PE is divided into two types • Primary – a lifelong problem • Secondary – where PE develops gradually over time when in the past a man has not been experiencing the condition. It can also have physical or psychological causes • Psychological – o Anxiety or stress - sometimes due to the newness of a relationship and concerns about ‘performance’. o Learning and training- the effects of teenage sexual experiences where men learn to masturbate in secret and therefore come as quickly as possible to avoid being ‘found out’. • Physical o Some medicines or illicit drugs such as cocaine or amphetamine o Chronic prostatitis (inflammation of the prostate gland) o Hormonal problems involving the thyroid gland o Conditions affecting the nervous system such as MS or peripheral nerve damage.

If you have decided PE is a problem for you and your relationship and want to tackle it, we can help you here. Self-help: There are various techniques you can try to help last longer: • Masturbate 1-2 hours before sex • Use a thick condom to reduce penile sensation • Controlling your breathing – taking a deep breath when you get close to the urge to ejaculate delays the reflex • Positions such as partner on top can be less stimulating and allow you to last longer. You can move from a more stimulation position to a less stimulation position and back. • Squeeze technique • Stop-start method • Controlling your mind – some men find thinking of something boring helps (although this might detract from the moment) • Don’t focus on penetration. Explore each other’s bodies so that penetration and orgasm are not the sole focus of the experience. Bringing your partner to orgasm before penetration may allow you to relax more. • To read more, there are a variety of books that can help. Try ‘She comes first: the thinking man’s guide to pleasuring a woman’ by Ian Kerner. Couples therapy • Can be really helpful in exploring how attitudes towards sex and past sexual experiences may be impacting on your sex life today. It can help you get closer to your partner and work through anxieties and stresses that may be contributing to the problem. Sex and relationship counselling is available around the country. The organisation Relate may be able to help www.relate.org.uk Medication • Anaesthetic cream – local anasethetic cream (called Emla) can be applied to the penis 30 mins before sex to numb the skin and decrease sensitivity. Many men have found this helpful and as it is applied only to the skin the chance of side effects is small. It has been found to increase time to ejaculation 4-6 fold. • Tablets – drugs used to treat anxiety and depression known as SSRIs (e.g. citalopram, fluoxetine, sertraline, paroxetine) work on the nervous system and have been found to have the side effect of causing a delay in reaching orgasm in both women and men. This side effect can be used to help men experiencing premature ejaculation. It can increase time to ejaculation up to 9 times. Because these medicines are being used for their side-effect rather than the problem they were originally designed to treat, they are not licensed for this use, but a doctor may be able to prescribe it for you after discussing your needs. This treatment involves taking a tablet or capsule every day and some people experience unwanted side effects such as nausea and dizziness, which often improves after a few weeks. • Priligy (dapoxetine) – Priligy works in the same way as SSRIs (see above). It temporarily affects the transmission of messages via nerve impulses that control ejaculation. It is only taken when needed i.e. it does not need to be taken every day, and has been specifically licensed for the treatment of premature ejaculation. It is taken by mouth 1-3 hours before sex. It is available from our pharmacy following a free online assessment.

Studies suggest Priligy increases the time from penetration to ejaculation by 1-2 minutes. 30.7% of men reported that their PE was better or much better when using Priligy at the standard dose (30mg). Some men find they need a higher dose (60mg). At the higher dose of Priligy 38.3% reporting their PE as better or much better. However, the chance of side effects such as fainting is also greater at this dose.

The main reported side effect of Priligy is dizziness (faintness) when standing up due to a drop in blood pressure (orthostatic hypotension). Typically this will affect 1 in 10 men. For this reason it is advised that you take Priligy with at least one full glass of water to stay hydrated and avoid alcohol. It is a good idea to get your blood pressure checked lying down and standing up before starting Priligy to see if you are at increased risk of faintness. If you do feel faint or nauseated while taking Priligy you should sit or lie down until the symptoms subside. Priligy should NOT be taken at the same time as medication for erectile dysfunction. The manufacturers recommend that the benefits to the patient should be reviewed after 4 weeks of treatment or 6 doses, and then every 6 months