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Facts about premature ejaculation

With prevalence rates of 20%-25% premature ejaculation (PE) represents the most frequent sexual dysfunction in men, reporting negative consequences for the sufferers and their partners.
The serious impact of PE on men and the partner include decreased sexual functioning, decreased levels of satisfaction, lower overall quality of life, increased levels of distress and higher levels of interpersonal difficulties.
There are several definitions of PE:
The first definition was concluded by an international expert panel appointed by the International Society for Sexual Medicine (ISSM). Acquired and lifelong PE is a male sexual dysfunction characterized by a sum of the following characteristics:
ejaculation which always or nearly always occurs prior to or within about one minute of vaginal penetration, and
the inability to delay ejaculation on all or nearly all vaginal penetrations, and
negative personal consequences, such as distress, bother, frustration and/or the avoidance of sexual intimacy.

 

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A new definition, published by the American Psychiatric Association (APA), related PE to the following features:

The persistent or recurrent pattern of ejaculation during partnered sexual activity within 1 minute following penetration or before an individual wishes it;
Lasting more than 6 months
Causing the patient a clinically relevant distress

Porst et al are pointing out that in a small set of patients, ejaculation occurred even prior to vaginal penetration, a phenomenon called ante-portal ejaculation, that represents the most severe form of PE.
Defining PE must take into consideration the high degree of psychosocial impact of PE.
A persistent PE, as well as unsuccessfully treated PE, are marking in a severe way the individual and his relationship.

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Moreover, a study conducted in 3 different ethnic groups, in South Korea, Italy and Mexico revealed for the first time that chronic PE can lead to relationship break-ups and even for divorces.
Also, premature ejaculation can occasionally make fertilization difficult for couples who are trying to have a baby if ejaculation doesn’t occur intravaginally.
Initially, researchers are not sure what causes premature ejaculation, but PE has been linked to health conditions like prostatitis (inflammation of the prostate gland), anxiety and other psychological issues, and (rarely) hyperthyroidism.  In addition, men with erectile dysfunction (ED) may experience PE because they have “learned” to ejaculate before losing their erection.
Some experts theorize that PE could be genetic in some men. Others believe that a chemical imbalance or receptor sensitivity changes in the brain are involved, at least for some men.
Nowadays, the experts agree that PE involves a multifactorial interaction of psychological and biological factors.
Psychological causes such as poor body image, depression, worrying about PE, or guilty feelings that increase your tendency to rush through sexual encounters are linked to developing PE.

Biological Factors

A number of biological factors might contribute to premature ejaculation, including:

  • Hormonal imbalance;
  • Abnormal levels of brain chemicals called neurotransmitters;
  • Inflammation and infection of the prostate or urethra;

 

Treatment for Premature ejaculation

Treatment for PE may help to increase the duration of intercourse and improve self-esteem and self-confidence.
Dapoxetine (Priligy) is the first approved treatment for the treatment of PE.
Dapoxetine (Priligy) is a short-acting selective serotonin reuptake inhibitors (SSRIs) (time to peak concentration, 1 hour) developed specifically for on-demand treatment of premature ejaculation, in adults between 18 and 64 years old.
Priligy works by increasing the time it takes to ejaculate and can improve the control over the fast ejaculation.
Taking into account the physiology of ejaculation and emphasis of serotonergic control, Delayed ejaculation was reported as an adverse effect of selective serotonin reuptake inhibitors (SSRIs) in men, making this class of drugs an excellent candidate for the treatment of PE.
After oral administration, peak plasma concentrations of dapoxetine are reached after an hour. Elimination is relatively rapid, and the terminal half-life is approximately 19 hours.
Priligy is nowadays used often on demand for treating PE because of its rapid action and short half-life.
Currently, dapoxetine is approved for the treatment of PE in over 50 countries.
Priligy is available in two strengths (30 mg and 60 mg).
Its safety and efficacy were proven in several randomized controlled trials (RCTs) on more than 6,000 men with PE in over 25 countries.
Dapoxetine was comparably effective both in men with lifelong and acquired PE.
The results of the treatment are often very good.
Both partners may appreciate the improvement in mood and their sense of general well-being that can last for hours, days or weeks after a positive, shared sexual experience.
Good sex does not always mean longer sex.
It was quite a surprise when ISSM reported that the average duration of intercourse, from penetration to orgasm, is around five minutes. It is a general fact that it can vary very considerably over time in a single sexual relationship. Good sex means long enough to be satisfactory for both partners. Both thirty seconds and ten minutes can be “great sex”.

