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Q: Is my premature ejaculation treatable?
A: Yes. There are three main ways to treat PE: desensitizing creams, SSRI antidepressants, and erectile dysfunction (ED) medication.
We believe PE is caused by a higher level of sensation between the penis (typically the head and bottom of the penis) and the brain. When the penis starts to feel pleasure, the brain gets triggered into the loop that results in ejaculation. So how do you interrupt the loop? The creams are one way. Men who can tolerate them prefer creams because they are not taking a medication. They work by numbing the nerves that send signals from the penis to the brain.
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Another way to do it is to raise the levels of serotonin in the brain with medications known as SSRIs. SSRIs are medications that are typically used to treat depression and other mental health disorders. During the initial trials for SSRIs, guys were saying they felt better but ejaculated after 45 minutes when it used to take them 15. So that’s how we learned SSRIs are a great way to control premature ejaculation.
There are two types of premature ejaculation. There’s the type that you’re born with (congenital) and the type that you develop over time (acquired). The most common type is congenital. Most men will tell you, “I’ve had this for my entire life. From the initial time I ejaculated from masturbating or my first sexual encounter, I ejaculated within 15 seconds.” You were born with that, versus the guy who comes to me at age 50 and says, “Everything was normal, but now I ejaculate too quickly.” The second question I always ask him is, how are your erections?
The answer usually is, “Not so good.” What’s happening is sort of like your Macbook—it knows it’s about to lose battery power, and it stops you from doing anything on your keyboard and says, “Saving all your data before shutdown.” It’s the same thing with ED and premature ejaculation. Your brain knows you’re going to lose your erection and not be able to penetrate your partner, so let’s just ejaculate now. This brings us to the third method of treatment. For these guys, when you use a PDE-5 inhibitor (such as Viagra) to give them a better erection, they will usually last longer because you’re improving that process.
I don’t think any one of these methods works better than the other. It’s really more about personal preference. Some men don’t like pills. Some men don’t like thinking that they’re on an antidepressant because they’re not depressed. And unfortunately, some of those SSRIs at higher doses can lead to decreased sexual desire and other sexual dysfunction. The downside to the creams is that it does ruin a little bit of the intimacy: You have to wait 15 minutes for it to work, or it can numb your partner’s vagina or mouth.
But for the patients who are diligent with taking their medications, I think we have upwards of an 85% success rate.