Approach to managing premature ejaculation

The main aims of treating premature ejaculation are to achieve control over ejaculation and satisfactory sexual intercourse for the person and their partner.

For lifelong premature ejaculation, treatment options are:

• pharmacotherapy alone
• pharmacotherapy combined with psychological or behavioural therapy.

Goals of psychological or behavioural therapy include learning techniques to control ejaculation, gaining confidence in sexual performance, reducing anxiety, adapting sexual repertoires, and improving communication. Consider referral to an accredited therapist with a specialist interest in sexual health practice, such as a sexual medicine specialist, sexologist, general practitioner, nurse, psychologist, other sexual health counsellor or sexual health physician. The Society of Australian Sexologists and the Australian Psychological Society set national accreditation standards for quality and safety of practice and list accredited members.

Choice of treatment depends on the individual’s preference.

For acquired premature ejaculation, assessment to identify the underlying condition includes enquiry into psychological and relationship problems, medical history, use of alcohol and recreational drugs, and evaluation for associated erectile dysfunction, chronic prostatitis, and hyperthyroidism.

Initial management of acquired premature ejaculation involves treatment of the underlying condition. Subsequent treatment involves psychological or behavioural therapy, pharmacotherapy, or a combination.

Pharmacotherapy options for premature ejaculation are:

• topical local anaesthetics to reduce sensitivity of the glans penis
• certain selective serotonin reuptake inhibitors (SSRIs) that delay ejaculation
• combination therapy with a phosphodiesterase type 5 (PDE5) inhibitor and a SSRI, for those who do not respond to SSRI monotherapy.

On-demand tramadol has shown short-term efficacy for premature ejaculation, but long-term studies of efficacy and tolerability are lacking, and there is the possibility for addiction and respiratory depression. It should only be considered when all other options have been explored and the harms and benefits have been discussed with the patient.