Understanding Premature Ejaculation: Causes and How to Treat It

Counseling and Sex Therapy
Selective Serotonin Reuptake Inhibitors
Access options
Analgesic, Opioid
How To Get Vardenafil
Diagnosing Premature Ejaculation in Men

The patient began vibratory stimulation to the frenular area at 8th minute of AVSS till ejaculation. A button has been placed under the cover where the patient presses to operate the vibrator. ELT was calculated in seconds with a chronometer. The test was repeated with second medication in 7–15 days. Among 40 patients, the results of 17 could be evaluated. When the patient took placebo and vardenafil, mean ELTs were 62.7 and 189.5 s, respectively. When compared with placebo, vardenafil improved ELT significantly (P = 0.04). After the beginning of AVSS, time to first recorded base or tip rigidities was shorter and time to last recorded tip or base rigidities following ejaculation was longer than placebo; however, these differences were not significant (P > 0.05 for each). This laboratory design might be used to evaluate the effects of drugs on patients with ejaculation disorders. In this laboratory setting study, vardenafil exerted a threefold increase in ejaculation delay outside the vagina in patients with lifelong PE. Jannini EA, Lenzi A (2005) Ejaculatory disorders: epidemiology and current approaches to definition, classification and subtyping. Althof S, Rosen R, Symonds T, Mundayat fildena 200 mg R, May K, Abraham L (2006) Development and validation of a new questionnaire to assess sexual satisfaction, control, and distress associated with premature ejaculation.

Counseling and Sex Therapy

Summary: Prevent Premature Ejaculation in a Way that Suits You

When the patient took placebo and vardenafil, mean ELTs were 62.7 and 189.5 s, respectively. When compared with placebo, vardenafil improved ELT significantly (P = 0.04). After the beginning of AVSS, time to first recorded base or tip rigidities was shorter and time to last recorded tip or base rigidities following ejaculation was longer than placebo; however, these differences were not significant (P > 0.05 for each). This laboratory design might be used to evaluate the effects of drugs on patients with ejaculation disorders. In this laboratory setting study, vardenafil exerted a threefold increase in ejaculation delay outside the vagina in patients with lifelong PE. McMahon CG, Althof SE, Waldinger MD, Porst H, Dean J, Sharlip ID, Adaikan PG, Becher E, Broderick GA, Buvat J, Dabees K, Giraldi A, Giuliano F, Hellstrom WJ, Incrocci L, Laan E, Meuleman E, Perelman MA, Rosen RC, Rowland DL, Segraves R (2008) An evidence-based definition of lifelong premature ejaculation: report of the International Society for Sexual Medicine (ISSM) ad hoc committee for the definition of premature ejaculation.

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Symonds T, Roblin D, Hart K, Althof S (2003) How does premature ejaculation impact a man s life? J Sex Marital Ther 29:361–370 Symonds T, Roblin D, Hart K, Althof S (2003) How does premature ejaculation impact a man s life? J Sex Marital Ther 19:276–288 Abdel-Hamid IA, El Naggar EA, El Gilany AH (2001) Assessment of as needed use of pharmacotherapy and the pause-squeeze technique in premature ejaculation. Int J Impot Res 13:41–45 Abdel-Hamid IA, El Naggar EA, El Gilany AH (2001) Assessment of as needed use of pharmacotherapy and the pause-squeeze technique in premature ejaculation. Int J Impot Res 13:41–45 Dinsmore WW, Wyllie MG (2009) PSD502 improves ejaculatory latency, control and sexual satisfaction when applied topically 5 min before intercourse in men with premature ejaculation: results of a phase III, multicentre, double-blind, placebo-controlled study. Dinsmore WW, Wyllie MG (2009) PSD502 improves ejaculatory latency, control and sexual satisfaction when applied topically 5 min before intercourse in men with premature ejaculation: results of a phase III, multicentre, double-blind, placebo-controlled study.

Selective Serotonin Reuptake Inhibitors

Burnett AL, Johns DG, Kriegsfeld LJ, Klein SL, Calvin DC, Demas GE, Schramm LP, Tonegawa S, Nelson RJ, Snyder SH, Poss KD (1998) Ejaculatory abnormalities in mice with targeted disruption of the gene for heme oxygenase-2. Truitt WA, Coolen LM (2002) Identification of a potential ejaculation generator in the spinal cord. Uckert S, Kuthe A, Jonas U, Stief CG (2001) Characterization and functional relevance of cyclic nucleotide phosphodiesterase isoenzymes of the human prostate. Orhan I, Onur R, Tasdemir C, Ayar A, Kadioglu A (2006) Sildenafil citrate inhibits agonist induced contractions in isolated rat seminal vesicles. Devan BD, Sierra-Mercado D Jr, Jimenez M, Bowker JL, Duffy KB, Spangler EL, Ingram DK (2004) Phosphodiesterase inhibition by sildenafil citrate attenuates the learning impairment induced by blockade of cholinergic muscarinic receptors in rats.

