The most common ejaculatory disorder

• Ejaculation that occurs sooner than desired
• Commonly defined as an intravaginal ejaculatory latency time of less than 2 minutes
  ––however, clinically it can be defined by the distress it causes to either one or both partners
• Can be classified into 2 main types, primary and secondary PE
• Primary (lifelong) PE
  ––patient has never had control of ejaculation
  ––disorder of different/lower set point for ejaculatory control
  ––unlikely to diagnose an underlying disease
  ––younger men don’t usually present early
• Secondary (acquired) PE
  ––patient was previously able to control ejaculation
  ––most commonly associated with erectile dysfunction (ED)

Clinical note: PE is a self reported diagnosis, and can be based on sexual history alone

The GP’s role

• GPs are typically the first point of contact for men with a disorder of ejaculation
• The GP’s role in management of PE includes diagnosis, treatment and referral
• Offer brief counselling and education as part of routine manageme

 

Diagnosis

Medical history

Sexual history Establish presenting complaint (i.e. linked with ED) Intravaginal ejaculatory latency time Onset and duration of PE Previous sexual function History of sexual relationships Perceived degree of ejaculatory control Degree of patient/partner distress Determine if fertility is an issue

Medical General medical history Medications (prescription and non prescription) Trauma (urogenital, neurological, surgical) Infections Psychological Depression Anxiety Stressors Taboos or beliefs about sex (religious, cultural

Physical examination

• General examination
• Genito-urinary: penile and testicular rectal examination (if PE occurs with painful ejaculation)
• Neurological assessment of genital area and lower limb

 

Treatment
Reducing penile sensation

• Topical applications: Local anesthetic gels/creams can diminish sensitivity and delay ejaculation. Excess use can be associated with a loss of pleasure, orgasm and erection. Apply 30 minutes prior to intercourse (or use condom) to prevent trans-vaginal absorption
• Lignocaine ointment: 5% 20-30 minutes pre-intercourse
• Lignocaine spray: 10% (‘Stud’ 100 Desensitising spray for men)
• Double condoms: Using 2 condoms can diminish sensitivity and delay ejaculation

Clinical note: combination treatment can be used.

Note: Consult your doctor before using any of the above medicine of method.

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