You don't have a premature ejaculation problem unless you frequently ejaculate before or shortly after beginning intercourse.
There are a great number of misconceptions and myths about premature ejaculation. The following are NOT typically causes of premature ejaculation:
In the early 1990s, research indicated that the pelvic muscles, specifically the muscles that surround the erectile bodies in the penis, are in a hyperactive state in men with premature ejaculation.
Further, it is known that during the ejaculation process there is increased activity of these same muscle groups. Consequently, it is likely that men who have premature ejaculation have hyperactive muscles that are already on their way toward the threshold to producing ejaculations.
Over the past few years that I have been evaluating and treating men with impotence and premature ejaculation (in excess of 3,000 men), we have noticed that men with premature ejaculation have increased sensitivity to vibration in the penis when compared to men without premature ejaculation. It is likely that premature ejaculation, at least in some men, may be due to a combination of hypersensitivity of the penis and hyperspasticity of the pelvic muscles. I should stress, though, that this is my idea and not one that’s been evaluated in controlled trials.
There is also a biochemical explanation for premature ejaculation that is showing a great deal of promise. The first hints of this came with the release of several anti-depressive medications called selective serotonin reuptake inhibitors (SSRIs), the best known of these being Prozac. One common side effect of SSRIs is delayed ejaculation or even inability to ejaculate. Since serotonin in he brain is one of the molecules involved in ejaculation, this led to the idea that low serotonin levels might cause premature ejaculation. We’ll discuss this further in the treatment section.
Currently, my approach
to premature ejaculation consists of a history and a physical examination
specifically geared to determine the amount of sensitivity of the penis
and detect any neurological problem. In many of my cases, the patient's
problem relates to hypersensitivity of the penis.
The most intensely studied medications have been Prozac, Paxil, Zoloft and Anafranil (a different kind of anti-depressant). Of these, Paxil seems to be the most effective. Depending on the dose, it may increase time to ejaculation from 1 minute to as long as 10 minutes. The others are also effective, although Anafranil tends to produce more side effects than the SSRIs.
The drug may be taken daily or about four hour before intercourse, although daily use is more effective. It takes one to two weeks for the daily dosing to become effective, and many men find that they can then stop the daily dose and just take the medication when they’re expecting to have intercourse.
Few of my patients mention any side effects with the SSRIS, but the recognized, if rare, effects are reduced libido, dry mouth, nervousness, nausea, diarrhea headache, drowsiness.
On the Horizon
Johnson & Johnson submitted an application for approval for dapoxetine to the FDA in late 2004, and the FDA rejected the application in October of 2005. Johnson & Johnson says it is working to answer questions raised by the FDA and is continuing development. Pfizer is also developing its own version of dapoxetine.
As to treating premature ejaculation, here is a list of things that DON'T work:
* long-term psychoanalysis