Premature ejaculation prevalent but poorly understood

Results from a survey of approximately 5,000 Asian men showed that one in three had premature ejaculation (PE) or probable PE and that understanding of the condition remained low among men in the Asia-Pacific region.

"Men have got to start realizing that PE is a medical condition that affects a high number of their peers so that they will be prompted to talk to their partners and their physicians and start looking at available treatments," said Professor P. Ganesan Adaikan, of the department of obstetrics and gynecology at the National University Hospital, Singapore.

According to the International Society of Sexual Medicine, PE is defined as "a male sexual dysfunction characterized by ejaculation which always or nearly always occurs prior to or within about 1 minute of vaginal penetration; and inability to delay ejaculation on all or nearly all vaginal penetrations; and negative personal consequences, such as distress, bother, frustration and/or the avoidance of sexual intimacy."

The Asia Pacific Premature Ejaculation Prevalence and Attitude (AP PEPA) study found that only 34 percent of the respondents strongly agreed that PE is a physical and medical condition. Some 35 percent mistakenly thought that PE and erectile dysfunction (ED) are similar, while 48 percent had the misconception that PE can be effectively treated using ED medication. Thirty-four percent believed that PE will disappear over time and 30 percent believed that it cannot be effectively treated.

"We need to make sure that these men are aware that every man who has PE can be helped either by counseling or medication or a combination of treatment and that the first person to talk to after his partner is his primary care physician, who in many cases can effectively treat PE. In some cases he may choose to refer [the patient] to a specialist, such as a urologist or a sexual health physician, or to some form of counseling," said Professor Chris McMahon, of the faculty of health sciences at the University of Sydney, Australia.

One way that PE can be treated with medication is with the use of selective serotonin reuptake inhibitors (SSRIs), McMahon said. He explained that serotonin is a messenger chemical that controls the speed of ejaculation and that increasing serotonin levels with the use of SSRIs significantly delayed ejaculation.

He, however, noted that SSRIs could currently only be used off-label for PE. "One of the major concerns is that these drugs were not developed as the treatment for PE. They are effective, but because they are not specifically approved for the treatment of PE, even though they are effective and even though they are relatively safe, they are used off-label," said McMahon, who is also director of the Australian Centre for Sexual Health in Sydney, Australia. "We really need an approved, on-demand treatment that is effective and safe for PE."

A drug that has been specifically developed to treat PE is the short-acting SSRI, dapoxetine. Dapoxetine is currently approved for the on-demand treatment of PE in men aged 18 to 64 years in several countries, including Sweden, Austria, Finland, Germany, Spain, Italy, New Zealand and South Korea. At this stage, the US FDA has not approved the drug. The drug has yet to receive marketing authorization in Singapore.

AP PEPA also showed that one in 10 men was not satisfied with the sense of control over ejaculation or the length of control before ejaculation while 6 to 7 percent were highly distressed by the short time before ejaculation and the inability to control ejaculation.

"The impact PE has on men and their partners can be devastating for a relationship. This is not simply a problem with a man's self-esteem or prowess, but it also has great impact on a woman's fulfillment and, ultimately, the entire relationship," said Professor George Lee, a consultant urological surgeon at the University of Malaya, Kuala Lumpur, Malaysia.