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Modern Treatment options for PE


PE is a common sexual complaint and also a treatable condition. When it happens infrequently it is not a point of concern. Treatment approach towards PE includes: Counselling Medications Adapting sexual techniques that delay ejaculation Treatment of PE more or less depends on its nature and classification.

Doctor should differentiate PE as a symptom and PE as a syndrome before considering treatment options. Only individuals with lifelong PE with IELT (Intra-vaginal Ejaculation Latency Time) shorter than 1-1.5 minutes (normal – 6 ½ minutes in 18-30 years old) should require medication as a first option along with or without therapy. For those in other categories, treatment should consist of:

Patient reassurance (counselling) Behaviour therapy Psycho - education to explain that irregular early:

Treatments

Self-help and Behavioural techniques

  • Masturbating and ejaculating an hour or 2 before intercourse (helps delay ejaculation during sex)
  • Distraction methods – Focus attention away from sexual stimulation. Avoiding intercourse for a period of time and focusing on other types of sexual play (extending foreplay or intervening / repeating foreplay techniques again when there is ejaculatory response)
  • Thrust more slowly
  • Withdrawal of penis at the ejaculatory response and re-starting after the response ceases
  • Using more than 1 condom

Topical anaesthetics – Application of numbing creams and sprays such as lidocaine over the penis before sex (Possible side effect – temporary loss of sensitivity and decreased sexual pleasure, allergy)

Oral medications

Antidepressants – Ex. Sertraline, Paroxetine, Fluoxetine, Clomipramine etc (possible side effects – nausea, dry mouth, drowsiness, decreased libido etc) Analgesics – like Tramadol delays ejaculation (may have same side-effects like antidepressants) Phosphodiesterase-5 inhibitors – Sildenafil (Viagra, Revatio), Tadalafil (Cialis, Adcirca) or Vardenafil (Levitra, Staxyn) {possible side-effects – headache, facial flushing, temporary visual changes and nasal congestion} Counselling.

Talking with mental health provider about your relationships and experiences, details of sex life etc Helps best when combined with drug therapy Others: Cutting down on the use of alcohol, tobacco, illegal drugs Communication with your partner Use condom to reduce stimulation of penis.

Change positions and bring varieties in sexual intercourse Psychoanalysis – According to Freudian theory – rapid ejaculation was a symptom of underlying neurosis. Man suffers unconscious hostility (noe strong evidence) towards women, so he ejaculates rapidly, which satisfies him but on the other hand frustrates his lover who is unlikely to experience orgasm that quickly. PE could be cured by psychoanalysis The theory was not successful in curing PE.

  • Kegel exercises – to strengthen the muscles of the pelvic floor
  • Masters and Johnson’s ‘stop-start technique’ and ‘squeeze technique’
  • Focus exercises
  • Mind/body coordination exercises
  • Masturbation exercises
  • Deep breathing
  • Whole body massage
  • Study – Men who have PE have a faster neurological response in the pelvic muscles.

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