmacological point of view we have the following options:
- 1st line treatments:
- Selective serotonin reuptake inhibitors (SSRIs): They are drugs that can be indicated daily (Paroxetine, Sertraline, etc.) or on demand (Dapoxetine), and which significantly reduce ejaculation and improve control.
- Topical anesthetics: Applied as creams with a condom for about 15 minutes before sexual intercourse to decrease the sensitivity of the glans.
- Spray anesthetic (Prilocaine + lidocaine): the glans is sprayed 5 minutes before having sex in order to decrease the sensitivity of the glans.
- 2nd line treatment:
- Tramadol: administered on demand about two hours before intercourse, it has been shown to significantly prolong the time until ejaculation.
- PDE5 Inhibitors: they are not drugs specifically intended for EP, but patients with secondary EP associated with erectile dysfunction benefit from the use of these medications to delay ejaculation.
Initially, the aim is to decrease performance anxiety and to re-learn a certain level of eroticism and fun during sex.
The initial goal of psychosexual therapy is to improve ejaculatory control and prolong the duration of intercourse with:
- Sexual psychoeducation (sexual information in general, sexual myths and taboos).
- Promoting a healthy lifestyle (Self-care).
- Relaxation training and learning to create a comfortable, calm and safe sexual environment.
- Training in Social Skills (Assertiveness) and communication.
- Improving introspection and self-control.
- Learning to know the level of anxiety and excitement before and during the sexual act (higher anxiety means higher levels of erotic excitement).
- Self-stimulation program: the man must be empowered to detect premonitory sensations to orgasm when excitation inevitably leads to ejaculation (known as “ejaculatory reflex”). The best way to detect it is with masturbation, focusing repeatedly on the sensations that precede orgasm.
- Personalized Sensory training techniques with the partner.
A high percentage of premature ejaculators can achieve good sexual functioning in a few weeks if they perform the proposed exercises.
When the patient does not have a partner, the treatment will be carried out in two phases (individually and when he has a sexual partner).
Often, it is combined with pharmacological treatment, which is called Combination therapy.
The sessions will be 1 hour long bi-weekly, in which individual and couple visits will be staged. Tasks will be delivered in between both individual sessions and with partner collaboration.