Drug interactions

Ekmekcioglu gel erectile dysfunction O, Inci M, Demirci D, Tatlisen A (2005) Effects of sildenafil citrate on ejaculation latency, detumescence time, and refractory period: placebo-controlled, double-blind, crossover laboratory setting study. Mondaini N, Ponchietti R, Muir GH, Montorsi F, Di Loro F, Lombardi G, Rizzo M (2003) Sildenafil does not improve sexual function in men without erectile dysfunction but does reduce the postorgasmic refractory time. Int J Impot Res 15:225–228 Mondaini N, Ponchietti R, Muir GH, Montorsi F, Di Loro F, Lombardi G, Rizzo M (2003) Sildenafil does not improve sexual function in men without erectile dysfunction but does reduce the postorgasmic refractory time. In vitro measurement of ejaculation latency time (ELT) and the effects of vardenafil on ELT on lifelong premature ejaculators: placebo-controlled, double-blind, cross-over laboratory setting. Health Care Professional-initiated education on U=U significantly improves patients' self-assessed sexual health, irrespective of gender. Perelman MA (2006) A new combination treatment for premature ejaculation: a sex therapist’s perspective.

Dose	Onset Time	Duration of Action	Adjustments	Precautions
5 mg	30-60 minutes	Up to 4-5 hours	For elderly or hepatic impairment	Avoid high-fat meals before intake
10 mg	30-60 minutes	Up to 4-5 hours	Standard dose	Do not exceed once per 24 hours
20 mg	30-60 minutes	Up to 6 hours	Not recommended for first use	Consult doctor for titration

Waldinger MD, Schweitzer DH, Olivier B (2005) On-demand SSRI treatment of premature ejaculation: pharmacodynamic limitations for relevant ejaculation delay and consequent solutions. Yilmaz U, Tatlisen A, Turan H, Arman F, Ekmekcioglu O (1999) The effects of fluoxetine on several neurophysiological variables in patients with premature ejaculation. Beretta G, Chelo E, Fanciullacci F, Zanollo A (1986) Effect of an alpha-blocking agent (phenoxybenzamine) in the management of premature ejaculation. Basar MM, Yilmaz E, Ferhat M, Basar H, Batislam E (2005) Terazosin in the treatment of premature ejaculation: a short-term follow-up. Balbay MD, Yildiz M, Salvarci A, Ozsan O, Ozbek E (1998) Treatment of premature ejaculation with sertralin. McMahon CG, Stuckey BG, Andersen M, Purvis K, Koppiker N, Haughie S, Boolell M (2005) Efficacy of sildenafil citrate (Viagra) in men with premature ejaculation. Atan A, Basar MM, Tuncel A, Ferhat M, Agras K, Tekdogan U (2006) Comparison of efficacy of sildenafil-only, sildenafil plus topical EMLA cream, and topical EMLA-cream-only in treatment of premature ejaculation. Salonia A, Maga T, Colombo R, Scattoni V, Briganti A, Cestari A, Guazzoni G, Rigatti P, Montorsi F (2002) A prospective study comparing paroxetine alone versus paroxetine plus sildenafil in patients with premature ejaculation. Sun XZ, Deng CH, Dai YP (2007) A clinical study of sertraline and vardenafil in the treatment of premature ejaculation complicated by erectile dysfunction. Zhonghua Nan Ke Xue 13:610–612 Sun XZ, Deng CH, Dai YP (2007) A clinical study of sertraline and vardenafil in the treatment of premature ejaculation complicated by erectile dysfunction.

Vardenafil can sometimes cause visual disturbances.
It does not cure PE but might delay ejaculation temporarily.
Always follow prescribed dosing instructions.
Use caution when combining with other medications.
It is available by prescription only.
Several factors influence Vardenafil's effectiveness.
Men using Vardenafil should monitor side effects.
It may improve self-esteem in men with PE.
Some men report increased confidence in bed.
Vardenafil may be less effective if taken with high-fat meals.
Not suitable for men with certain eye conditions.
Always consult a healthcare professional before use.

