Therapy of praecox ejaculation

Praecox ejaculation ( PE) is a trouble of normal ejaculatory latency implying an early orgasm after few seconds or minutes after penetration. In extreme cases the orgasm can happen only because of strong arousal without penetration or penis manipulation. In most cases ejaculatory latency time ( IELT) is one/two minutes.

PE is a condition that generates frustration of men and dissatisfaction of partner, giving rise to great discomfort of couple requiring Andrologist consultation and psycho-sexologist counseling.  Sometimes after prostate/vesicular inflammation can take place a transient PE that slowly disappears with healing or rather can undergo alternating phases of regression or relapse.

Onto PE play a crucial role some psycho stimuli especially those related to stress or performance anxiety: particularly the second  is promoted from the more or less sensed fear of experiencing detumescence also partial during intercourse. In those situations an early orgasm, putting end to coitus, rescue man from so unpleasant condition of feeling his penis become more or less flaccid during sex.

Other psycho factors can depends on penis size and shape dissatisfaction with inadequacy feelings or on other psycho-sexual disturbances as about gender identity and role, mommy issues or more generally discomfort with women as about discharging sperm into vagina and so on. In the vast majority of cases is present some hypersensitivity of glans and prepuce mucosa able to trigger an immediate ejaculatory reflex as soon as touched. This hypersensitivity  can be present since childood  or can follow circumcision  that exposes glans till then covered by skin and therefore less sensitive to external rubbing. 

Therapies for PE intend to counteract those two main causes of problem, i.e. psycho-emotional and hypersensitivity conditions. Onto psycho-emotional sphere are effective drugs like inhibitors of serotonin reuptake that produce a general sedation and consequent relative inhibition of ejaculatory reflex. More recently have been proposed and employed with some success Tramadol a central opioid drug that besides can promote addiction especially if taken longtime. 

To avoid those side effects or adverse reactions by prolonged consumption those drugs can be taken on-demand i.e. only before a sexual intercourse.  The second way to afford this condition is to desensitize glans and prepuce  mucous membranes with physiotherapy as described before. Moreover are available on the market many  medicinals as cream or spray able to desensitize partially penis distal areas, but those products acting as neuroleptic , have the disadvantage of intercourse to be planned, that not always is possible or pleasing.

So, according to our opinion, the best way to treat PE consists in desensitizing progressively the penis mucosal areas adding, whenever it should be not sufficient, a neuroleptic drug customizing dosing to individual feedback.
In our experience the majority of patients respond in a satisfactory way to physiotherapy alone. But the association with neuroleptic drugs can resolve also the hardest cases.