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Prevention and medical treatment of premature ejaculation
Can we prevent premature ejaculation? |
Often, when premature ejaculation is temporary or not very important, treatment is primarily based on psychosexual counseling. Thus, several measures or techniques can help delay the time of ejaculation, including3 :
These “exercises” must be repeated several times in order to be able to last about twenty minutes without ejaculating. Little by little, they will allow better control of ejaculation. |
Medical treatments for premature ejaculation
The recommendations2 recent reports from the International Society of Sexual Medicine advocate a combined care combining, if necessary:
- pharmacological treatment
- psychosexual intervention.
Pharmacological treatment of premature ejaculation
The arrival on the European market in 2013 of the first drug intended to specifically treat premature ejaculation, dapoxetine, changed the management of this disorder4.
Dapoxetine belongs to the class of selective serotonin reuptake inhibitors (SSRIs). It has been marketed under the name Priligy® for the treatment of premature ejaculation in men aged 18 to 64, since the end of March 2013 in France and in 25 countries.5.
In North America, dapoxetine has not yet been approved.
Dapoxetine is not considered an antidepressant because it is very quickly eliminated by the body: there is no trace of the drug in the blood about twenty hours after taking it.
So she acts quickly (one or two hours after taking). It allows, according to clinical studies, to multiply by about 3 the time between penetration and ejaculation, after a treatment period of twelve weeks. Note, however, that taking a placebo tablet also made it possible, according to these trials, to increase this time by a factor of 1,5 to 2.6-8 .
In France, dapoxetine is available in two strengths (30 and 60 mg), in tablet form to be taken on demand, 1 to 3 hours before sexual activity.
The treatment is delivered on medical prescription and is not covered by Health Insurance. The most common side effects are nausea, headache, diarrhea and dizziness.
Remark : It has long been known that selective serotonin reuptake inhibitors, which are a widely used class of antidepressants, have the effect of delaying ejaculation. Until the introduction of dapoxetine (and probably still today, especially where dapoxetine is not available), the various drugs in this class were often prescribed to men with premature ejaculation, but not Marketing Authorization (marketing authorization), that is to say in a context different from that recommended by the manufacturer and the health authorities. SSRIs other than dapoxetine (paroxetine, clomipramine, sertraline and fluoxetine in particular) are all relatively effective against premature ejaculation. Finally, other molecules, such as phosphodiesterase 5 (IPDE5) inhibitors, used in the treatment of erectile dysfunction, may have some efficacy in the treatment of premature ejaculation. |
Local treatment of premature ejaculation
Widely used, apart from official prescription authorizations, the application of a local anesthetic on the glans allows ejaculation to be delayed by “numbing” the penis.4.
The products used are generally based on lidocaine, in gel or spray. To avoid numbing the partner, the anesthetic can be applied for about twenty minutes and then washed off with water before intercourse. In 2010, a spray combining lidocaine and prilocaine, to be applied 5 minutes before sexual intercourse, showed good efficacy in delaying ejaculation. It could be marketed shortly9.
Psychosexual care
Follow-up with sex therapy or psychotherapy is also recommended, especially when the psychological consequences of premature ejaculation are significant, when there is strong performance anxiety or a relationship problem.
The French Association of Urology10 advises a behavioral therapy which consists in practicing a sexual activity voluntarily interrupted, “before the onset of the anxiety of result”. After several weeks, it becomes easier to feel the arrival to a point of no return before ejaculation, which allows for better control.
However, the effectiveness of these measures is unpredictable.
السلام علیګم ښه پر زړه پوری معلومات دي خو داسي نه ښی چی یو څوک ور نه ګټه واخلی