Premature ejaculation (PE) is a common problem that many men face, and one which brings feelings of shame and embarrassment. Understandably, it can also be a tough topic for physicians to broach with their patients, albeit an important one. PE is one of the most common sexual dysfunctions men face, making it imperative for doctors to initiate a dialogue on the subject in a safe and encouraging fashion.

But what’s the best way to do so? One suggestion is to broach the subject by asking broad questions about the patient’s sex life, rather than a specific inquiry regarding PE. Posing questions such as, “How is your sex life?” or “Are you having any sexual problems?” can serve as a gateway for patients to discuss their problems.

 

The difference between PE and ED

It is also very important to make note of the difference between PE and erectile dysfunction (ED). While both can impact men of any age, PE tends to affect younger men while ED tends to affect older men. Additionally, ED tends to have high co-morbidity rates with other diseases, such as diabetes and vascular diseases, while PE is not known to have any co-morbidity. Oftentimes, PE has a greater psychological impact on relationships than ED because the man may be perceived as being selfish in bed rather than suffering from a serious medical condition.

Once the subject of PE is addressed, it’s important to help patients understand what’s normal in a healthy sexual relationship. Many men watch pornography, and this has distorted their impression of normal sexual intimacy. Watching porn frequently causes men to draw unrealistic comparisons between themselves and the porn. This begs the question, what is the average amount of time most couples have intercourse for? The standard time most couples last ranges from four to five minutes. Australian men have clocked in at the top at six minutes, while American men tend to fall in the middle at about five.

 

Treatment

And now, doctors must answer the question, what is the best way to treat PE? It can be hard to treat, because there are no FDA-approval drugs as of now. There are many clinical trials in place, but to join, a patient must meet strict criteria for PE, including the inability to participate in any intercourse for more than a minute. Most often, doctors use off-label anti-depressants, such as Zoloft, Paxil, or Prozac, as these have all proven to help delay orgasm. Other off-label treatments include Tramadol and Cialis, and clinical trials of Botox are currently underway.

If a doctor doesn’t want to take the drug route, there are always topical options. Topical treatments are often safer, as they have no systemic side effects and can generally be taken on-demand, directly prior to sex. Topicals, such as Promescent, an over-the-counter spray that helps prolong intercourse, or Pre-Boost, a wipe that functions similarly, are great alternatives to prescription medications.

The last takeaway for men struggling with PE is they should know they’re not alone. It’s important for them to have conversations with their partners about what their medical problems entail. Also crucial to note, men aren’t the only ones suffering from sexual dysfunction; studies show as many as 43% of women may experience sexual dysfunction.

Jed Kaminetsky, MD
Dr. Jed Kaminetsky, M.D. is a Clinical Associate Professor at New York University Medical Center and is a practicing urologist with University Urology, one of the largest urologic practices in the New York City metropolitan area. Additionally, Dr. Kaminetsky is the Medical Director of Manhattan Medical Research. He is a highly regarded urologist and skilled in treating all urologic disorders and performing minimally invasive prostate surgeries. Dr. Kaminetsky’ academic interests include the study of both male and female sexual dysfunction, which has led him to become a national and world wide thought leader. Dr. Kaminetsky work has been published in many medical journals which led to a nationwide recognition and development of various treatment schemes for patients with sexual and erectile dysfunction. He is currently conducting studies addressing premature ejaculation, ED, male and female sexual dysfunction, BPH, prostate cancer, bladder cancer, voiding dysfunction, and hypogonadism. He has been a Sub-Investigator on a multitude of various diseases, including Diabetes, Osteoporosis, Influenza, Crohn’s Disease, Psoriasis, Osteoarthritis, and Acne.

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