What is the average time for a man to ejaculate during intercourse?
https://www.ncbi.nlm.nih.gov/books/NBK547548/.
Is there a defined time how sex should last?
There's no definition of how long sex should last; this depends on the individual couple.
How many men are affected?
90% of men reach ejaculation within 1 min from penetration
10% of men reach ejaculation within 2 to 3 min from penetration
How is premature ejaculation classified?
Early orgasm or ejaculation can be broadly divided into:
Ejaculation happens before or within one minute after penile penetration
No control to delay ejaculation before or after penile penetration
Commonly this impacts negatively on the mental and physical status of the individual leading to a reduction of sexual activity, depression and sense of isolation. This is perceived as a huge hurdle in starting or keeping a relationship.
What are the causes of early orgasm?
What will you expect from your clinical visit
How to perform squeeze technique
Your partner masturbates you, but halts before ejaculation. At this point the glans (head of penis) is squeezed for around 20 seconds. The grip is released. Leave another 30 seconds to pass before resuming masturbation. Repeat these steps several times.
The stop-go technique is similar, but the squeezing is not applied.
Topical anaesthetics in a nutshell
Local anaesthetics can improve ejaculatory control and sexual satisfaction however results are mixed.
The commonly utilised anaesthetic agents are Lidocaine and Prilocaine.
Finding the right dosage of the topical anaesthetic preparations can be challenging.
Excess application may lead to penile numbness and difficulty in achieving an erection and/or ejaculation.
Care has to be taken to avoid the anaesthetic entering the partner’s vagina causing reduced sensation and even difficulty to achieve female orgasm. That is why the man using such preparations should always wash his penis thoroughly before sexual intercourse.
Is there any oral therapy
Dapoxetine (Priligy)
This on demand SSRI was specifically designed to address premature ejaculation. Dapoxetine was found to improve the control over ejaculation and increases sexual satisfaction both for him and his partner.
Dapoxetine is taken 1 to 3 hours before sexual performance. This can only be taken once in a day.
Dapoxetine is not recommended for men with cardiac (heart), renal (kidney) and hepatic (liver) problems. It can also interact with other medicines; your doctor will advise you.
Other Antidepressants
Selective Serotonin Inhibitors (SSRIs) are used to address depression, but they also used to delay ejaculation. The ones commonly prescribed are paroxetine (most effective), sertraline and fluoxetine.
Typically on demand dosing of SSRIs is not as effective. Ideally the medication should be taken 4 to 6 hours before the intercourse.
One can take a daily dose but typically it takes up to 2 weeks before one can judge if there is a positive effect.
Your doctor may prescribe SSRIs treatment on a daily basis for 6 weeks and then on-demand dosing can be attempted in order to minimise the side effects of these.
Common side effects of SSRIs are tiredness, nausea, headaches, loose stools, excessive sweating. These typically are mild and should improve after a couple of weeks.
Alpha blockers
If Dapoxetine or other SSRIs are contraindicated one may explore daily dosing of alpha blockers like tamsulosin or silodosin.
PDE5i’s (phosphodiesterase inhibitors)
This is only utilised for patients suffering from premature ejaculation secondary to erectile dysfunction. Once good erections are attained Dapoxetine or other SSRIs have to be utilised.
Other treatments
Intra-cavernosal Injection Therapy
Premature ejaculation leads to early erection loss which negatively impacts the couple and one’s self-esteem. In very severe cases of premature ejaculation, when other treatments have failed, aides patients maintaining the erection even after ejaculation and resume intercourse.
Whilst this unlikely leads to the patients satisfaction it might improve a partner’s sexual satisfaction and in some cases, building an element of confidence.
Combination Therapy
In most patients a combination of the above mentioned treatments is the way forward for example topical therapy with SSRIs.
Is there a role for surgical intervention?
If premature ejaculation is secondary to tight foreskin or recurrent inflammation of the glans or foreskin then surgery may have a role but evidence on this is limited.
