It is a relatively widespread disorder – 5 to 10% of men would be concerned – but which has little honor in the mainstream press. In question, persistent taboos around sexuality. With significant consequences for the men concerned. “As is often the case with sexual dysfunction, men suffering from premature ejaculation have great difficulty talking about it, and do not know which professionals to turn to”, regrets Dr. Carol Burté, andrologist and sexologist in Cannes and at the CHPG, in Monaco. Result: the disorder is little taken care of, leaving men, couples, in distress. However, this disorder, once diagnosed, can benefit from effective therapies (behavioral and cognitive) and drug treatments. The dot with the Dr Carol Burte.
How is premature ejaculation defined?
This is an ejaculation that occurs before – or very soon after – the start of vaginal intercourse or other sexual stimulation. Ejaculation control is perceived by the men concerned as nil or weak.
Does this imply that ejaculation is “controllable”?
You can’t really control an ejaculation; like all other sexual reactions, it is a reflex, which by definition escapes the will. On the other hand, we can postpone the moment when it occurs, by managing the level of excitation.
Is this where the shoe pinches in the 5 to 10% of men concerned?
When it comes to so-called primary premature ejaculation (which exists since the first sexual intercourse), the cause is indeed often linked to poor learning of the management of excitement. It is different when this disorder settles in a man who had previously had no difficulty (so-called secondary premature ejaculation); in this case, we rather find associated an underlying pathology or erectile dysfunction (erection disorder).
How do the men concerned experience this dysfunction?
Even if premature ejaculation is a source of distress and anxiety for those who suffer from it, but also for their partners, they rarely talk about it. Especially since most of them do not know who to contact; they search for information on the Internet, try to follow the many advices that can be found there, with generally very disappointing results. Hence a discouragement and a renouncement to consult, all the more regrettable that solutions exist.
What are they?
Several methods are available: from behavioral and cognitive therapies – which give very interesting results in this area – to drug treatments, including body therapy, rehabilitation, meditation, relaxation, hypnosis, etc.
How do drugs for premature ejaculation work?
They make it possible to delay the moment of ejaculation, which leads to a rapid improvement in the symptom. Two drugs have demonstrated their effectiveness in clinical studies and have obtained marketing authorization (1): dapoxetine (Priligy) which is a short-term serotonin reuptake inhibitor (main neuromediator involved in ejaculation) ‘stock. This is an “on demand” treatment; the man takes it in anticipation of sexual intercourse. Due to its rapid elimination, if there are side effects (dizziness, nausea, headache), they are very limited in time. The second is an anesthetic spray (Fortacin), to be sprayed on the glans within half an hour before penetration. It consists of a mixture of lidocaine and prilocaine. As it has a local effect, apart from rare allergies or a bad dosage, it is well tolerated. Used on a regular basis, it helps the brain get used to receiving less intense messages from this part of the body, and thus helps to reduce excitement.
Are medications enough to treat the disorder?
No. Management of premature ejaculation should be integrative; it is important that it combines drug approaches and behavioral counseling aimed at helping patients better manage the level of arousal. It is a question of getting him to be aware of his sensations, to breathe calmly, to relax his muscles, to take breaks… And if the man is in a relationship, it is preferable to integrate the partner into the supported.
1. Marketing authorization.