Premature Ejaculation Problems in Men

by Dr. Alex Shteynshlyuger, a board-certified urologist, and specialist in the treatment of penile problems in men


If you have any questions, to schedule a consultation or if you need a second opinion, please contact us or call: 646-663-4151


Why Do Men Come Too Fast and Experience PE (Premature Ejaculation)?

Premature Ejaculation

Premature ejaculation is a fairly common condition that affects many men at some point in their life.  For most men, premature ejaculation is an occasional concern.  Some men have severe and persistent premature ejaculation that has been present their entire life.

In studies, premature ejaculation is measured as intravaginal ejaculatory latency time (IELT), the time from penetration to ejaculation.  For some men, premature ejaculation may be so severe that they ejaculate even before the ability to penetrate as soon as they get excited and often within 30-60 seconds of getting an erection or vaginal penetration.  Premature ejaculation can have a severe effect on relationships both from guilt felt by the man and lack of satisfaction by partners. It can also cause depression and performance anxiety.

Two types of premature ejaculation are commonly seen in men.  Lifelong premature ejaculation is present since the onset of sexual activity and typically occurs every time a man ejaculates.  Lifelong premature ejaculation tends to be more severe in nature, with time to ejaculation anywhere from 15-30 seconds to 2-3 minutes.

Men also can develop acquired premature ejaculation that often occurs as men get older or may occur occasionally. This tends to be less severe with men typically complaining of ejaculating within 2-5 minutes.

Causes of Premature Ejaculation

The exact cause of premature ejaculation is not clear but it is apparent that serotonin pathways in the brain affect premature ejaculation as SSRI (selective serotonin reuptake inhibitors) prolong ejaculatory time by increasing serotonin levels in the brain.

One hypothesis is that premature ejaculation is an evolutionary adaptation. Men who ejaculate faster may have an advantage in reproduction and survival. 

It appears that men with attention deficit hyperactivity disorder may be at increased risk for premature ejaculation as well.

There are some reports that some men with premature ejaculation who also have scrotal varicoceles benefit from varicocele repair.

Treatment for Premature Ejaculation At New York Urology Specialists.

Premature ejaculation often coexists with erectile dysfunction.  Often, erectile dysfunction may be masked by a severe premature ejaculation.  Anxiety caused by premature ejaculation often leads to problems with obtaining and maintaining erections with a partner.

It is also important to differentiate erectile dysfunction from premature ejaculation. Men with premature ejaculation ejaculate too soon and then lose the erection.  Men with erectile dysfunction lose erection typically without ejaculation.

Guidelines from American Urological Association (AUA) and our practice at New York Urology Specialists is that patients with any degree of erectile dysfunction associated with premature ejaculation first get treated with the goal of correcting erectile dysfunction.  Treatment for erectile dysfunction often improves symptoms of premature ejaculation especially in men with acquired premature ejaculation. 

Exact treatment depends on the individual situation but medications such as sildenafil (Viagra) or daily Cialis (tadalafil) work well for most men.  In addition to treating erectile dysfunction, medication such as Viagra and Cialis appear to shorten the refractory period in men.  Medications such as Cialis and Viagra can also allow men to maintain an erection and satisfy their partner even after ejaculation.

Treatment for Premature Ejaculation

Treatment options for premature ejaculation include behavioral therapy, psychotherapy, and medications.   While psychotherapy may be helpful, it is often impractical.

Behavioral Therapy for Premature Ejaculation

Behavioral therapy involves a number of methods. One simple method is for men to stop thrusting to allow the sensation of impending orgasm to pass before resuming.  That can prolong ejaculatory time.  Some men find that after masturbation when they get a second erection they are able to last longer. This is more common in men with acquired ejaculation.

SSRI: Effective Treatment Option for Premature Ejaculation

Most effective treatment option for premature ejaculation involves using SSRI, antidepressant medications that have a beneficial side effect of prolonging ejaculatory time.  These medications can be taken a few hours prior to intercourse if sex is planned.  More commonly we advise that men take medications daily to avoid last-minute worry about the timing of medication use.  

If SSRI medications do not help, certain medications that affect pain receptors can be tried.

Topical ‘numbing” creams, wipes, and sprays can be used for the treatment of premature ejaculation.  They are effective. Men often get frustrated because applying a bit too much causes numbness (not too good); not using enough does not help.  Finding the right balance can be a challenge.

Penile Injection Therapy with Alprostadil (Edex) or Trimix

Another effective treatment option that can overcome premature ejaculation is intracorporeal injection therapy with medications such as alprostadil or Trimix which produce a very strong erection.  These medications do not affect premature ejaculation but enable men to maintain erections for a prolonged period of time even after ejaculating which can allow them to satisfy their partner.  The dose of medications can be adjusted to produce an erection of adequate duration.  Typically the goal is to find a dose that will produce an erection that lasts less than 1 hour to avoid risks of priapism (an erection that lasts more than 2-3 hours).

Why Choose New York Urology Specialists for Treatment of Premature Ejaculation Problems in Men?

  • All treatment is performed by a Board-certified urologist experienced in treating men with penile symptoms using medical therapy, minimally invasive therapies, lasers and open surgery.
  • We are one of the few practices in the region to offer a full range of options for treatment of sexual and penile problems in men
  • We offer treatment options for balanitis, genital warts, phimosis, Peyronie’s disease, and penile cysts in our office which avoids the risks, costs, and recovery from general anesthesia.  
  • Extensive Experience: Hundreds of men and women have treated successfully using medical therapy and surgery.

Excellence-Urology_Care VasectomyWhen it comes to experience and innovation – New York Urology Specialists are a step ahead.  Better Science Means Better Care.  We specialize in minimally invasive highly effective treatment for symptoms of penile pain, urethral burning, foreskin inflammation and penile cancer. Many treatment procedures are performed in the convenience and privacy of office settings under local anesthesia.

If you have any questions, to schedule a consultation or if you need a second opinion, please contact us or call: 646-663-4151

Medicare and major insurances accepted. Urologist. We offer affordable rates and financing options.

Schedule an Appointment with Dr. Shteynshlyuger:

Call today: 646-663-4151 or make an appointment online

Dr. Alex Shteynshlyuger is a fellowship trained board-certified urologist with expertise in evaluation and treatment of penis problems in men.  He uses modern effective and proven treatment methods. He is highly recommended by doctors and patients alike.

He has successfully treated hundreds of men of all ages with penile problems including irritation and inflammation of the penis, bent penis, and weak erections. 

If you or someone you know has been experiencing urological symptoms, make an appointment to take advantage of Dr. Shteynshlyuger’s expert advice. Please feel free to Contact Us with any questions.

 


If you have any questions, to schedule a consultation or if you need a second opinion, please contact us or call: 646-663-4151

We offer affordable, highest-quality urology care with or without insurance.   Find out our office hours or directions to our office. We offer weekday, weekend and evening office hours.



If you have any questions, to schedule a consultation or if you need a second opinion, please contact us or call: 646-663-4151

Dr. Alex Shteynshlyuger is a board-certified urologist in NYC who specializes in treating men with penis problems including lumps, pain in the penis, penile masses, erectile dysfunction, circumcision.


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