Premature Ejaculation

premature-ejaculation There is a lot we can do to help men who ejaculate (“come”) too quickly. Prescription medication can dramatically increase the time from penetration to ejaculation safely and conveniently, increasing a man’s confidence. If you suffer from premature ejaculation, there are plenty of available treatments. Complete Our Questionnaire

What is it?

It is the occurrence of ejaculation of semen within seconds of penetration. While some definitions state this time scale is 15 seconds or less, I suspect most of us would say ejaculation after 16 seconds is not entirely satisfactory.

Effectively, anything under a minute is probably premature ejaculation, and could be dealt with as such.

What causes it?

The majority of medical opinion is that it is largely of psychological cause, unlike Erectile Dysfunction, which may be partly or entirely physically caused. However a minority body of opinion believes that an underlying dysfunction in the nerve-muscle balance in the pelvis is indeed the true underling cause. There is in fact some data to support this. The jury is out on this at present, however the occurrence of lifelong extremely rapid Premature Ejaculation in first degree male relatives does gives ground to the theory that it is largely of neurological origin.

Early sexual experiences fraught with anxiety can lead to a feedback loop where each successive anxiety – producing sexual encounter intensifies the Premature Ejaculation.

Can Erectile Dysfunction and Premature Ejaculation coexist?

Unfortunately yes: please see: “Can I take oral medication for both Premature Ejaculation AND Erectile Dysfunction together?”

How common is it?

This depends on whom you believe. Most men (even if not suffering from Premature Ejaculation as defined above), when asked, state that they would like greater ejaculatory control. The general consensus is about 30% of the male population when questioned, state to have experienced Premature Ejaculation at some point in their lives.

What medications can help?

The problem with the anaesthetic agents is their tendency to anaesthetise the partner unless a condom is worn. On the other hand, condom use reduces sensation and assists in delaying ejaculation. Some sprays and creams have better skin penetration and are reputed to leave little residue to anaesthetise the partner afterwards. EMLA cream, a prescription anaesthetic cream is the most effective. Unfortunately numbing the penis does exactly that: it numbs the penis. However, some patients definitely do benefit from locally applied anaesthetic applications.

The antidepressant class SSRI including Fluoxetine, Sertraline, Paroxetine and Dapoxetine all have been shown to act positively in Premature Ejaculation.

Dapoxetine (Priligy) is different to the other SSRIs, in that it is extremely rapidly absorbed and then rapidly excreted. This makes it in practice relatively useless as an antidepressant but very appropriate for Premature Ejaculation. Its clinical effect is seen in several hours, unlike Fluoxetine for example, where a week or so of treatment is required to see the effect for Premature Ejaculation. Paroxetine works equally well with two important differences: It needs to be taken three to four hours prior to sex and it is vastly cheaper.

What Dapoxetine/ Priligy dosages are available?

Dapoxetine/Priligy is manufactured in 30, 60 and 90 mg strengths. Research shows that patients with lifelong Premature Ejaculation respond best to the 60mg dose and those with more recent onset ie in preceding weeks or a few month only, require 30 mg. Increasing the dose to 60 mg by the second (recent onset) group conferred no additional clinical benefit. At askthedoctoruk clinic, we stock 30 and 60 mg strengths only. The questionnaire specifically deals with this issue to ensure you are prescribed the correct dose.

Paroxetine 20 mg seems to suit most men with Premature Ejaculation

How is Dapoxetine/Priligy taken?

When taken between one to three hours prior to intercourse, most patients note definite clinical benefit with their Premature Ejaculation.

How is Paroxetine taken?

Clinical trials and patient experience confirm that this works best when taken three to four hours prior to intercourse.

What is available from Ask The Doctor?

Dapoxetine (Priligy) is the most officially approved medication licensed for Premature Ejaculation in EU countries and is the only UK licensed prescription medication which we recommend for patients. Priligy was licensed for treatment of Premature Ejaculation in March 2012. Other medications, while as yet unlicensed can be safely prescribed by a registered doctor for specified patients.

Paroxetine: this SSRI with long safe clinical use as an antidepressant can be used off license on an individual named patient basis.

EMLA cream is also available but while a cheaper option, is less practically and reliably helpful for most.

What are the side effects of Dapoxetine (Priligy) and Paroxetine?

Men with serious liver disease should not take it, as drug elimination is impaired. Cases with serious heart disease should also not take it as heart conducting defects may be worsened. This is true but more relevant to long term regular use. Similarly, patients with a permanent pacemaker should avoid this medication for the same reason.

Price List

Medication Strength per dose Pack size Price £
EMLA Cream 25mg 5 20
EMLA Cream 25mg 30 30
Priligy 30mg 3 60
Priligy 30mg 6 100
Paroxetine 20mg 14 50