For men suffering from premature ejaculation, the problems can be devastating. It can cause stress, affect their self esteem and have a detrimental effect on their relationship; it may even cause the breakdown of their relationship. When Priligy (dapoxetine) was licensed in 2013 in the UK for the treatment of premature ejaculation in men aged 18 to 64 years, I am sure there was a great deal of excitement among sufferers. The drug was now available on the NHS although it had been available via private prescription since 2010.
Dapoxetine is a type of medication known as an SSRI, selective serotonin reuptake inhibitor, which is a group of medications used most commonly to treat depression. It was not unusual for SSRIs to be used ‘off label’. This term is used to describe a prescription medication that is being prescribed for a condition for which it was not officially approved.
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Types of premature ejaculation
There are two types of PE:
- Primary PE, also known as lifelong premature ejaculation. In this type of PE, the condition has been a lifelong complaint
- Secondary PE, also known as acquired premature ejaculation. This type of PE has developed more recently
Causes of premature ejaculation
There are both physical and emotional factors that may cause PE.
Physical factors include:
Prostate problems – chronic prostate infection known as prostatitis has been found to be closely related to the incidence of PE a man suffers. It has been shown that if the prostatitis is treated then the PE can correct itself
Thyroid problems – an overactive thyroid condition, also known as hyperthyroidism is also closely related to an increase in premature ejaculation. Similarly, once the condition has been treated, the PE can resolve itself
Using recreational drugs
The theory that whether a man has been circumcised is related to whether they suffer from PE. The problem with this theory is that there are diametrically opposite opinions on the subject. One group believes that once circumcised, the end of the penis, which is very sensitive, is exposed and so this will result in PE. The other theory is that if the penis is circumcised then the end of the penis will become desensitised and so PE is less likely. Generally, circumcision is not likely to be worth the risk as a PE treatment and should be discussed with your doctor at length, if this is something you are considering.
Emotional factors can include:
Anxiety can be a major cause of PE. Anxiety triggers the sympathetic nervous system which in turn can trigger ejaculation.
Other stresses which are allied to anxiety such as depression, stress, relationship problems and historic sexual trauma are linked to both primary and secondary premature ejaculation.
Early sexual influences can also affect sexual behaviour. For example, a teenager who fears being caught whilst masturbating may ‘rush things’ and this can become a learned behaviour.
Being brought up surrounded by stigma related to sex can have a long lasting effect on a young mind.
Other treatment for premature ejaculation
For the sake of completeness and bearing in mind that Priligy may not be an acceptable treatment for you, other treatments for premature ejaculation include:
Some measures which may help include:
Masturbating 1 – 2 hours prior to having sex
Using a thick condom in order to reduce the level of stimulation to the penis
Taking a quick, deep breath in order to shut down the ejaculatory reflex. This is an automatic reflex that happens when ejaculation occurs.
Have sexual intercourse with your partner on top. This way they will be able to pull away when ejaculation is about to happen.
Take breaks during sex before ejaculation happens. This will enable you to take your mind off the subject and think, for a short time, about something else.
For people involved in a long term relationship, couple therapy may help to resolve the issue as well as bring them closer together. Couples therapy is carried out by a sex therapist and techniques which they may suggest include:
Addressing any relationship problems. The therapist will help them through the process of resolving any issues.
Another appropriate treatment is to encourage the couple to explore each other’s bodies in a different, non-sexual, way. The aim of this will be to retrain the brain and body. In addition, it can be a very relaxing and intimate experience.
There are techniques that are aimed at teaching ways to reverse learned behaviours, particularly those which can result in premature ejaculation. There are two popular techniques for this:
The ‘squeeze’ technique. This involves your partner masturbating you up until the point of ejaculation when they squeeze the tip of the penis. By holding the squeeze for 10 – 20 seconds, ejaculation is prevented. There is then a waiting period lasting about 30 seconds. The process is then repeated several times.
The other technique is known as the ‘stop-go’ technique. This is similar but masturbating to the point of ejaculation is followed by a break. The process is repeated until ejaculation is permitted.
It can take quite a lot of practice to see positive results from these techniques but it is worth persevering.
Some other SSRI medication has been used to treat premature ejaculation. Types of this drug that have been used include:
To see results from losing these medications can take 2 -3 weeks to become apparent, although some med can achieve quicker results. There are side effects too which are usually mild and will most likely only last 2 – 3 weeks. They include:
- Nausea and vomiting
- Excessive sweating
Topical anaesthetics can also be used to treat premature ejaculation. Lidocaine or prilocaine can be administered as cream or ointment. It is applied to the tip of the penis and will result in reduced sensitivity in the area. The disadvantage of this is that the anaesthetic can be transferred from the penis to the walls of the vagina. In order to avoid this, it has been found that using anaesthetic alongside using a condom can be very effective in prolonging the period leading up to ejaculation.
Phosphodiesterase 5 inhibitors (PDE – 5 inhibitors)
These are a class of drugs used to treat erectile dysfunction; Viagra (sildenafil) and Cialis (tadalafil) are two examples of this class of drugs.
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How does Priligy work?
Dapoxetine, the active ingredient in Priligy helps to reduce the amount of serotonin that is reabsorbed into the nerves. Serotonin is a chemical involved in ‘signalling’ in the nervous system and amongst other purposes, it is involved in ejaculation. Reducing the reuptake of serotonin into the nerves can help to prolong the period of time until ejaculation.
The advantage of dapoxetine over other SSRIs is that it can be used on-demand rather than being taken on a regular basis. This is because it has a much more rapid action. The recommended starting dose for all patients is 30mg, to be taken between 1 and three hours prior to sexual activity. When beginning treatment with Priligy, the 60mg dose should not be taken. As explained above, Priligy does not need to be taken on a continuous basis but is only required when sexual activity is anticipated.
As with most medications, Priligy has some side effects. They include:
In addition, there are some circumstances under which it may not be appropriate to use this medication. They include:
- If you have a tendency to faint
- If you have a heart condition
- If you have epilepsy
- If you have a mental health condition such as bipolar or depression
- If you have liver problems
- If you have kidney problems
- If you have ever had an allergic reaction to the medication
- If you have glaucoma
- If you are taking any other medication including over the counter and herbal products
If any of the above is true in your case, please discuss with your doctor whether or not it is appropriate to take Priligy.
As we have covered, there are a number of options that can help in the treatment of premature ejaculation. Your doctor will be able to advise which is the best option for you!