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Premature ejaculation is a treatable medical condition

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Premature ejaculation is a widespread sexual health issue impacting numerous men globally. Thanks to the efforts of pharmaceutical companies producing Viagra (and its derivatives), you would probably know a thing or two about erectile dysfunction. Surprisingly, premature ejaculation is twice as common as erectile dysfunction among men aged 18 to 59. Despite its prevalence, people often leave this male sexual problem unaddressed. This article will teach you all you know about the condition and how you can begin treatment. 
Sire can help you understand problems related to premature ejaculation with professional guidance

The Premature Ejaculation Prevalence and Attitudes (PEPA) survey conducted locally revealed that 77% of Singaporean men with premature ejaculation have never communicated their problem to a doctor. At Sire, we endeavour to change this. In this comprehensive guide, we delve into the secrets to lasting longer, exploring the causes, and providing practical medical solutions. 

Understanding Premature Ejaculation (PE)

Defining the Different Types

Men often refer to premature ejaculation as the occurrence of ejaculation that happens too early, shortly after initiating sexual activity. This can result in the penis becoming flaccid or limp, complicating the process of penetration. Ejaculation often occurs before both partners achieve satisfaction, leading to distress in the man and/or his partner.

Going into the specifics, the International Society of Sexual Medicine defines PE as a male sexual dysfunction characterised by:

  • A persistent or recurrent pattern of ejaculation occurring within approximately one minute following vaginal penetration and before the individual wishes it;
  • The symptom above have been present for at least 6 months and experienced on almost all or all (approximately 75%-100%) occasions of sexual activity; and
  • The symptom causes significant negative personal consequences such as distress, bother, frustration and/or the avoidance of sexual intimacy.  

Lifelong/Primary PE

Lifelong PE, sometimes referred to as primary premature ejaculation, occurs from a man’s first sexual experience. It remains present for all or most of a man’s sexual life. For men with lifelong PE, ejaculation occurs too quickly, either before vaginal penetration or within about 1 minute afterwards. The American Urological Association suggests a time of within 2 minutes. 

Acquired/Secondary PE

Acquired PE, sometimes known as secondary premature ejaculation, typically develops gradually or suddenly with ejaculation being normal prior. The time of ejaculation is short but not as fast as in primary PE, often about 2-3 minutes. Experts also suggest a 50% or more reduction in ejaculation time from prior estimations. Psychological causes are more likely to associate with acquired PE.

PE with Concurrent ED

Approximately 30% of men with PE have concurrent erectile dysfunction. This typically results in early ejaculation without a full erection. The fear of losing an erection may lead to rushing through intercourse, whether consciously acknowledged or not. Typically, the first line of treatment addresses erectile dysfunction, and the addition of premature ejaculation treatment occurs when there is little or no improvement.

Recognising the Signs

Recognising premature ejaculation involves paying attention to key indicators. If you consistently climax within a minute of penetration or struggle to control ejaculation, it is time to seek solutions. 

If you find it hard to talk to your doctor about premature ejaculation, we are here to help. The Premature Ejaculation Diagnostic Tool (PEDT) is a short, validated questionnaire you can use to understand your condition. Doctors use the validated PEDT to identify men who may have premature ejaculation.

Use this diagnostic tool as a first step to understand your condition better. It can also serve as a starting point for a discussion with your doctor. Select the response that best represents your answer for the following questions. While your experiences may change from time to time, select the response that best describes your general experience with intercourse. 

Note: Ejaculation here means from the time of penetration (when your penis enters your partner) until ejaculation (release of semen).

Exploring Sire premature ejaculation treatment options in Singapore - Diagnostic Survey

A score of 9 or 10 suggests a probable diagnosis of premature ejaculation.

If you score ≤8 indicates a low likelihood of premature ejaculation.

Unsure about your score? At Sire, we make it convenient and discreet for you. Simply fill in our survey form to get started and our doctors will follow up with you.

You can also take our free erectile dysfunction assessment based on the International Index of Erectile Function (IIEF-5) questionnaire here. 

Causes of Premature Ejaculation

Causes of Premature Ejaculation- Sire

Premature ejaculation can stem from various factors, ranging from psychological triggers to biological predispositions. Understanding these causes is crucial in developing effective strategies to address and overcome the issue. Psychological factors such as anxiety, stress and performance pressure often play a significant role, alongside biological factors and relationship issues. 