Access options

Zhonghua Nan Ke Xue 13:610–612 Mathers MJ, Klotz T, Roth S, Lummen G, Sommer F (2009) Safety and efficacy of vardenafil versus sertraline in the treatment of premature ejaculation: a randomised, prospective and crossover study. Mathers MJ, Klotz T, Roth S, Lummen buy super p force jelly G, Sommer F (2009) Safety and efficacy of vardenafil versus sertraline in the treatment of premature ejaculation: a randomised, prospective and crossover study. Aversa A, Pili M, Francomano D, Bruzziches R, Spera E, La Pera G, Spera G (2009) Effects of vardenafil administration on intravaginal ejaculatory latency time in men with lifelong premature ejaculation. Int J Impot Res 21:221–227 Aversa A, Pili M, Francomano D, Bruzziches R, Spera E, La Pera G, Spera G (2009) Effects of vardenafil administration on intravaginal ejaculatory latency time in men with lifelong premature ejaculation. Int J Impot Res 21:221–227 Waldinger MD, Hengeveld MW, Zwinderman AH (1994) Paroxetine treatment of premature ejaculation: a double-blind, randomized, placebo-controlled study.

Off-Label Uses

Waldinger MD, Hengeveld MW, Zwinderman AH (1994) Paroxetine treatment of premature ejaculation: a double-blind, randomized, placebo-controlled study. Waldinger MD (2007) Four measures of investigating ejaculatory performance. Burnett AL (2000) Lecture 2: nitric oxide synthase and heme oxygenase knockout mice-what have we learned? Int J Impot Res 12(Suppl 3):S42–S44 Burnett AL (2000) Lecture 2: nitric oxide synthase and heme oxygenase knockout mice-what have we learned? Int J Impot Res 12(Suppl 3):S42–S44 Burnett AL, Johns DG, Kriegsfeld LJ, Klein SL, Calvin DC, Demas GE, Schramm LP, Tonegawa S, Nelson RJ, Snyder SH, Poss KD (1998) Ejaculatory abnormalities in mice with targeted disruption of the gene for heme oxygenase-2. Aversa A, Pili M, Francomano D, Bruzziches R, Spera E, La Pera G, Spera G (2009) Effects of vardenafil administration on intravaginal ejaculatory latency time in men with lifelong premature ejaculation.

Analgesic, Opioid

Jannini EA, Lenzi A (2005) Ejaculatory disorders: epidemiology and current approaches to definition, classification and subtyping. Althof S, Rosen R, Symonds T, Mundayat fildena 200 mg R, May K, Abraham L (2006) Development and validation of a new questionnaire to assess sexual satisfaction, control, and distress associated with premature ejaculation. McMahon CG, Althof SE, Waldinger MD, Porst H, Dean J, Sharlip ID, Adaikan PG, Becher E, Broderick GA, Buvat J, Dabees K, Giraldi A, Giuliano F, Hellstrom WJ, Incrocci L, Laan E, Meuleman E, Perelman MA, Rosen RC, Rowland DL, Segraves R (2008) An evidence-based definition of lifelong premature ejaculation: report of the International Society for Sexual Medicine (ISSM) ad hoc committee for the definition of premature ejaculation. Symonds T, Roblin D, Hart K, Althof S (2003) How does premature ejaculation impact a man s life? J Sex Marital Ther 29:361–370 Symonds T, Roblin D, Hart K, Althof S (2003) How does premature ejaculation impact a man s life?

Citalopram (Celexa)

J Sex Marital Ther 19:276–288 Abdel-Hamid IA, El Naggar EA, El Gilany AH (2001) Assessment of as needed use of pharmacotherapy and the pause-squeeze technique in premature ejaculation. Int J Impot Res 13:41–45 Abdel-Hamid IA, El Naggar EA, El Gilany AH (2001) Assessment of as needed use of pharmacotherapy and the pause-squeeze technique in premature ejaculation. Int J Impot Res 13:41–45 Dinsmore WW, Wyllie MG (2009) PSD502 improves ejaculatory latency, control and sexual satisfaction when applied topically 5 min before intercourse in men with premature ejaculation: results of a phase III, multicentre, double-blind, placebo-controlled study. Dinsmore WW, Wyllie MG (2009) PSD502 improves ejaculatory latency, control and sexual satisfaction when applied topically 5 min before intercourse in men with premature ejaculation: results of a phase III, multicentre, double-blind, placebo-controlled study. Perelman MA (2006) A new combination treatment for premature ejaculation: a sex therapist’s perspective. Int J Impot Res 21:221–227 Aversa A, Pili M, Francomano D, Bruzziches R, Spera E, La Pera G, Spera G (2009) Effects of vardenafil administration on intravaginal ejaculatory latency time in men with lifelong premature ejaculation. Int J Impot Res 21:221–227 Waldinger MD, Hengeveld MW, Zwinderman AH (1994) Paroxetine treatment of premature ejaculation: a double-blind, randomized, placebo-controlled study. Waldinger MD, Hengeveld MW, Zwinderman AH (1994) Paroxetine treatment of premature ejaculation: a double-blind, randomized, placebo-controlled study.

