While occasional premature ejaculation is often not a concern for men, for many men the condition is chronic and requires treatment because it happens so frequently during sexual activity.
Premature ejaculation is the early release of semen during sexual activity, typically within a minute or so of intercourse. It is among the most common sexual complaints. Odds are pretty good that every man will experience some type of premature ejaculation at some point in their sex life, but it typically is not a concern because it happens infrequently. But for some men, premature ejaculation is a regular occurrence, if not during every sexual encounter. For these men, treatment is an important course of action to maintain a healthy sexual relationship.
Men may be diagnosed with premature ejaculation as a chronic condition if they:
- Always or nearly always orgasm early during sexual activity, within one to three minutes
- Cannot control ejaculation during sexual activity nearly all or all of the time
- Feel anxiety and frustration about the condition and avoid sexual intimacy because of it
There are a variety of treatment options for premature ejaculation, including behavioral therapy, counseling, medication, and products such as condoms to help reduce the occurrence. Among the treatments available are drugs like antidepressants that are licensed for other purposes, but have been found to help delay ejaculation, as well as help improve sex for men and their partners.
What else should I know about premature ejaculation?
One of the main symptoms of premature ejaculation is the inability to control or delay ejaculation during sexual activity. Some research has shown that the average time it takes for men to ejaculate during sexual activity is about five minutes. But for men who suffer from premature ejaculation, their orgasm occurs within three minutes of penetration, and in many cases less than one minute. This can be true in all sexual activities, including masturbation.
Medical professionals define premature ejaculation in two ways:
- Lifelong premature ejaculation: A condition that occurs all or nearly all of the time during sexual activity, starting with a man’s first sexual experience.
- Acquired premature ejaculation: A condition that develops over time after experiencing sex without any problems controlling ejaculation.
While many men worry that their occasional experience of premature ejaculation equates to a chronic condition, this typically is not a problem to be concerned about. The chronic problem exists if this occurs frequently.
When should a doctor be consulted about premature ejaculation?
When premature ejaculation occurs regularly and is negatively impacting your sex life, it is important to discuss the condition with a doctor. This can be a difficult top to discuss and it is common to feel embarrassed. But your doctor can help you identify the cause of your premature ejaculation. It may be a physical cause or a psychological one. Once the cause is better understood, your doctor will be able to offer recommendations for treatment options that can help increase your ability to delay ejaculation and help improve your overall sex life.
Your doctor will likely ask questions about your sex life and your overall health history. They may want to conduct a physical exam to determine if any obvious physical factors may be the cause of premature ejaculation. Your doctor may order blood tests to help determine this, particularly if you are experiencing difficulty in achieving and maintaining an erection, in addition to concerns about premature ejaculation. Your doctor also may recommend that you visit another specialist, perhaps a urologist or a mental health provider, who specializes in working with patients who suffer from premature ejaculation.
Your doctor also can discuss treatment options with you, including the use of medications that have shown success in helping men delay ejaculation.
How do antidepressants help treat premature ejaculation?
Researchers studying premature ejaculation have found that many medications can help delay orgasm. These medications are not specifically developed to treat the condition. But the researchers discovered that, beyond the reasons they were approved by the U.S. Food and Drug Administration for other medical conditions, they also treat premature ejaculation. In those cases, doctors can prescribe the drugs “off-label,” which means beyond the reason they were licensed.
Research has found that some antidepressants created to help with anxiety and mood disorders are among the drugs that can be used off-label to treat premature ejaculation. Your doctor may choose to prescribe these medicines for your condition, either taken on-demand just before sexual activity or for daily use. These drugs may also be prescribed alone or in conjunction with other treatments for your condition.
With the use of some antidepressants, doctors discovered that a side effect for many men is delayed ejaculation. This is true specifically for selective serotonin reuptake inhibitors, also known as SSRIs, that now are more widely used to treat premature ejaculation.
The various SSRIs used for this purpose include paroxetine (Paxil, Pexeva, Brisdelle), escitalopram (Lexapro), citalopram (Celexa), sertraline (Zoloft) or fluoxetine (Prozac). These medications typically require five to ten days to begin working. But it can take up to two to three weeks in some cases for the treatment to see the full effect of delaying ejaculation. However, some side effects include nausea, perspiration, drowsiness, and decreased libido.
For example, research shows that taking Paxil three to four hours before sexual activity can help with treating premature ejaculation. As Dr. Laurence Levine explains, Paxil helps to inhibit serotonin reuptake in the brain, which affects mood and emotion and delays ejaculation.
While the SSRI dapoxetine is often used as the first treatment for premature ejaculation in some countries, it is not currently available in the United States. Of the SSRI drugs available for use in the United States, paroxetine is believed to be the most effective for treating premature ejaculation.
If your doctor determines that SSRIs do not help improve the ability to control or extend your ejaculation time, they may consider prescribing other drugs as an alternative, including the tricyclic antidepressant clomipramine, known as Anafranil.
