Premature Ejaculation (PE)

Premature ejaculation (PE) is a common sexual concern affecting men, characterised by the inability to delay ejaculation long enough for both partners to enjoy sexual activity. It can lead to feelings of embarrassment, frustration, and anxiety, and may impact a person’s sexual satisfaction and relationship quality.

Overview of Premature Ejaculation (PE)

1. Types of Premature Ejaculation:

  • Lifelong (Primary) PE: Occurs from the first sexual experience and persists throughout life. It may be due to biological factors such as neurotransmitter imbalances, genetic predispositions, or heightened sensitivity.
  • Acquired (Secondary) PE: Develops later in life, often associated with specific triggers such as psychological issues, stress, or underlying health conditions (like prostatitis or thyroid problems).

2. Symptoms:

  • Ejaculation that always or nearly always occurs within one minute of vaginal penetration.
  • Inability to delay ejaculation during all or nearly all penetrations.
  • Negative personal consequences, such as distress, frustration, or the avoidance of sexual intimacy.

3. Possible Causes:

  • Biological Factors:
    • Neurochemical imbalances, particularly involving serotonin levels in the brain.
    • Abnormal reflex activity of the ejaculatory system.
    • Hormonal imbalances (e.g., low testosterone).
    • Genetic predisposition.
  • Psychological Factors:
    • Performance anxiety or stress.
    • Early sexual experiences, particularly those involving rapid ejaculation.
    • Relationship issues or lack of emotional intimacy.
    • Psychological conditions such as depression or anxiety.
  • Underlying Medical Conditions:
    • Erectile dysfunction (ED): Men with ED may develop a pattern of rushing to ejaculate.
    • Inflammation or infection of the prostate or urethra.
    • Neurological conditions.

4. Diagnosis:

  • Medical History: Discussing symptoms, sexual history, and overall health with a healthcare provider.
  • Physical Examination: To rule out physical causes, including any signs of genital infection or neurological problems.
  • Questionnaires: Standardized tools such as the Premature Ejaculation Diagnostic Tool (PEDT) may be used to assess severity.

5. Treatment Options:

  • Behavioral Techniques:

    • Start-Stop Method: Involves stopping sexual stimulation when you feel close to ejaculation, then resuming once the sensation subsides. Repeating this process helps gain better control over ejaculation.
    • Squeeze Technique: Squeezing the penis just before ejaculation to reduce arousal and delay climax.
    • Pelvic Floor Exercises: Strengthening the pelvic floor muscles can help with ejaculatory control. Kegel exercises, which involve contracting and relaxing these muscles, are often recommended.

  • Medications:

    • Topical Anesthetics: Creams or sprays containing numbing agents (e.g., lidocaine or prilocaine) applied to the penis before intercourse can reduce sensation and help delay ejaculation.
    • Oral Medications:
      • Selective Serotonin Reuptake Inhibitors (SSRIs): Antidepressants like paroxetine, sertraline, or fluoxetine are used off-label to delay ejaculation. They typically take a few days to weeks to be effective.
      • Tricyclic Antidepressants: Dapoxetine, a short-acting SSRI, is specifically approved for PE in some countries.
      • Phosphodiesterase-5 Inhibitors (PDE5 inhibitors): Drugs like sildenafil (Viagra) may help in cases where both ED and PE are present.

  • Counseling and Therapy:

    • Cognitive Behavioral Therapy (CBT): Helps address anxiety, stress, or negative emotions related to sexual performance.
    • Sex Therapy: Addresses relationship issues, emotional intimacy, and sexual communication, often involving both partners.

  • Lifestyle Changes:

    • Regular Exercise: Improves overall health and can help manage stress and anxiety.
    • Healthy Diet: Maintaining a balanced diet supports overall wellness and may indirectly affect sexual performance.
    • Limiting Alcohol and Avoiding Recreational Drugs: These substances can contribute to PE.

6. Self-care and Home Remedies:

  • Practicing Mindfulness: Mindfulness techniques, such as deep breathing or meditation, may help reduce anxiety and improve focus during sexual activity.
  • Use of Condoms: Thicker condoms can reduce sensitivity and help delay ejaculation.
  • Pre-intercourse Masturbation: Some men find that masturbating an hour or two before sex helps delay ejaculation.

7. Medical Devices:

  • Penile Rings: Placed around the base of the penis to reduce blood flow and prolong erection, potentially delaying ejaculation.

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FAQ's

What is Shockwave Therapy?

Low-Intensity Shockwave Therapy (Li-SWT) is a treatment modality that utilizes acoustic (sound) waves to target damaged or impaired tissue to encourage the body to create healthier tissue. It also helps stimulate blood vessel growth.   Shockwave therapy has been safely used for decades. Today it is being successfully used to treat conditions such as erectile dysfunction (ED), Peyronie’s Disease, and sometimes male or female pelvic pain. 

