Premature ejaculation is defined as persistent or recurrent ejaculation with minimal sexual stimulation before, upon, or shortly after penetration and before it is wished by the man or his partner
7. PREMATURE EJACULATION (PME)
“Premature ejaculation is defined as persistent or
recurrent ejaculation with minimal sexual
stimulation before, upon, or shortly after
penetration and before it is wished by the man or
his partner”
(Neil Baum, Bradly Speiler et al, Medical aspects of human sexuality, May
2001:15-25)
(AUA guidelines on PME, 2004)
8. PREVALENCE
• The most commonly experienced male sexual
dysfunction in American men.
• 1/3rd of all sexually active men suffer from PE.
• A prevalence of 21% (10-30%) in men ages 18
to 59 in the United States
(Lauman EO, Paik A et al,JAMA 281:537,1999)
9. PSYCHOLOGICAL CAUSES
• Early sexual experiences,
• Performance anxiety,
• Low arousal levels, or
• Decreased sexual desire
• Psychological stress (fear, guilt, anxiety) with
sexual activity
• Relationship or partner issues
13. BEHAVIOURAL TECHNIQUES
• ‘Stop-start’ and ‘squeeze’ techniques
• Extended foreplay
• Pre-intercourse masturbation
• Cognitive distractions
• Alternate sexual positions
• Interval sex and increased frequency of sex
14. PSYCHOSEXUAL COUNSELLING
• Address the issue that has created the anxiety or
psychogenic cause
• Address methods to improve ejaculatory control.
Therapy options
- meditation/relaxation
- hypnotherapy
- neurobiofeedback
15. ORAL PHARMACOTHERAPY
• Delayed ejaculation a common
side-effect of SSRI and TCA
• SSRIs are now commonly prescribed for PE.
• Premature ejaculation can be treated effectively
with several serotonin reuptake inhibitors (SRIs)
(AUA Guidelines on PME, 2004)
16. OVERVIEW OF MEDICAL MANAGEMENT
• Primary PE:
• 1st line: SSRI, reducing penile sensation
• 2nd line: Behavioural techniques, counselling
• Most men require ongoing treatment to
maintain normal function
17. Secondary PE
• Secondary to ED: Manage the primary cause
or
• 1st line: Behavioural techniques, counselling
• 2nd line: SSRI, reducing penile sensation
• Many men return to normal function
following treatment
18. OTHER ORAL MEDICATIONS FOR PE
• Role of PDE5 inhibitor ?
• SSRI + PDE5 inhibitors
-down-regulation of receptors involved in
somatosensory latency times
-reduction in performance anxiety
• Role of α-blockers ?
Beretta G et al, Acta Eur Fertil,17:43,1996