Advice: A common, difficult problem to treat.
Refer To: Men may benefit from psychosexual counselling.
This is a common problem, and does not have a urological cause. PE is difficult to define, but the WHO provide the following definition:
Inability to delay ejaculation sufficient to enjoy lovemaking, and/or ejaculation before or soon after the beginning of intercourse.
Prevalence in the population runs at 20-30%, and it can have major emotional and relationship effects. It may be acquired or lifelong.
Causation is unclear, but there may be the following associations:
- Psychological problems (probably the majority)
- Hormonal (hyperthyroidism, increased leptin). These associations have not been proven.
Care is required with potential treatments.
- Psychosexual counselling, if indicated.
- The following treatments may help, but are ‘off-label’ for premature ejaculation. Side effects are common. They are mentioned here purely for educational interest and treatment with these agents is not necessarily recommended.
- Topical local anaesthetic preparations
- PDE-5 inhibitors