Premature Ejaculation (PE)
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Premature ejaculation or PE as it is commonly known is by far the MOST common sexual problem in men younger than 40 years.
Before we even start, we have to establish some facts and definitions.
How do we know if someone has premature ejaculation?
There are many expert definitions.
- WHO defines PE as men who ‘ejaculate before they want to’. According to their definition as many as 33% to 50% of people in the world have premature ejaculation.
- Another definition by some US researchers defines PE as ‘ejaculating before the partner achieves an orgasm’. They found up to 70% of people have PE.
- Another definition by some European researchers is by measuring the IELT (Intra-vaginal Ejaculatory Latency Time).These researchers found that the average IELT is about 4 to 5 minutes. So by statistical definition, any duration below 2.5% of the mean is considered premature ejaculation which is 90 seconds.
- Then there is the definition according to the DSM (Diagnostic and Statistical Manual of Mental Disorders) which is:
- Persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it. The clinician must take into account factors that affect duration of the excitement phase, such as age, novelty of the sexual partner or situation, and recent frequency of sexual activity.
- The disturbance causes marked distress or interpersonal difficulty.
- The premature ejaculation is not due exclusively to the direct effects of a substance (e.g., withdrawal from opioids).
So who has premature ejaculation and who doesn’t?
First, PE is NOT an illness or a disease. It is a lifestyle choice. There was a person in one of the studies who could last for 25 minutes and yet still said that he has premature ejaculation. There is this place in Italy where the faster a man ejaculates the more of a man he is considered to be. There is also the famous caveman analogy. In ancient times the faster a man ejaculates greatly increases his chances of making a woman pregnant. So according to Darwin’s law of evolution, his DNA is passed down more than the man who takes a very long time to ejaculate. So in terms of nature and survival, ‘premature ejaculation’ is an evolutionary advantage.
Of course, PE is a real problem if:
- It is causing or arising from inter-personal relationship problems.
- It is causing or arising from psychological issues like anxiety and depression.
- It is a sign of hidden erectile dysfunction (ED).
- It is due to a low serum Testosterone level.
- It is a sign of an underlying medical disease.
- It is due to stopping a drug.
- It is severe enough to affect fertility.
When you consult our Doctors for premature ejaculation, we will first make sure you don’t suffer from the above illnesses. Treatment will depend on what problem you have. So if you have anxiety, we treat the anxiety. If you have ED or heart problem, we treat these problems.
What are the premature ejaculation treatment options?
If you have none of the above then we can talk about treating premature ejaculation itself. There are several methods below:
- Distraction Method.
- Start and stop method.
- Masters and Johnson Method.
All the methods have varying success reports on scientific studies.
The more established medical methods to treat premature ejaculation are:
- Anaesthetic creams, gels and sprays. The spray has had best results in scientific studies. Just spray on 5 minutes before and it numbs the head of the penis. The problem with cream and gels is you need to leave it on for at least 30 minutes and might also numb your partner.
- Tramadol. This is a pain-killer medicine derived from opium. It changes the chemical content at nerve endings and gives more control over ejaculation. It may cause nausea and vomiting.
- SSRIs. Also known as Selective Serotonin Re-uptake Inhibitors. These are a class of medicines that are used to treat anxiety and depression. They increase a chemical known as Serotonin at our nerves thereby giving us more control over when we ejaculate. There are various types and various ways of dosing. The side effects are usually limited to mild sedation and nausea. The only SSRI indicated in the treatment of PE is Dapoxetine (Priligy).
- Levitra (Vardenafil). The ‘Duration Study’ is a scientific study that proves Levitra can increase duration of sex from 4 minutes to 12 minutes. It has the usual possible side effects of these drugs like headache and flushing.
- Cialis (Tadalafil) 5mg low-dose once-a-day pill taken in conjunction with Priligy (Dapoxetine) before sexual activity has been found to be very effective in improving Premature Ejaculation.
Need more advice?
Andrology and Infection Centre at Novena Medical Center Men’s Clinic.
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About Dr. Tan
Dr. Tan graduated from the National University of Singapore in 2001. His residency was in the two largest public hospitals in Singapore; Tan Tock Seng Hospital and Singapore General Hospital.