Premature Ejaculation Treatment
Time is important
Premature Ejaculation Therapy and Treatment
Our premature ejaculation therapeutic approach is based on the latest clinical studies, guidelines from international scientific societies of sexual medicine and our extensive clinical experience.
Our therapeutic protocol follows a personalized and multimodal approach which consists of a combination of the following elements:
Patient information and education
The patient suffering from premature ejaculation receives an adequate explanation of the main characteristics of their disorder. Patient education is a fundamental phase for the success of the treatment, especially in the case of subjective and variable premature ejaculation.
Secondary Premature Ejaculation: Treatment and Control of Risk Factors
Initial treatment aims to correct the identified risk factors. >> see 2. Acquired or secondary premature ejaculation - causes
a) Behavioral therapy
You can improve ejaculation control and ejaculation time with techniques such as "Start-Stop" and "Start-Stop-Squeeze".
This type of therapy may be more useful for those suffering from secondary, episodic and subjective premature ejaculation.
b) Local anesthetics
One of the leading theories on the causes of premature ejaculation is genital hypersensitivity. The application of local anesthetics on the glans may therefore be helpful for some patients. Options include:
· Creams (eg EMLA)
· Condoms with local anesthetics
It is important to use local anesthetics correctly in order to achieve an optimal dosage and to avoid completely numbing (anesthetizing) your partner's penis or genitals.
c) Antidepressant drugs - selective serotonin reuptake inhibitors (SSRIs)
Several antidepressants cause delayed ejaculation by increasing the intravaginal ejaculatory latency time (IELT):
paroxetine: increases by 9 times
escitalopram: increases by 5 times
fluoxetine: increases by 4 times
sertraline: increases by 4 times
When using SSRIs, it is important to evaluate the dosage and type of intake, as needed (eg before intercourse) or daily. It is important to follow the instructions of the specialist which may vary according to the type of disorder.
d) drug therapy
Dapoxetine (Priligy®) is a drug specially developed for the treatment of premature ejaculation and is therefore the initial treatment for almost all patients. Its advantage is that it has a fast effect and has a short duration, which means that it can be taken shortly before sexual intercourse (1-2 hours).
Some scientific studies report that the daily use of alpha-blockers (such as tamulosin and silodosin), usually used for the treatment of disorders related to prostatic hypertrophy, can improve ejaculation time. This type of drug is usually prescribed to patients who have not benefited from dapoxetine (and who also have urinary disorders)
inhibitors PDE-5 inhibitors can be an excellent option in patients suffering from premature ejaculation secondary to erectile dysfunction. If premature ejaculation does not improve after treatment for erectile dysfunction, PDE-5 inhibitors should be supplemented with other treatment options.
e) Intracavernous injection therapy
In more severe cases of premature ejaculation, such as ante-portam ejaculation (i.e. even before starting intercourse), where other treatments have not been successful, alprostadi injection therapy can allow the patient to maintain an erection even after ejaculation and to resume intercourse.
This therapeutic modality may not be particularly pleasant for patients, but it can improve the sexual satisfaction of the partner and, in some cases, help to better control ejaculation.
f) Combined therapy
Many patients with premature ejaculation do not respond to individual therapeutic modalities and require combination therapy.
Patients suffering from ejaculation due to a genital problem such as short frenulum or phimosis can benefit from surgical correction of the problem.
Circumcision should not be considered as a routine treatment for premature ejaculation, as it may not do any good if you have a healthy foreskin.