Treatment of premature ejaculation consists of behavioral or medical therapy. Behavioral therapy focuses on “start-stop” or “squeeze” techniques, whereby the individual tries to prevent release of the ejaculate. Such techniques have initial success rates up to 95%; however, they do not tend to work over the long term, and their success rate is only 25% 3 years after treatment. However, behavioral therapy is important in the initial management of premature ejaculation.
Oral therapy is the most common treatment for premature ejaculation. The medications used are actually antidepressants, either clomipramine (Anafranil) or a class of antidepressants called serotonin reuptake inhibitor drugs (SSRIs). Fluoxetine (Prozac) and paroxetine (Paxil) are the two SSRIs that are most commonly used for premature ejaculation, and another medication that has also been used is sertraline (Zoloft). Clomipramine is the most commonly studied therapy for premature ejaculation and has been used in doses of 25 to 50 mg on as needed, daily, and every other day schedules. Side effects of clomipramine include dry mouth, constipation, and feeling “different.” With the 50-mg dose, nausea, sleep disturbance, fatigue, and hot flashes are infrequently noted. Sertraline in doses of 25 to 50 mg is another drug that has been shown to increase the time to ejaculation. Side effects of sertraline are uncommon and include transient anorexia (loss of appetite) and headache. Fluoxetine and paroxetine in doses of 20 to 40 mg per day have been shown to have a beneficial effect on premature ejaculation. The side effects of these medications include nausea, headache, and insomnia. Topical anesthetic gels such as EMLA can decrease penile sensitivity and should be placed on the penis and kept in contact with the skin by using a condom over the gel for about 30 minutes. The cream should be washed off before intercourse because it may affect the partner’s vaginal sensitivity.
How does one treat retrograde ejaculation?
In some individuals, retrograde ejaculation may be treated with such medications as ephedrine (pseudoephedrine, Sudafed, 30-60 mg) or antidepressants, such as desipramine (Norpramine, 50 mg), taken 1 to 2 hours before sexual activity. If the patient has undergone surgery on the bladder outlet, this therapy is less likely to be effective. In men who wish to have children, the sperm can be retrieved from the urine, processed, and used for assisted reproduction.
How does one treat anejaculation ?
In some spinal cord injury patients, ejaculation may be induced by the application of a vibrator to the penis, whereas in others, electroejaculation may be necessary. Electroejaculation often requires anesthesia and involves the placement of a probe into the rectum to induce ejaculation. This would be used to obtain ejaculate fluid for assisted reproduction and wouldn’t be used as part of routine sexual activity.