Premature ejaculation

If you have premature ejaculation caused by physical conditions, your GP should be able to suggest possible treatment options.

Treating premature ejaculation caused by psychological factors can be more challenging, but most men who persevere with treatment have successful outcomes.

Self-help

There are a number of self-help techniques that you may want to try before seeking medical help.

These include:

• masturbating an hour or two before having sex
• using a thick condom to help decrease sensation
• taking a deep breath to briefly shut down the ejaculatory reflex (an automatic reflex of the body during which ejaculation occurs)
• having sex with your partner on top (to allow them to pull away when you are close to ejaculating)
• taking breaks during sex and thinking about something boring

Couples therapy

If you are in a long-term relationship, you may benefit from having couples therapy. The purpose of couples therapy is two-fold.

Firstly, couples are encouraged to explore issues that may be affecting their relationship, and given advice about how to resolve them.

Secondly, couples are shown techniques that can help the man to ‘unlearn’ the habit of premature ejaculation. The two most popular techniques are the ‘squeeze technique’ and the ‘stop-go technique’.

In the squeeze technique, the woman begins masturbating the man. When the man feels that he is almost at the point of ejaculation, he signals to the woman. The woman stops masturbating him, and squeezes the head of his penis for between 10 to 20 seconds. She then lets go and waits for another 30 seconds before resuming masturbation. This process is carried out several times before ejaculation is allowed to occur.

The stop-go technique is similar to the squeeze technique except that the woman does not squeeze the penis. Once the man feels more confident about delaying ejaculation, the couple can begin to have sexual intercourse, stopping and starting as required.

These techniques may sound simple, but they do require a lot of practice.

Medication

Selective serotonin reuptake inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) are primarily designed to treat depression, but they also have the useful side effect of delaying ejaculation. Although SSRIs are not licensed to treat premature ejaculation, they are increasingly being prescribed for this use.

SSRIs used for this purpose include:

• paroxetine
• sertraline
• fluoxetine

Some men with premature ejaculation may experience an improvement in their symptoms as soon as treatment begins. However, you will usually need to take the medication for one to two weeks before you notice the full effects of the treatment.

Common side effects of SSRIs include:

• fatigue
• feeling sick and being sick
• diarrhoea 
• excessive sweating

However, these are usually mild and should improve after two to three weeks.

Dapoxetine

An SSRI, known as dapoxetine, has been specifically designed to treat premature ejaculation, but it is not currently licensed for use in the UK and is not usually available on the NHS.

The manufacturers have not yet applied for a licence; it is unclear whether they will do so in the future.

Some specialists in treating erectile dysfunction are providing dapoxetine on an unlicensed basis. This means the specialist is willing to take professional responsibility for prescribing unlicensed medication; this includes any necessary monitoring and follow-up treatment.

You should be aware that the doctor in charge of your care may not be willing to take such a responsibility.

If you are prescribed dapoxetine you are normally recommended to take it one to three hours before having sex.

Retarded ejaculation

As with premature ejaculation, the physical causes of retarded ejaculation can usually be treated. For example, if prescription medication is causing the problem, your GP may be able suggest alternatives.

There are also a number of alternative medications that can be used if it is thought SSRIs are responsible for causing delayed ejaculation. These include:

• amantadine – a medication originally designed to treat viral infections
• buproprion – a medication originally designed to help people stop smoking
• yohimbine – a medication originally designed to treat erectile dysfunction

These medications help block some of the chemical affects of SSRIs that are thought to contribute towards retarded ejaculation.

Sex therapy

Sex therapy uses a combination of psychotherapy and structured changes in your sex life. This can help to increase your feeling of enjoyment during sex, and help make ejaculation easier.

Some primary care trusts (PCTs) provide a sex therapy service on the NHS, but others do not. Therefore, levels of availability can vary widely depending on where you live.

You can also pay privately for sex therapy. Prices for a single session can vary from around £50 to £80. For information about private sex therapists in your local area you should visit the College of Sexual and Relationship Therapists website.

The relationship counselling service Relate also offers sex therapy at a number of its centres; you would be expected to pay for each session.

During sex therapy, you will have the opportunity to discuss any emotional or psychological issues related to your sexuality and relationship, in a non-judgemental way.

Activities may also be recommended for you to try at home while you are having sex with your partner (you should never be asked to take part in any sexual activities during a session with the therapist).

These may include:

• viewing erotic material prior to having sex, such as videos and magazines, to increase the feeling of sexual stimulation
• erotic fantasies and ‘sex games’ to make your lovemaking more exciting
• using lubricating creams, or jellies, to make the physical act of sex more comfortable and relaxing
• using sexual aids, such as vibrators, to increase pleasure

Retrograde ejaculation

Most men do not require treatment for retrograde ejaculation because they are still able to enjoy a healthy sex life and the condition does not have adverse effects on their health.

If treatment is required (usually due to wanting to father a child) medicines can be used to strengthen the muscles around the bladder neck. Pseudoephedrine (a medicine commonly used as a decongestant) has proved to be effective in achieving this.

However, if the retrograde ejaculation has been caused by significant muscle or nerve damage, treatment may not be possible.

Men who want to have children can have sperm taken from their urine for use in artificial insemination or in-vitro fertilisation (IVF).

Glossary

Local anaesthetic

A local anaesthetic is a drug injected by needle or applied as a cream, which causes a loss of feeling in a specific area of the body.