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Safety of dapoxetine (Priligy)

During the trials, nausea (11%), headache (5.6%), diarrhoea (3.5%), somnolence (3.1%) and dizziness (5.8%) were more commonly reported with dapoxetine 30 mg than with placebo.
These events were dose-related – all of them were more frequent with the 60 mg dapoxetine dose. Nausea and dizziness were the most common reasons for discontinuation with dapoxetine 30 mg. Because of the increased risk of adverse events, patients should be warned to take no more than one tablet in a 24-hour period.
Sexual adverse effects including erectile dysfunction, abnormal ejaculation and decreased libido were more common with dapoxetine than placebo. These occurred in 2.9% of patients taking dapoxetine 30 mg and 3.8% taking dapoxetine 60 mg versus 1.5% of patients taking a placebo.
An important concern is an orthostatic hypotension, that is when your blood pressure drops too much when you stand up from lying down.

Special warnings related to the dapoxetine treatment are underlined below.

Patients must take care when they feel dizzy, light-headed or feeling like fainting. The immediate measures when feeling these unwanted reactions is lying down with your head lower than the rest of your body or sitting down with your head between your knees until you feel better. This will stop you from falling and hurting yourself if you do faint.
Also, it is recommended to avoid alcohol when taking Priligy.
Priligy must be taken before sex, 1-3 hours in advance, with at least one full glass of water.
The maximum recommended dose is one tablet of Priligy (30 mg or 60 mg) per day.

Also, it is not recommended to take Priligy if you are in the case of administering one of the following:

  • Medicines for depression called ‘monoamine oxidase inhibitors’ (MAOIs)
  • Thioridazine used for schizophrenia
  • Other medicines for depression
  • Lithium a medicine for bipolar disorder
  • Linezolid an antibiotic used to treat infections
  • Tryptophan a medicine to help you sleep
  • St John’s wort, a herbal medicine
  • Tramadol used to treat serious pain
  • Medicines used to treat migraines, like sumatriptan, also called Imigran®; Migraitan®

It is important to read the Patient Information Sheet before initiating the treatment with Priligy. For any questions related to its efficacy and safety please write an email at [email protected]
Remember that you must have a prescription when ordering Priligy.

 

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References:

  1. http://www.issm.info/sexual-health-qa/what-is-premature-ejaculation/
  2. Porst, H., & Burri, A. (2018). Novel Treatment for Premature Ejaculation in the Light of Currently
  3. Used Therapies: A Review. Sexual Medicine Reviews. doi:10.1016/j.sxmr.2018.05.001
  4. Burri et al. Female Partner’s Perception of Premature Ejaculation and Its Impact on Relationship
  5. Breakups, Relationship Quality, and Sexual Satisfaction
  6. http://www.ema.europa.eu/docs/en_GB/document_library/Referrals_document/Priligy_29/WC
  7. 500124577.pdf
  8. Giuliano F, Clément P. Physiology of ejaculation: emphasis on serotonergic control. Eur
  9. Urol2005;48:408-17. [PubMed]
  10. Sangkum et al. Dapoxetine and the treatment of premature ejaculation
  11. Safarinejad MR. Comparison of dapoxetine versus paroxetine in patients with premature
  12. ejaculation: a double-blind, placebo-controlled, fixed-dose, randomized study. Clin
  13. Neuropharmacol 2006;29:243-52.

 

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