Premature Ejaculation treatment with supplements and alternative therapy by Ray Sahelian, M.D. (natural health information)
June 4, 2014

Premature ejaculation is the most common sexual dysfunction in men younger than 40 years. Most professionals who treat premature ejaculation define this condition as the occurrence of ejaculation prior to the wishes of both sexual partners. This broad definition thus avoids specifying a precise duration for sexual relations and reaching a climax, which is quite variable and depends on many factors specific to the individuals engaging in intimate relations. Premature ejaculation occurs in just under two minutes, as opposed to about eight minutes for men able to stay the course. And it can indeed lead to dissatisfaction, a sense of losing control and strained relationships.

Definition
Premature ejaculation is defined by the International Society for Sexual Medicine as orgasm that occurs within about one minute of vaginal penetration in the majority of encounters.

Premature ejaculation natural remedy
5-HTP is normally used to increase serotonin levels and often used to treat depression. 5-HTP is not normally known as a premature ejaculation pill, but it may help with premature ejaculation by increasing levels of serotonin. 5-HTP may not stop premature ejaculation, but at least it may slow the process. One herb that could be tried is kava. Tryptophan amino acid is another option to try.

Q. I would just like to know the dosage that would be recommended for treating PE, if you are meant to take it daily, or before sex, etc and the amount.
   A. It would probably be taken for a few days and it is a good idea to start with low dosages of 50 mg but each person is different in their response and dosage requirement.

Q. I am suffering from severe premature ejaculation. I've done some research and i found that Tongkat ali is a good herb to consume for this condition. However the problem is that there are too many fake products and I would like to ask you which brand/company you recommend? Furthermore, i would also appreciate it if you could recommend any additional supplements, medicines or herbs for this problem.
   A. I am not sure tongkat ali would help, but it is worth a try.

Q. Is there another supplement besides 5-htp that helps with premature ejaculation. I saw this in your book "Natural Sex Boosters" and wondered was there something else that helped also.
   A. Sometimes kava works for premature ejaculation, but each person is different, it is hard to make a prediction since herbs have not been studied in this area much.

Natural premature ejaculation cure
I am not aware of a premature ejaculation cure, however a nutrient called 5-HTP can, in my professional experience, slows the onset of premature ejaculation and in some cases may prevent premature ejaculation.

Diagnosis and prevalence
PE has prevalence rates of 20-30%. PE may be classified as lifelong (primary) or acquired (secondary). Diagnosis is based on medical and sexual history assessing intravaginal ejaculatory latency time, perceived control, distress, and interpersonal difficulty related to the ejaculatory dysfunction. Physical examination and laboratory testing may be needed in selected patients only.

Premature ejaculation treatment
In the 1960s, PE was considered a learned behaviour that had to be treated by behavioural therapy, such as the so-called stop-start technique. The efficacy of this method was questioned. Physicians have always looked for medication that could delay ejaculation. Many studies, controlled and open label, have now shown that rapid ejaculation can be treated quickly with clomipramine and SSRIs.
   Pharmacotherapy is the basis of treatment in lifelong PE, including daily dosing of selective serotonin reuptake inhibitors and topical anaesthetics. Dapoxetine is the only drug approved for the on-demand treatment of PE in Europe. Behavioral techniques may be efficacious as a monotherapy or in combination with pharmacotherapy. Recurrence is likely to occur after treatment withdrawal. In the US, the most commonly used pharmacologic medication or treatment to control premature ejaculation is a drug from the selective serotonin reuptake inhibitors (SSRIs) class, drugs which are used normally as antidepressants in the clinical setting. The names of some of these drugs are Prozac, Paxil, and Zoloft. I believe 5-HTP is much cheaper and worth a try before going on to a premature ejaculation drug .
   EMLA, an anesthetic cream, may be another option. EMLA appears to be effective in treating premature ejaculation. Researchers assigned 84 men with premature ejaculation to receive sildenafil (Viagra) alone; EMLA alone; sildenafil plus topical EMLA; or placebo. The rates of effectiveness were 40 percent for placebo, 55 percent for sildenafil alone, 86 percent for the combination of sildenafil plus EMLA, and 73 percent for EMLA alone. Headache and flushing occurred in patients taking sildenafil as part of their treatment, but no side effects were reported by patients taking placebo or EMLA only. Topical EMLA cream alone had effectiveness equal to that of the combination treatment.

Andrologia. December 2013. Relevance of seminal plasma nitric oxide levels and the efficacy of SSRI treatment on lifelong premature ejaculation. Our study indicates that premature ejaculation is significantly related with a higher level of seminal NO. Baseline seminal plasma NO values obtained in patients with PE were significantly higher than in the healthy control group. After treatment with SSRIs, decreased seminal NO may retard ejaculation. Further studies are needed to confirm this suggestion and the role of NO in the pathophysiology and treatment of premature ejaculation.