Would you like to find out the cause of your premature ejaculation? Speak to an MOH approved doctor here

Psychological Factors

Several psychological factors may contribute to premature ejaculation, including abuse, poor body image and depression. Anxiety, commonly associated with premature ejaculation, may stem from concerns about sexual performance or other issues. Stress and relationship problems can also contribute to premature ejaculation. Addressing these psychological factors is essential in treatment. 

Physical Factors

Underlying medical conditions like erectile dysfunction and inflammation of the prostate gland (prostatitis) can predispose men to premature ejaculation. Increasingly, research demonstrates an imbalance of brain chemicals in premature ejaculation. Our body produces serotonin, a natural brain chemical that regulates mood, emotion, sleep and sexual desire. Low levels of serotonin may shorten the time to ejaculation, leading to premature ejaculation. Consulting with a healthcare professional can help identify and address any underlying biological factors. 

Lifestyle Factors

Unhealthy lifestyle habits such as excessive alcohol consumption, smoking and lack of exercise can also contribute to premature ejaculation. Adopting a healthier lifestyle can have a positive impact in the treatment of premature ejaculation. 

Seeking Professional Help

As men gain sexual experience and age, we typically acquire the ability to delay orgasm. Premature ejaculation may occur with a new partner, in specific sexual situations, or after an extended period since the last ejaculation. Whatever the cause, help is available in Singapore. Scheduling a consultation with a healthcare provider is a crucial initial step. This allows for a comprehensive assessment of your health, ruling out any underlying medical conditions that might contribute to premature ejaculation. 

Medical PE Treatments

Doctors prescribe medical interventions, including topical anaesthetics and medications, to manage premature ejaculation.We tell you all about premature ejaculation treatment that is  available in Singapore. 

Topical Anaesthetics

The penis is one of the most sensitive organs in the body. The erection process involves a seductive mix of factors, progressing from sensation to arousal and then to orgasm. For men with premature ejaculation, too much sensation causes ejaculation to occur too quickly than what they or their partner would like. Topical anaesthetics work by reducing penis sensation and delaying orgasm, resulting in ejaculation only when ready. This can allow for increased control over ejaculation. We tell you the commonly used topical anaesthetics in Singapore used in the treatment of premature ejaculation. 

Lignocaine 2% Gel

Doctors typically use Lignocaine 2% gel as a topical medication for local anesthesia and pain relief. Medical professionals apply it to the skin or mucous membranes to numb the area before performing procedures like injections, sutures or minor surgeries. Lignocaine gel works by reducing penis sensitivity in PE treatment. This helps to delay ejaculation and provide men with more control over climax during sexual activity. Lignocaine 2% gel is available over-the-counter in Singapore, a prescription is not required. 

Want to know how to apply lignocaine gel for premature ejaculation? Find out more here

EMLA Cream

Similar to lignocaine gel, EMLA cream contains local anaesthesia to numb the skin and provide pain relief. EMLA cream contains two types of local anaesthesia: lidocaine 2.5% and prilocaine 2.5%. This combination provides a potent anaesthetic effect. Unlike lignocaine gel, EMLA cream would require a prescription in the treatment of premature ejaculation.  

We tell you how EMLA cream is helping Singaporean men fix their PE here.  

Get emla at Sire

Get Emla from Sire,

We always recommend get a consultation prior to starting any medication. 

Delay Sprays

Delay sprays are also known as premature ejaculation sprays or desensitising sprays. They typically contain a local anaesthetic like benzocaine or lidocaine. This reduces sensitivity in the most sensitive areas of the penis, preventing rapid ejaculation. Currently, there is no commercially available delay spray product in Singapore. 

Curious about delay sprays? Find out how they prolong sex and how to obtain them safely in SIngapore

How Should I Choose?

In Singapore, lignocaine 2% gel and EMLA cream are commercially available. Obtaining a delay spray product might be rather difficult as there is currently no product registered with the HSA. Depending on preferences, some men prefer a gel or a cream over a spray due to greater control during application. 

Between lignocaine 2% gel and EMLA cream, the EMLA cream would provide a more potent numbing effect. Compared to creams, gels are generally better absorbed. Depending on your personal preferences, our doctors at Sire can navigate the options with you.

