“Premature ejaculation (PE) is also referred to as rapid or early ejaculation and is defined according to three essential criteria: (1) brief ejaculatory latency; (2) loss of control; and (3) psychological distress in the patient and/or partner.” UTD. You need all 3 aspects to qualify for the diagnosis.
Treatment options
- 1st-line Rx: SSRIs.Doses e.g. Paroxetine 10 to 40 mg daily, Sertraline 50 to 200 mg daily, fluoxetine 20 to 40 mg daily, citalopram 20 to 40 mg daily, and escitalopram 10 to 20 mg daily. Paroxetine is most effective of the SSRIs for PE. SSRIs take up to 3 wks to work. Stop working when you d/c the SSRI.
- 2nd-line Rx: Clomipramine 12.5 to 50 mg daily. Use when can’t use SSRIs or if they don’t work.
- PDE5i especially for pts w/ co-existing ED. If the pt has coexisting ED, tx the ED first with PDE5i. If it doesn’t work, then add the SSRI.
- Topical Anesthetics e.g. Lidocaine-prilocaine condoms or spray
- Psychotherapy/sex therapy when psychogenic and/or relationship component is suspected.
- Combined psychotherapy with pharmacotherapy works better than either alone.
- Masturbation prior to sex.
- Pause & squeeze technique.
Resources / References
See this article: https://www.uptodate.com/contents/treatment-of-male-sexual-dysfunction