Premature Ejaculation (PE) is a legitimately-recognized medical problem that needs a thorough medical evaluation. In many cases, sex therapy can also help in solving this particular problem and it is sometimes recommended that patients be treated by both a physician and a sex therapist concurrently.
A first appointment will typically be between 45 and 60 minutes. It will include both a verbal history and a physical exam. We will take a thorough medical history because in order to place your premature ejaculation in the context of your history. This may include questions such as how long you last prior to ejaculation. Some men ejaculate during foreplay. There are men who even ejaculate while in the process of getting undressed and before significant contact has occurred. Others penetrate, but ejaculate much earlier than they would like and spend most of the time inside attempting not to ejaculate. Some other questions include:
- What is the quality of your erections?
- What happens when you try to have intercourse?
- Do you have decreased rigidity?
- Do you have difficulty maintaining your erection?
- At what point do you lose your erection?
- Do you wake up in the morning or at any point while sleeping with an erection?
- How rigid are the nocturnal erections?
- What is your sexual interest level (libido) like?
- Does your penis have a curve, bend, or twist in it when it is rigid?
- What is the status of your relationship? Are you married, divorced, single, gay, etc.?
- How is the relationship going?
You might have an issue of premature ejaculation along with erectile dysfunction. Here, it’s very important to determine which came first. Many men with erectile dysfunction have difficulty maintaining their erections even prior to ejaculation. Since they feel consciously or subconsciously pressured during intercourse to ejaculate prior to losing their erections, they can sometimes get into the habit of having premature ejaculation.
But let’s assume that the erectile dysfunction preceded the premature ejaculation. Usually, then we’d deal with the erectile dysfunction as the primary issue. Often, when these men can achieve successful and long-lasting erections, they will not ejaculate as quickly. If after treatment for erectile dysfunction the premature ejaculation remains a problem, we would look at that separately.
You and your doctor may discuss other subjects depending on his thoughts on diagnosis. These include:
After ejaculation, how long does it take you to have a second erection and reach an orgasm?
This information will be useful in determining treatment options. Some men have long-standing premature ejaculation, but their habit has been to ejaculate quickly (either through masturbation or with their partner) for the first ejaculation and then to have more leisurely intercourse because they last longer the second time. Many of these men come to the physician when they get older or have other medical problems and lose the ability to get a rigid second erection in the same lovemaking session. At this point, the premature ejaculation interferes significantly with their lovemaking.
How often do you ejaculate?
This can be either through masturbation or with a partner. Many men who develop premature ejaculation do not have satisfying sexual experiences. Because of this, they become somewhat avoidant of sexual situations even in the context of a relationship or marriage and have decreased frequency of intercourse and ejaculation. With decreased frequency and longer time periods between ejaculations, many men will ejaculate more quickly. Premature ejaculation can then become a vicious cycle. One of the ways of breaking the cycle is to encourage the man to ejaculate at some point prior to intercourse so that he will then last longer during intercourse.
How has the premature ejaculation affected your relationship?
Often, premature ejaculation is a chronic problem. For many couples, this has caused significant disturbance in their sexual relationship. Many partners harbor significant resentment, especially if this is a problem that the man has refused to address for a number of years. Usually, a partner is very grateful that the man has sought treatment because it shows that he understands there is a problem and would like to satisfy his partner more completely.
Have you had prior treatments?
If you have been placed on medication, it is important to know which medication and the dosage. If you have done any behavior modification, it is important to let the physician know this as well.
Your physician will do biothesiometry (a simple and painless procedure) to check the threshold for sensation of vibrations in your penis. Recent studies have shown that men with premature ejaculation tend to have a decreased threshold for sensation. In other words, their penises are more sensitive. Since ejaculation is a reflex (one that is modified to some degree by conscious thought) these men will ejaculate more quickly. It just takes much less stimulation to trigger their reflex.
There are several different treatment options. We generally recommend a combination of interventions. Treatment options include:
- Behavior Modification – You can learn behaviors and techniques to make you last longer. There are several good books and exercise videotapes available.
- Medical Treatment – There are a number of medical options available including medications that may significantly delay ejaculation. Some medications and treatments allow a patient to maintain an erection even after ejaculation so you can more completely satisfy your partner. Sometimes, it is possible for a man to ejaculate a second time prior to losing his erection.
- Topical Anesthetics – Frequently, we recommend a topical anesthetic as part of the plan. They are safe, fast-acting, and easy-to-use. We are having good success with Promesent, a new topical spray available on-line (www.promescent.com) or at our office. We also often write men for a prescription cream, which is a combination of Lidocaine and Prilocaine.
A specialist will offer a variety of options based on what is appropriate for each particular situation. Patients should always participate fully in developing a treatment plan that will work best for them.