A persistent or recurring sexual problem in the male characterixzed by orgasm and ejaculation early after intromission in sexual contact, befor he desires it. Mostly due to anxiety related tosexual performance or as part of a general anxiety state. Occasionally, due to errors in expectation, and in adolescents, due to heightened excitation. Rarely due to urologic pathology like prostatitis, urethritis, or pelvic trauma or surgery.
Treatment
Psychotherapy and sex-education.
Use of condom, or topical anaesthetic to lessen sensitivity
‘Pause-squeeze technique’ (Masters & Johnson’s) in which 4 seconds or moderate pressure is applied to
the frenulum during pre-ejaculatory phase, penetration suspended for a time, and process repeated
until control is achieved. Not benn found a very satisfactory method.
Clomipramine (25 mg daily) (Anafranil, Novartis), a tricyclic antiobsessional drug, has given very
satisfactory results.
Anxiolytics in those with severe anxiety
“As needed” therapy – Antidepressants of SSRI group Sertaline (50 mg, 4-8 hours before intercourse),
and antidepressant paroxetine (20 mg, 4-5 hours before intercourse), have both given good results, in independent trials.