Vardenafil's effect duration typically ranges from 4-6 hours.
It may help improve confidence in men with PE.
Vardenafil is a PDE5 inhibitor primarily targeting ED.
Off-label use for PE is common but not officially approved.
Psychological factors also influence premature ejaculation.
Combining Vardenafil with topical anesthetics may enhance delay.
It is contraindicated with nitrate medications.
Vardenafil does not directly alter ejaculatory reflexes.
Proper dosage can minimize risks and maximize benefits.
Sometimes men use Vardenafil with additional pelvic exercises.
Men should avoid alcohol while using Vardenafil.
Long-term safety data for PE use is limited.

Waldinger MD (2007) Four measures of investigating ejaculatory performance. Burnett AL (2000) Lecture 2: nitric oxide synthase and heme oxygenase knockout mice-what have we learned? Int J Impot Res 12(Suppl 3):S42–S44 Burnett AL (2000) Lecture 2: nitric oxide synthase and heme oxygenase knockout mice-what have we learned? Int J Impot Res 12(Suppl 3):S42–S44 Burnett AL, Johns DG, Kriegsfeld LJ, Klein SL, Calvin DC, Demas GE, Schramm LP, Tonegawa S, Nelson RJ, Snyder SH, Poss KD (1998) Ejaculatory abnormalities in mice with targeted disruption of the gene for heme oxygenase-2. Burnett AL, Johns DG, Kriegsfeld LJ, Klein SL, Calvin DC, Demas GE, Schramm LP, Tonegawa S, Nelson RJ, Snyder SH, Poss KD (1998) Ejaculatory abnormalities in mice with targeted disruption of the gene for heme oxygenase-2. Truitt WA, Coolen LM (2002) Identification of a potential ejaculation generator in the spinal cord. Uckert S, Kuthe A, Jonas U, Stief CG (2001) Characterization and functional relevance of cyclic nucleotide phosphodiesterase isoenzymes of the human prostate.

Precaution / Contraindication	Explanation	Alternative Actions
Nitrate medications	Contraindicated, risk of severe hypotension	Avoid Vardenafil with nitrate use
Severe cardiovascular disease	Increased risk of adverse events	Consult cardiologist before use
Liver impairment	May require dose adjustment	Lower dose or alternative therapy
Alcohol consumption	May increase side effects	Limit to reduce adverse effects

Orhan I, Onur R, Tasdemir C, Ayar A, Kadioglu A (2006) Sildenafil citrate inhibits agonist induced contractions in isolated rat seminal vesicles.

How To Get Vardenafil

No awkward doctor visits. Get premature ejaculation treatment all online.

McMahon CG, Stuckey BG, Andersen M, Purvis K, Koppiker N, Haughie S, Boolell M (2005) Efficacy of sildenafil citrate (Viagra) in men with premature ejaculation. Atan A, Basar MM, Tuncel A, Ferhat M, Agras K, Tekdogan U (2006) Comparison of efficacy of sildenafil-only, sildenafil plus topical EMLA cream, and topical EMLA-cream-only in treatment of premature ejaculation. Salonia A, Maga T, Colombo R, Scattoni V, Briganti A, Cestari A, Guazzoni G, Rigatti P, Montorsi F (2002) A prospective study comparing paroxetine alone versus paroxetine plus sildenafil in patients with premature ejaculation. Sun XZ, Deng CH, Dai YP (2007) A clinical study of sertraline and vardenafil in the treatment of premature ejaculation complicated by erectile dysfunction. Zhonghua Nan Ke Xue 13:610–612 Sun XZ, Deng CH, Dai YP (2007) A clinical study of sertraline and vardenafil in the treatment of premature ejaculation complicated by erectile dysfunction. Devan BD, Sierra-Mercado D Jr, Jimenez M, Bowker JL, Duffy KB, Spangler EL, Ingram DK (2004) Phosphodiesterase inhibition by sildenafil citrate attenuates the learning impairment induced by blockade of cholinergic muscarinic receptors in rats. Ekmekcioglu gel erectile dysfunction O, Inci M, Demirci D, Tatlisen A (2005) Effects of sildenafil citrate on ejaculation latency, detumescence time, and refractory period: placebo-controlled, double-blind, crossover laboratory setting study.

