Premature Ejaculation – Diagnosis & Treatment

What is Premature Ejaculation (PE)?

Premature Ejaculation (PE), also referred to as early or rapid ejaculation, is defined by the International Society for Sexual Medicine (ISSM) as “a male sexual dysfunction characterized by 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. It often causes significant anxiety and frustration for the couple and can lead to avoidance of sexual intimacy.

Premature ejaculation (PE) is uncontrolled ejaculation either before or shortly after sexual penetration. It happens with minimal sexual stimulation and before the person wishes. It may result in unsatisfactory sex for both partners.

Premature ejaculation is traditionally categorized into either Lifelong PE or Acquired PE. Patients with lifelong PE could never achieve a normal ejaculatory experience, often ejaculating in less than 1 minute. In the case of acquired PE, there is usually a contributory factor such as performance anxiety that causes rapid ejaculation in otherwise healthy individual. Patients with acquired PE may experience an ejaculatory time of less than 3 minutes. While premature ejaculation is more common in younger men, it can happen at any age.

PE is by far one of the most common forms of sexual dysfunction affecting as many as 1 in 4 adult men in Canada, according to the survey conducted by Canadian Male Sexual Health Council in 2009 (1). Still, many experts believe that PE is probably under-diagnosed as many men find it difficult to openly discuss it with their care providers.

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Diagnosis of Premature Ejaculation

Having an orgasm too soon is not always cause for concern. However, clinical diagnosis is made when a man exhibits the following symptoms:
  • Ejaculation occurs too quickly, often in the first few minutes of intercourse, or in other sexual situations, even during masturbation.
  • Inability to delay ejaculation most of the time.
  • Feelings of anxiety, or avoidance of sexual intimacy as a result.

Both psychological and biological factors can play a role in premature ejaculation. Although many men feel embarrassed talking about it, premature ejaculation is a common and treatable condition.

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Causes of Premature Ejaculation

The exact cause of premature ejaculation is still uncertain however, many believe that Lifelong PE is believed to be a result of penile hypersensitivity, while acquired PE is often caused by a complex neurochemical and psychological disturbance (2). In addition, there are some speculations that PE may also be affected by genetic, ethnic, and cultural factors for which further scientific evidence is required.

Premature ejaculation involves a complex interaction of psychological and biological factors.

What is the Treatment for a Short Frenulum?

Psychological factors that might play a role include:

  • Early sexual experiences
  • Sexual abuse
  • Poor body image
  • Depression
  • Worrying about premature ejaculation
  • Guilty feelings that increase your tendency to rush through sexual encounters
  • Relationship problems between you and your current partner
  • Anxiety related to sexual performance or other issues.

Biological Causes of Premature Ejaculation

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

  • Frenulum Breve – a tight band of tissue connecting the glans (head of the penis) to the shaft of the penis on its underside. When the frenulum is tight or short this is called a frenulum breve.
  • Abnormal hormone levels
  • Abnormal levels of brain chemicals called neurotransmitters
  • Inflammation and infection of the prostate or urethra
  • Inherited traits
  • Erectile dysfunction

Consequences of Premature Ejaculation

Premature ejaculation can cause problems in your personal life, including:

  • Stress and relationship problems – A common complication of premature ejaculation is relationship stress.
  • Fertility problems – Premature ejaculation can occasionally make fertilization difficult for couples who are trying to have a baby if ejaculation doesn’t occur intravaginally.
  • Erectile Dysfunction – studies have also shown that up to 30% of men with premature ejaculation also have difficulties getting or maintaining an erection (3).

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Vancouver Treatment Options for Premature Ejaculation at Pollock Clinics

At Pollock Clinics, an individualized treatment plan will be determined for each patient after a thorough medical examination and consultation and with consideration of patient’s goals, values and preferences.