How Does Shockwave for ED Work?

Shockwave therapy is an alternative to traditional treatments, such as oral medications (Viagra, Levitra, and Cialis), vacuum erection devices, injectable medications, and intra-urethral suppositories. 

When treating ED with shockwave therapy, low-intensity shock waves are applied to different treatment zones on the penis and on the perineum. Using targeted high-energy sound waves, Li-ESWT can speed up tissue repair and improve blood flow, nerve regeneration, and cell growth. This helps improve the strength and quality of erections. 

Is Shockwave Therapy Painful?

While “shockwave” on the surface may sound unpleasant, patients typically tolerate it well. It applies short, frequent, and high-intensity bursts of energy (in the form of ultrasonic sound waves) into soft tissue. Some patients may experience mild discomfort during or after their procedure. 

What Should I Expect for My Appointment?

Prior to your appointment, you may be instructed to shave the affected area. For example, you may be asked to shave the testes and penis prior to treatment for ED. There are no other preparations needed for your procedure. 

Appointments take approximately 30 minutes, and the procedure itself usually takes about 15-20 minutes. However, sessions may be longer depending on the customised treatment for each individual. Patients usually require six (6) treatments, with the effects expected to last for two to three years. The treatment may be repeated, if needed, after that timeframe. 

Treatments are not uncomfortable, and people do not require pain relief or aesthetic; however, patients may have soreness, redness, or some bruising in the treatment area. There are no restrictions following the therapy, but you should take it easy for the rest of the day. 

How Much Does Shockwave Therapy Cost?

Medical aid do not cover Shockwave Therapy, and patients should expect to pay out-of-pocket. At Shockwave Clinic, the cost pr treatment is Rand 2400.00  and 6-8 weekly treatments are normally required as the minimal about of treatments to get the full benefit.

Is Shockwave Therapy Right For You?

Your urologist will discuss your individual situation and help you determine if shockwave therapy is an appropriate treatment option for you.

 

Erectile Dysfunction

Erectile dysfunction (ED) is a very common sexual disorder affecting more than 1 in 5 men. ED is the inability to achieve and/or maintain an erection for sexual intercourse. While most often associated with older men, ED affects a significant proportion of younger men. When treating ED with shockwave therapy, low-intensity shockwaves are applied to different treatment zones on the penis and on the perineum

“Erectile dysfunction is a common disorder of men that increases with age and may profoundly affect their quality of life. Low-intensity shock wave therapy has been proven to be effective treatment for erectile dysfunction. We use the DUOLITH® SD1 to treat patients with vascular erectile dysfunction with good success”
Milad Hanna, M.B., B.Ch. FRCS – NHS Trust, London.

Peyronie’s Disease

Peyronie’s disease is a condition that causes bending of the penis. The problem is caused by scar tissue, called plaques, that forms inside the penis. The disease is generally progressive, most men first notice the presence of the disease when they feel thickened areas (plaques) under the skin of the penis. As the disease progresses further, pain may occur with or without an erection as the penis becomes more curved. The condition can make sexual intercouse difficult or impossible. Shockwave therapy directly targets the pain points and breaks down the plaques within the penis.

“We use the DUOLITH® SD1 to treat several andrological conditions such as erectile dysfunction (ED), chronic pelvic pain syndrome (CPPS) and Peyronie’s. The DUOLITH® SD1 is very easy to operate and provides excellent results. Patients experience safel and gentle treatments”
Professor Lars Lund, MD, DMSci, Head of Research Department of Urology Odense University Hospital and University Denmark.

Chronic Pelvic Pain Syndrome / Prostatitis

Also known aschronic prostatitis, Chronic Pelvic Pain Syndrome (CPPS)is characterized by pain in the region of the pelvic floor and / or urination problems without evidence of urinary tract infection. Some patients experience erectile dysfunction. CPPS is found in men of any age, with the peak incidence in men aged 35 – 45 years. Extracorporeal shockwave therapy (ESWT) is performed using a perineal approach, treating both the prostate and the pelvic floor.

Hard-Flaccid Syndrome

Hard flaccid syndrome is a condition which causes men’s penises to be permanently semi-erect, even if they are not aroused. Erections are typically difficult to achieve, may not be as rigid and men with the condition may find they require more stimulation or arousal than they did before. The condition can be quite painful for those who have it, particularly during ejaculation, urination and erection.

Shockwave therapy for hard flaccid is a treatment that can help treat erection problems associated with the condition and can also relieve pain and repair some of the damage done to the penis.