Diagnosing Premature Ejaculation in Men

Further counseling, including mental health assessment and psychosexual therapy, remains the cornerstone of sexual dysfunction treatment for all genders. Primarily oral PDE5 inhibitors (sildenafil, tadalafil, vardenafil)* On-demand use: administer at least 30 minutes before sexual activityContinuous use: Tadalafil 5 mg daily On-demand use: administer at least 30 minutes before sexual activity *Use lower doses with boosted PIs (PI/r or PI/c): sildenafil 25 mg every 48 hours; tadalafil 5 mg as an initial dose, maximum 10 mg every 72 hours; vardenafil 2.5 mg, maximum 2.5 mg every 72 hours Consider behavioral interventions and/or psychosexual counseling, SSRIs, tricyclic antidepressants, clomipramine, and topical anesthetics Use lower doses of clomipramine and other tricyclics with boosted PIs; see Drug-drug interactions between antidepressants and ARVs Dapoxetine, a short-acting SSRI, is the only drug approved for on-demand treatment of premature ejaculation in Europe. Treatment must be maintained, as recurrence is highly likely upon discontinuation Discontinue or switch drugs contributing to delayed ejaculation (antidepressants, antipsychotics, diuretics, antiseizure medications) Treat comorbidities such as hypertension, pelvic nerve injury, or diabetic neuropathy PDE5 inhibitors (e.g., sildenafil — see DDI); benefit in women is generally less than in men Lubricants and/or hormonal therapy (topical or systemic) if pain is related to vaginal dryness Analgesics for pain associated with menstrual symptoms Topical lidocaine, capsaicin, or vestibulectomy for irreversible pain conditions Q. I am in a new sexual relationship and surprised that at age 63 I have premature ejaculation.

Surgical treatments

Mondaini N, Ponchietti R, Muir GH, Montorsi F, Di Loro F, Lombardi G, Rizzo M (2003) Sildenafil does not improve sexual function in men without erectile dysfunction but does reduce the postorgasmic refractory time. Int J Impot Res 15:225–228 Mondaini N, Ponchietti R, Muir GH, Montorsi F, Di Loro F, Lombardi G, Rizzo M (2003) Sildenafil does not improve sexual function in men without erectile dysfunction but does reduce the postorgasmic refractory time. In vitro measurement of ejaculation latency time (ELT) and the effects of vardenafil on ELT on lifelong premature ejaculators: placebo-controlled, double-blind, cross-over laboratory setting. Health Care Professional-initiated education on U=U significantly improves patients' self-assessed sexual health, irrespective of gender. Further counseling, including mental health assessment and psychosexual therapy, remains the cornerstone of sexual dysfunction treatment for all genders. Primarily oral PDE5 inhibitors (sildenafil, tadalafil, vardenafil)* On-demand use: administer at least 30 minutes before sexual activityContinuous use: Tadalafil 5 mg daily On-demand use: administer at least 30 minutes before sexual activity *Use lower doses with boosted PIs (PI/r or PI/c): sildenafil 25 mg every 48 hours; tadalafil 5 mg as an initial dose, maximum 10 mg every 72 hours; vardenafil 2.5 mg, maximum 2.5 mg every 72 hours Consider behavioral interventions and/or psychosexual counseling, SSRIs, tricyclic antidepressants, clomipramine, and topical anesthetics Use lower doses of clomipramine and other tricyclics with boosted PIs; see Drug-drug interactions between antidepressants and ARVs Dapoxetine, a short-acting SSRI, is the only drug approved for on-demand treatment of premature ejaculation in Europe. Treatment must be maintained, as recurrence is highly likely upon discontinuation Discontinue or switch drugs contributing to delayed ejaculation (antidepressants, antipsychotics, diuretics, antiseizure medications) Treat comorbidities such as hypertension, pelvic nerve injury, or diabetic neuropathy PDE5 inhibitors (e.g., sildenafil — see DDI); benefit in women is generally less than in men Lubricants and/or hormonal therapy (topical or systemic) if pain is related to vaginal dryness Analgesics for pain associated with menstrual symptoms Topical lidocaine, capsaicin, or vestibulectomy for irreversible pain conditions Q. I am in a new sexual relationship and surprised that at age 63 I have premature ejaculation.