When it’s all over in a flash ...

WHAT counts as ‘premature’? Ejaculating within a minute or less, states the International Society for Sexual Medicine.

Although associated with over- eager young men, premature ejaculation can affect males of all ages and cause a lot of distress.

‘Often men with premature ejaculation lose partners,’ says Mike Kirby, a professor of men’s health.

It is one of the most common sexual problems — about 30 per cent of men will experience it at some point.

It may have genetic or psychological causes. Sadly, the penis can be ‘trained’ to perform prematurely, says sex and relationship councillor Victoria Lehmann. Early experiences, such as one-night stands or fear of discovery, may lead to a pattern of it.

Stress caused by relationship problems may also be a cause: sexually demanding partners, unrealistic expectations and a lack of communication and trust can all play their part.

Victoria urges couples to seek help together.

‘The outcomes are usually much better if you work with the couple,’ she says.

There are physical solutions — the Sexual Advice Association recommends a ‘stop-start’ exercise, which involves stimulating the penis until just before the point of no return, then stopping and waiting for up to 60 seconds before starting again.

This should be repeated three or four times before ejaculation and can be done regularly for several weeks.

Another solution are overthe-counter sprays to desensitise the head of the penis. Many contain the anaesthetic lidocaine, which is applied minutes before intimacy.

Doctors may also prescribe a selective serotonin reuptake inhibitor (SSRI), an antidepressant which, in lower doses than for depression, slows the nerves causing ejaculation.

However, side-effects can include weight gain and low libido.

In 013, dapoxetine, a shortacting SSRI marketed as Priligy, became the first drug licensed for premature ejaculation in the UK.

It works like an antidepressant but more quickly and should be taken an hour or two before sex.

Prostate or bladder surgery or a spinal cord injury can lead to retrograde ejaculation, where semen is sent backwards into the bladder. As well as a ‘dry’ ejaculation, urine passed after sex may be cloudy.

There is no pain, but the condition could affect fertility. It can also be caused by diabetes or blood pressure medication. Operations to treat it are considered by the NHS only if fertility is an issue.

PILLS AND PUMPS

PRESCRIPTION drugs are the first-line treatment for erectile dysfunction (see previous page), but men whose problems are a result of prostate surgery may need a more radical solution.

Blood flow is important to keep the tissues oxygenated, so after pelvic surgery for cancer ‘we recommend using a pump every day to keep the penis healthy and to stop the shortening that sometimes occurs’, says Professor Kirby.

Pumps, sometimes available on the NHS, are used with a daily dose of Viagra or Cialis.

If these fail, men are taught to self-inject the penis with a prescription-only drug called alprostadil that can be effective within five to 0 minutes and gives erections lasting about 40 minutes.

Alternatively, alprostadil can be used as a cream inserted into the opening of the urethra with an applicator. The erection will develop over the next five to ten minutes.

The most radical solution is a penile prosthesis, an inflatable tube implanted inside and along the length of the penis.

An internal, manual pump is placed between the testicles and the tube can be pumped up to create an erection.