At Pollock Clinics, we offer a wide variety of treatment options. Our aim is to provide a biopsychosocial multidisciplinary treatment plan for premature ejaculation including psychosexual and behavioural therapy through our certified sex therapist, a variety of topical and oral medications, as well as the surgical option of penile frenulectomy as indicated for some patients.

There are variety of pharmacological and non-pharmacological treatment options for premature ejaculation with varying degrees of effectiveness and potential side effects. Traditionally, topical anesthetics such as Lidocaine/prilocaine combination applied to penis can be used to treat PE by reducing penile sensitivity; however, the side effects such as genital numbness and irritation for the patient and his partner can be quite a bothersome if the topical medication is not applied and administered properly.

Oral medications such as Selective Serotonin Reuptake Inhibitors (SSRIs) which are used to treat depression and anxiety have been shown effective in prolonging the ejaculatory time. Some experts also suggest a trial of Phosphodiesterase-5 inhibitors (such as Viagra, Cialis or Levitra) to help with PE especially in men who also suffer from erectile dysfunction. Other medications such as Tramadol (opioid medication) and older generation antidepressants (such as Clomipramine) have also been suggested but may in some people be associated with a more significant side effect profile.

Behavioural and psychosexual therapies have also been proven effective in delaying ejaculation especially in men with acquired PE. There are surgical options as well i.e. penile frenulectomy. All of these options are available through our Premature Ejaculation Program. Other proposed alternative treatments such as acupuncture, herbal medicine, yoga, etc. will certainly require further investigation for their efficacy.

Penis frenectomy vancouver
Penile frenulectomy vancouver

Penile Frenulectomy for Premature Ejaculation

Premature ejaculation is one of the most common male sexual dysfunctions reported. Some studies report that a short frenulum is found in up to 43% of individuals affected by premature ejaculation. It is thought that the frenulum plays an important role in penile erection and when frenulum tension exceeds a certain limit, orgasm and ejaculation may be accelerated. When the frenulum is lengthened, penile tension and sensitivity may be decreased.

Penile frenulectomy and frenuloplasty are procedures that can alleviate the pain associated with a tight band of tissue connecting the glans (head of the penis) to the shaft of the penis on its underside. When the frenulum is tight or short this is called a frenulum breve.

A tight frenulum can exist in both circumcised and uncircumcised men and can create a restriction that is susceptible to micro-trauma, causing bleeding, painful erections, and in some cases, the common sexual dysfunction of premature ejaculation.

The procedure involves the removal of the restricting tissue for increased range of motion in the penile skin and enhanced sexual enjoyment.

At Pollock Clinics in Vancouver, the procedure (done in under 20 minutes) is performed using a long-acting local anesthetic and has a brief recovery period.

Penile frenulectomy has been shown to be effective in some but not in all cases of premature ejaculation.

For more information on this procedure, please click here.

Sex Therapy for PE

Sex therapy can help a man or couple overcome a variety of sexual difficulties and challenges.

Sex therapy is often helpful in the treatment of erectile dysfunction and premature ejaculation, even when physical factors are the principal cause.

Sexual difficulties, no matter what the cause, can strain your relationship. Frequently, a man with erectile problems experiences performance anxiety, which makes him reluctant to initiate sexual contact. His partner may perceive this as rejection, which could trigger feelings of frustration and resentment.

Sex therapy, with our experienced, certified sex therapist, can help a couple overcome these feelings and re-establish intimacy.

For more information on therapy with Tom Foster, our certified sex therapist, please click here.

References :

(1) Canadian Male Sexual Health Council Survey to Assess Prevalence and Treatment of Premature Ejaculation in Canada. 2009: https://doi.org/10.1111/j.1743-6109.2009.01362.x

(2) Premature Ejaculation: An Observational Study of Men and Their Partners. The Journal of Sexual Medicine. 2005: 10.1111/j.1743-6109.2005.20353.x

(3) Disorders of Orgasm and Ejaculation in Men. The Journal of Sexual Medicine. 2010: 10.1111/j.1743-6109.2010.01782.x

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