Selective Serotonin Reuptake Inhibitors (SSRIs)

Serotonin is a key hormone in our brain that has been found to play an important role in ejaculation. Men with higher levels of serotonin tend to climax later. SSRIs work by increasing serotonin levels. This helps to delay ejaculation. 

SSRIs are typically used as antidepressants. They have been found to have a side effect of delaying ejaculation in men. Long-term use of SSRIs has been shown to extend the time between erection and ejaculation in men. In Singapore, SSRIs are prescription-only medications. 

Dapoxetine

Dapoxetine (brand name: Priligy) is the only SSRI approved for the treatment of premature ejaculation in over 50 countries, including Singapore. Clinical trials have shown that when dapoxetine is taken 1-2 hours before intercourse, it is effective from the first dose. Increased ejaculatory control, lower emotional distress and increased satisfaction were reported in these trials. 

At Sire, we explore six common myths about Priligy and where to obtain Priligy safely in Singapore

Other SSRIs

Unlike dapoxetine that is taken on demand, all other SSRIs are prescribed to be taken daily for the treatment of premature ejaculation. Available agents in Singapore include paroxetine, sertraline, fluoxetine, citalopram and escitalopram. 

SSRIs are typically prescribed at the lowest dose and increased slowly as required at 3-4 week intervals. It takes about 2-3 weeks of treatment to see a noticeable improvement in ejaculation delay.  

Which SSRI is better?

It depends on your lifestyle preferences. At Sire, our doctors can prescribe dapoxetine and sertraline. If you have sex 2-3 times per week and want to last longer each time, sertraline may be a better treatment option for you. It is also typically prescribed for men who struggle with lifelong premature ejaculation. Read more about sertraline here

If you don’t have sex as often, Priligy may be a better option as it is taken on-demand. This can minimise common side effects of SSRIs like nausea, headache, dizziness and fatigue. When you consult with our doctors, we will navigate the different solutions with you.

Phosphodiesterase (PDE) inhibitors

PDE5 inhibitors like Viagra may be effective for the treatment of premature ejaculation, specifically in men with underlying erectile dysfunction. For men with both erectile dysfunction and premature ejaculation, a PDE5 inhibitor is typically prescribed first to treat the ED. If ejaculatory does not improve, SSRI is usually added on.  

PDE5 inhibitors are not recommended for premature ejaculation treatment in men with normal erectile function.  

Behavioural Therapy

Several behavioural techniques can be employed to enhance control over ejaculation. These techniques have been found to be effective in some men. The goal of behavioural therapy is to help men identify the signs of an imminent ejaculation or orgasm. With practice, ejaculatory control can be improved. 

Stop-Start Method

The stop-start method involves pausing sexual activity when nearing climax and resuming once the heightened arousal subsides. This technique helps men develop better control over the timing of ejaculation. The stop-start method can be applied in a cycle of 3 pauses proceeding to orgasm. 

Squeeze Technique

The squeeze technique entails gently squeezing the base of the penis when close to climax. This action interrupts the progression towards ejaculation, offering an effective way to delay it. The partner can restart sexual stimulation at least 30 seconds later, in a cycle of 3 pauses proceeding to orgasm. 

Masturbation

Masturbating 1-2 hours before sexual intercourse can help delay ejaculation by reducing the level of arousal and sensitivity. The time taken to reach orgasm is delayed during subsequent sexual activity. 

Psychological Approaches

Psychological-Approaches-to-treat-PE

Counselling and therapy play a crucial role in addressing the psychological factors contributing to premature ejaculation. Studies have demonstrated the effectiveness of behavioural and psychological approaches in the treatment of premature ejaculation. For couples facing challenges, engaging in therapy together can provide a supportive environment for addressing concerns and finding shared solutions. 

At Sire, our in-house sex therapist can help men and couples suffering from premature ejaculation:

  • Develop sexual skills with behavioural techniques. This can increase sexual self-confidence and reduce performance anxiety, delaying ejaculation. 
  • Resolve psychological and relationship issues that may have precipitated or have resulted from premature ejaculation. 

Combining Treatment Approaches

Studies have suggested that combining medical, behavioural and psychological approaches may be more effective than medications alone. Individuals may find the most success by combining various treatment approaches tailored to their unique circumstances. 

