The most common cause of male sexual dysfunction is premature ejaculation. Up to 1/3 of men suffer from rapid ejaculation, and the incidence increases with age. Although we really don’t know exactly what causes PE, we do have some potential suspects. Some physicians believe it to be caused by psychological issues, while others blame cortical representation of the pudendal nerve, hypersensitivity of the glans penis, or hyperthyroidism. Fortunately, there are a number of potential remedies.
1) Behavioral Therapies
The squeeze technique enlists the participation of the partner, assuming that there is one. As the gentleman reaches the “danger zone,” before he finishes, the partner squeezes the junction of the glans penis and the shaft. The couple resume sexual activity, and repeat as needed.
The start-stop technique requires the couple to discontinue activity as they approach climax. After a period of rest, in which the male tries to remember the name of all of Adam Sandler’s movies, the couple resumes activity.
2) Prescription Medications
A number of medications, the foremost of which include Paroxetine, Clomipramine, pde5-inhibitors, and opioid analgesics have proven successful in delaying ejaculation. All of these meds have potential side effects.
Paroxetine (Paxil), at a daily dose of 10 mg has the best results. It is an SSRI, and potential side effects include nausea, drowsiness, dizziness, trouble sleeping, loss of appetite, weakness, dry mouth, sweating, blurred vision, and yawning.
Clomipramine (Anafranil) also has a host of potential side effects which can include visual disturbances, nausea, dry mouth, constipation and fatigue.
3) Topical Anesthetics
There are both over-the-counter agents, as well as those such as EMLA which require a prescription.