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Overcoming Premature Ejaculation with New On Demand Therapies

Author: Sheena H
Reviewed by Michael Hua, Pharm D

As a man, when you are participating in sexual activity with a partner, one of your most pressing concerns will be to make sure your partner is just as pleased with the experience as you. However, if you are dealing with premature ejaculation (PE), sex with a partner can be frustrating because you feel like you cannot last long enough to deliver a satisfactory experience.

As difficult as PE is to talk about, this is a very common sexual function issue among the male population. Further, there are treatments available that can help, even one off-label medicine that can be taken as needed to prolong the sexual experience. Here is a closer look at what defines PE, how to stop premature ejaculation, and a new compounded medicine that may help a great deal.

How Many Men Are Affected by PE?

PE is considered to be highly underreported because many men do not disclose their issues to their doctor. Nevertheless, some estimates claim that as much as 30 to 40 percent of men deal with premature ejaculation at some point in their adult life. PE is thought to be the most prevalent problem related to sexual function in men and it could affect as many as one out of every five adult males.

The primary symptom of premature ejaculation is simply ejaculation that occurs sooner than what would be desired during sexual encounters. The precise definition of the duration of stimulation for ejaculating prematurely can vary depending on different medical organizations. Usually, PE means ejaculation occurs within a minute or soon after penetration or sexual activity begins.

In any case, if you feel that you are ejaculating too quickly to have satisfactory sex with your partner and it is causing issues, it is important to reach out for medical advice. Secondary problems related to PE include:

  • Depression

  • Performance anxiety

  • Unsatisfactory sex life

  • Relationship problems

PE is diagnosed mostly through discussion with your doctor. There is no lab test or blood test that can really determine that you do have PE. Instead, your doctor will ask you several questions. While PE can be relatively uncomfortable to talk about, it is important to be as open as possible so you get an accurate diagnosis and the help you need. Some things your doctor may ask include:

  • How often does the problem occur?

  • Does PE happen during masturbation and with a partner?

  • How long have you been experiencing problems with PE?

  • Are there certain circumstances when PE occurs?

  • What would you estimate your time-to-ejaculation to be?

  • Do you have issues with erectile dysfunction?

The doctor may also ask a few questions about your medical history or any medications you are currently taking, as these factors may also affect your sexual function.

A number of factors can be behind PE, including psychological, chemical, and physical factors. In some cases, men with PE will be dealing with more than one underlying cause. Physical causes can be anything from hormonal imbalances to low dopamine or serotonin levels. Likewise, some men are purely dealing with ultra-sensitivity of the nerves that are found in the penis. Chemical issues can be related to taking certain medications or using certain illicit substances.

As far as emotional or psychological factors that can be behind PE, several factors could also be to blame, such as:

  • Stress

  • Nervous anxiety

  • Guilt

  • Depression

  • Relationship problems

In addition, something as simple as remaining abstinent for long periods or being overly excited could cause you to ejaculate prematurely.

Oftentimes, PE has both physiological and psychological factors involved. Therefore, a lot of doctors recommend a multifaceted approach to treatment that includes some form of natural behavioral modification that may help slow ejaculation times.

Medicine for Premature Ejaculation

Historically, medicine for premature ejaculation has been limited to medications that are meant to treat erectile dysfunction as a whole and not just problems with PE. For example, some doctors recommend sildenafil (Viagra) or tadalafil (Cialis), both of which are primarily designed to help men retain an erection. These medications do nothing to slow down ejaculation but may help with continued activity after ejaculation.

Over-the-Counter Aids for PE

Numbing agents in the form of desensitizing sprays or creams are common recommendations. And, some of these agents have been clinically proven to be effective for prolonging ejaculation. For example, studies done on a PE spray made with lidocaine showed that some men gained around four minutes during product-use events. The only issue with these numbing agents is they are not very discreet because they must be applied immediately before sex, and they can also cause too much sensitivity loss if you use too much. Further, some men have issues with topical products transferring to their partners during sex.

How to Stop Premature Ejaculation Naturally

A few things you can try at home for PE include methods meant to help you learn to control the feelings and thoughts that generate an orgasm. For example, the stop-start method involves stimulation until you feel orgasm is close, and then stopping stimulation until the urge to ejaculate subsides. This process can be done repeatedly during sex to prolong orgasm. Another option, referred to as the squeeze method, involves sex until the urge to ejaculate happens, stopping, and then applying firm pressure to the glans of the penis until the urge to ejaculate passes.

Distracted or controlled thought processes may also help; the idea is to pull your focus away from the stimulation and think about something else, such as going over a list of your favorite sports in your mind. Sometimes, relationship issues and performance anxiety may also be involved in PE, in which case some level of counseling may be recommended.

Pelvic floor exercises may also help. These exercises help to build the pelvic floor and the muscles that surround your groin. Therefore, strengthening these muscle groups may give you more bodily control during sexual intercourse, which may help you delay ejaculation.

For some men, wearing a thick condom during sex can help with PE. The thick condom deters some of the sensitivity levels that lead to orgasm during sex, so you may be able to prolong the experience a little. Some companies do market condoms specifically for men who have issues with PE.

Selective serotonin reuptake inhibitors (SSRIs) are one of the most common medications prescribed for depression. However, one of the non-intended side effects of SSRIs is delayed orgasm, especially in men. Therefore, theoretically, SSRI medication was proposed as an option that could help with premature ejaculation when prescribed for off-label use.

Some medical professionals recommend SSRIs for daily use for premature ejaculation, but on-demand treatment (taking the medication only when needed for sex) is a more viable option with fewer side effects. The most well-researched SSRI for premature ejaculation that can be taken on-demand is clomipramine, which can be compounded at a compounding pharmacy.

An in-depth effort was done to decide how much of the SSRI clomipramine should be taken for PE in 2021. In total, 14 randomized controlled trials that involved 710 patients were analyzed by researchers to determine the best dosage of clomipramine to delay ejaculation. The best outcomes occurred at a dose of 50mg; this dose was less likely to cause adverse reactions or undesirable side effects.

Another study published in the Journal of Urology found that an on-demand dosage of 15mg of clomipramine improved the intravaginal ejaculation latency time from 68 seconds to 260 seconds on average. No major adverse side effects were reported by the men taking the medication. The study also demonstrated that the SSRI could be an effective solution without being taken every day.

Issues with premature ejaculation can definitely interfere with your sexual health and personal relationships. However, PE is very common and is often something that can be improved with a combination of the right medications and behavioral training. It also doesn't hurt to talk openly to your partner if you are in a steady relationship so they understand your issues and can work with you to find solutions.

Using an SSRI like clomipramine for PE has been shown to be an effective option for many men, and there is no need to take the medicine every day or take a high dose to see an improvement. If you would like to know more about clomipramine, reach out to one of our pharmacists at Harbor Compounding Pharmacy so we can help.

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