Treatment of Premature Ejaculation

Premature ejaculation (PE) is a common problem, the treatment of which has received an increasing interest in recent years. Traditional management continues to be psychotherapy, with techniques such as the 'squeeze' and 'stop-start' most commonly employed. The application of local anaesthetics to the glans to delay ejaculation, first described over 60 years ago, continues to be used both in medical practice and as an 'over-the-counter' remedy. Over the years, a variety of psychopharmacological agents, especially antidepressants, have been described as treatments for PE. At the present time, the selective serotonin re-uptake inhibitors, licensed for other indications, emerge as the most effective agents to delay ejaculation, but none are licensed for the treatment of PE. There appears to be a high relapse rate irrespective of the mode of therapy used.
Introduction

It is axiomatic that a man presenting with premature ejaculation (PE) requires proper psychosexual, relationship and medical assessment. As there is comorbidity of PE with female sexual dysfunction,[1,2] the patient's partner should be involved in the assessment process. Both partners' reasons for seeking treatment for PE and what they hope to get out of the treatment should also be elucidated. The physician should ascertain whether these expectations are attainable; if not, initial treatment should address the couple's unrealistic expectations.

It is important to hear a description of the problem from both partners and to listen for similarities and discrepancies in their reports. When rapid ejaculation becomes a problem, it depends not only on ejaculatory latency after vaginal penetration but also on the sexual attitudes of both partners, which vary with the sociocultural background of each. There may be differences in distress levels in the male as compared with his partner. A survey of representative population samples in Sweden, Finland, Estonia and St Petersberg, Russia, found that females stated that PE was a problem in their male partners more often than those men who reported this as a problem. Later cohorts of females reported this problem in their male partners far more commonly than earlier cohorts, suggesting a societal change in female expectations of male sexual performance.[3]

Source
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