The Sire Difference

Personalised Treatment Plans

Unlike generic solutions found online, Sire offers personalised treatment plans tailored to your unique needs. Our approach recognises that there is no one-size-fits-all solution for premature ejaculation, what works for one person may not work for another. A degree of trial and error may be involved in finding the most effective treatment combination. At Sire, we stay committed on this journey with you.

Experienced Professionals

Our team consists of experienced healthcare professionals, including doctors and our in-house sex therapist. We work closely together to provide a comprehensive and effective treatment approach. 

Privacy and Confidentiality

We understand the sensitivity of addressing intimate health concerns. At Sire, we prioritise privacy and confidentiality, ensuring a comfortable and discreet experience for our men. 

Summary

Premature ejaculation is a common concern among men, you are not alone. Addressing premature ejaculation involves a comprehensive approach that considers physical, psychological and relational aspects. By exploring medical treatments and considering behavioural and psychological approaches, you can reclaim control and enjoy fulfilling intimate experiences. Remember, seeking professional advice is a proactive step towards a healthier, happier sex life. At Sire, you can consult a doctor and/or a sex therapist discreetly, at the comfort of your own home. 

Frequently Asked Questions (FAQs)

Q: How long is considered premature ejaculation?

While there is no strict definition, ejaculating within one to two minutes of penetration is often considered premature. Individual experiences and satisfaction levels may vary. You can get started on our online survey to understand more. 

Q: Can premature ejaculation be cured completely?

Premature ejaculation can often be effectively managed, if not completely cured, through a combination of lifestyle changes, behavioural therapies, counselling and, in some cases, medications. Improvements can lead to lasting results. However, a complete cure may vary from person to person. 

Q: Is premature ejaculation more common in certain age groups?

While premature ejaculation can affect men of all ages, it is more common in younger men. Ageing and experience often contribute to improved ejaculatory control over time. 

Q: What is the best treatment for premature ejaculation?

Treatment options include medications like topical anaesthetics and SSRIs, behavioural therapy and counselling. The best approach depends on individual circumstances and preferences. Seeking professional advice is the first step towards treatment success.

Q: Are there any side effects of topical anaesthetics?

Temporary numbing and a potential decrease in sexual pleasure are common side effects of using topical anaesthetics like anaesthetic creams or gels. It is crucial to use them as directed. Always consult a healthcare professional when in doubt.

Q: How does behavioural therapy help?

Behavioural therapy focuses on psychological and emotional aspects. A sex therapist can help individuals identify and modify negative behaviours. Individuals can also gain better control over ejaculation through techniques like the stop-start method, improving overall sexual satisfaction.

Q: When should you seek medical help?

If premature ejaculation consistently hinders your sexual satisfaction or relationship, it is advisable to seek medical help promptly. At Sire, you can seek the guidance of a healthcare professional discreetly, at the comfort of your own home.  

Q: Can premature ejaculation impact fertility?

Premature ejaculation typically does not impact fertility, but it can make it hard for a partner to get pregnant. This may happen if ejaculation does not occur in the vagina. If you have concerns about your fertility and conceiving,  it is essential to discuss them with a healthcare professional. 

Q: Is it normal for men to experience performance anxiety?

Yes, performance anxiety is a common concern for men. Open communication with your sexual partner, managing stress and seeking support can help alleviate its impact on sexual performance. Seek professional advice if you experience performance anxiety that affects your life, help is available.  

Q: How can partners support each other?

Partners can support each other by fostering open communication, understanding and exploring treatment options together. Mutual support plays a crucial role in managing premature ejaculation and is often a determining factor for successful treatment. 

Q: How to prevent premature ejaculation?

Techniques to prevent premature ejaculation include practising pelvic floor muscle exercises, utilising behavioural strategies and exploring different sexual positions. Adopting a healthy diet and exercise regimen and managing stress levels can also improve overall sexual satisfaction. Consult a healthcare professional if you have any concerns.

Premature ejaculation is a treatable medical condition

Not lasting longer than a minute? Prescription-only medications allow you to delay your climax and enjoy sex longer. As medication is taken on demand before sex, you don’t have to worry about stopping the action midway.

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It’s estimated that 30% of men, of all age groups, suffer from PE (Montorsi, 2005)—although that number may be higher, since only a small fraction of men with PE talk with their doctor about it (Porst, 2007).

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Sire is part of the MOH’s list of direct telemedicine providers.

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