Premature Ejaculation

Lifelong PE – the hard truth!

Premature ejaculation (PE) is clinically categorized as either lifelong or acquired. Lifelong PE is defined by early ejaculation that occurs consistently across all settings and situations—beginning from the very first masturbatory or sexual experience. In every circumstance, ejaculation invariably happens in under one minute. 

Terms you should be aware of for this conversation:

IELT – Intravaginal Ejaculation Latency Time
PE – Premature Ejaculation
SSRI – selective serotonin reuptake inhibitor

In lifelong PE or premature ejaculation, treatment comes down to either on-demand or permanent medication. Unlike with other forms of PE, there is no “cure”. Drugs that are approved for PE are Dapoxetine and Lidocaine / Prilocaine spray.

The penis contains two erectile chambers known as the corpora cavernosa, which consist of vascular cavernous tissue. A closer look reveals small sinuses—hollow spaces situated between microscopic tissue beams. During an erection, these vascular spaces engorge and fill with blood. 

Sexual arousal will activate a division of the nervous system called the parasympathetic nervous system. And the parasympathetic nervous system will send signals into the penis and cause nitric oxide to be released within.  

The process of achieving an erection begins with the relaxation of the trabecular smooth muscle within the corpora cavernosa, which remains tightly contracted while the penis is flaccid. When nitric oxide is released, it diffuses into these muscle cells and activates the enzyme soluble guanylyl cyclase (sGC).

This enzyme triggers the production of cyclic guanosine monophosphate (cGMP), a molecule that lowers internal calcium levels and causes the supportive smooth muscle tissue to completely relax and unwind, opening the internal hollow sinuses to hold blood. 

Nitric Oxide – the ignition for solid erections

Simultaneously, the penis requires a massive and rapid influx of blood to transition into an erect state. Nitric oxide drives this by acting on the smooth muscle lining the helicine arteries, which supply blood directly to the erectile chambers. This action causes vasodilation, widening the blood vessels and dramatically reducing resistance so that arterial blood can rush rapidly at high pressure into the newly expanded cavernosal spaces. 

Priligy 30mg (a Schedule-5 drug) is a prescription medication primarily used for the on-demand treatment of premature ejaculation (PE) in adult men aged 18 to 64.

The active compound is dapoxetine, which belongs to a class of medications called selective serotonin reuptake inhibitors (SSRIs)

Unlike traditional daily antidepressants, dapoxetine is uniquely fast-acting and rapidly eliminated from the body. It works by increasing serotonin activity in the nervous system, which effectively delays the neurological signals that trigger ejaculation, granting the user greater ejaculatory control.

If someone is having difficulty achieving or maintaining an erection, one possible solution would be to maintain higher levels of cyclic GMP. And this is exactly what Viagra does. First, Viagra taken in the proper amounts do not directly cause an erection. Instead, it enhances the physiological response to sexual stimulation. The stimulus could be as simple as a thought, visual, auditory, olfactory, and tactile stimulation. 

Ejaculation is primarily regulated by the sympathetic nervous system. 

The Mechanism: Dapoxetine blocks the reuptake of serotonin (a chemical messenger) between nerve cells. 

The Result: Higher serotonin levels delay the pathways in the brain that trigger an orgasm. Studies show it can double or triple the time it takes to ejaculate while giving the patient a greater sense of control and sexual satisfaction. 

What is your IELT time and when should you actually be worried?

Dapoxetine belongs to a group of drugs by the name of SSRI’s – selective serotonin reuptake inhibitors. Dapoxetine should only be prescribed to men who meet all the following criteria: 

• An intravaginal ejaculatory latency time of less than 2 minutes and 
• Persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the man wishes and 
• Marked personal distress or interpersonal difficulty because of premature ejaculation and 
• Poor control over ejaculation and 
• A history of premature ejaculation in most of the intercourse attempts over the prior 6 months. 

If you are looking for premature ejaculation (PE) solutions that you can buy over the counter (OTC) at local retailers like Clicks Pharmacies or Dis-Chem, you have a few options: 

• Topical Numbing Creams and Sprays: Products like EMLA cream or Fraink Delay Cream contain local anesthetics (like lidocaine or prilocaine). They are applied directly to the skin to reduce sensitivity and delay ejaculation. These are generally available over the counter as lower-schedule products. 
• Climax Control Condoms: Many major condom brands sell varieties lined with a mild numbing agent (like benzocaine) inside the tip to help prolong intercourse. 
• Natural Sexual Health Supplements: As mentioned previously, herbal formulations (such as those containing Tongkat Ali or Ashwagandha) are widely available OTC to support general male vitality and libido, though they do not work the same way as prescription pharmaceutical blockbusters like Priligy (ask your doctor for a prescription). 

What about the start-stop and squeeze techniques?

These are historic and certainly made sense at the time they were invented back in the 1950’s and 1960’s. That was well before the SSRI era. Complementary sexual counselling of the couple is useful in my opinion. Because pressure and performance anxiety often worsen the problem. It is important that both partners work together here and use their relationship as the foundation.

What’s normal in terms of the amount, the colour and the texture

Fluid Volume: 1.5 to 5 mL is standard. A volume lower than 1.5 mL is called hypospermia, while a volume over 6 mL is known as hyperspermia. Abstaining from sex or masturbation for a few days typically increases fluid volume, while frequent ejaculations temporarily lower it.

From white to beige to yellow are normal. If black or red coloured semen persist over ten ejaculations, we recommend you see a doctor immediately.

Semen consists of 5% sperm and 20% prostatic fluid. The remaining 75% is seminal plasma, a nutrient-rich, alkaline cocktail produced by a network of accessory glands designed to protect, nourish, and transport the sperm.