Curr Drug Saf. 2014 Jan 19. Selective Serotonin Reuptake Inhibitors for Premature Ejaculation: Review of Erectile and Ejaculatory Side Effects. Premature ejaculation is one of the most prevalent sexual disorders affecting men today. The lack of approved therapies has resulted in the prescription of many 'off-label' treatments to manage the condition. Selective serotonin reuptake inhibitors have an interesting side effect of prolonging ejaculatory latency. Consequently, these agents are often considered a first line treatment for patients suffering from premature ejaculation. Erectile dysfunction is another common side effect reported by men treated with selective serotonin reuptake inhibitors. Nitric oxide is the primary mediator of erectile function. Preclinical studies have provided evidence that selective serotonin reuptake inhibitors decrease nitric oxide bioavailability. This invited mini-review aims to examine the physiology of the erectile and ejaculatory responses, discuss the indicated and 'off-label' clinical utility of selective serotonin reuptake inhibitors, and to summarize evidence from basic science and clinical studies pertaining to mechanisms of how selective serotonin reuptake inhibitor therapy modify ejaculatory and erectile function.

J Clin Pharm Therapy February 2014. An improved dosage regimen of sertraline hydrochloride in the treatment for premature ejaculation: an 8-week, single-blind, randomized controlled study followed by a 4-week, open-label extension study.

Anesthetic spray remedy
An anesthetic spray applied to the penis five minutes before intercourse helps men who suffer from premature ejaculation to last longer after penetration. Dr. W. Wallace Dinsmore from the Royal Victoria Hospital, Belfast, UK, says, "Our study shows that when the PSD502 spray was applied to the man's penis five minutes before intercourse it improved both sexual performance and sexual satisfaction, which are key factors in treating premature ejaculation." The PSD502 spray, made by London, UK-based Plethora Solutions Ltd, is a combination of two anesthetics, lidocaine and prilocaine, which act as desensitizing agents, which can help delay orgasm for men. BJU International, April 2009.

A spray that numbs the penis can help prevent premature ejaculation according to drug maker Sciele Pharma Inc, a division of Japan's Shionogi. Tests on more than 500 men suffering from premature ejaculation showed they were more satisfied and less distressed when they used the spray. Stanley Althof of the Center for Marital and Sexual Health of South Florida says PE should be defined as ejaculation occurring within approximately one minute of penetration that causes the patient distress. The drug is a combination of the numbing agents lidocaine and prilocaine. Dr. Ira Sharlip of the University of California San Francisco tested 300 men with premature ejaculation, asking them to apply the spray five minutes before intercourse. The men on average had climaxed less than a minute into intercourse before the spray. Using the spray for three months, 60 percent of the men lasted more than three minutes.

Medication for PE
Some clinical studies have shown that just one tablet of the drug Priligy can make men last up to three times as long during sexual intercourse. Priligy contains the active ingredient dapoxetine, which regulates serotonin levels in the brain. The pills are on sale in some European countries. Nitin Makadia, head of male sexual health at British pharmacy chain Lloyds, says, "Priligy has the potential to do as much for men's sexual health as Viagra." The pill is not without side effects however, with warnings of dizziness, headaches and feeling restless. This medication is not supposed to be taken with alcohol. It is expensive.

Cause of premature ejaculation
There may be a psychological component to premature ejaculation. Insufficient concentration of the neurotransmitter serotonin is now thought to be a physical cause.

Prevalence
Premature ejaculation is the most common male sexual dysfunction, affecting approximately 20 percent to 30 percent of the male population at any one time. Currently, available data suggest that only 1 percent to 12 percent of males self-reporting premature ejaculation receive treatment for their dysfunction.

Classification of Premature Ejaculation
A classification of premature ejaculation must distinguish between hyper-orgasmic or hypo-orgasmic, between situational or global; furthermore, it must define whether it occurs during vaginal penetration only or also in masturbation, and must study its latency periods and its relationships to the erectile dysfunction, with which it is often associated.

Premature ejaculation Research
The first drug formulated to treat premature ejaculation delayed climax and increased reported satisfaction in a late-stage study, its developer, Johnson & Johnson, said . A Phase III clinical trial of 2,614 men showed the drug provided "significant improvements in sexual function, including ejaculatory control, satisfaction with sexual intercourse for men and their partners, and increases in intravaginal ejaculatory latency time," Ortho-McNeil Pharmaceutical, a unit of J&J, said in a statement. The drug, called dapoxetine, is being co-developed by J&J's Alza Corp. and Johnson & Johnson Pharmaceutical Services, LLC units. The company's Ortho-McNeil Pharmaceutical unit will market the drug in the United States if it receives U.S. Food and Drug Administration approval.

Premature ejaculation. Definition and etiology.
Arch Ital Urol Androl. 2004.
There is no general agreement on the definition of premature ejaculation, therefore scientific studies often reach discordant results depending on whether they assess the increase in ejaculatory latency or the couple's sexual satisfaction. Etiological theories can be divided into psycho-sexual (anxiety-related, behavioral) and biological (pelvic floor alteration, hypersensitivity of the glans penis, accelerated conduction and cortical amplification of the genital stimuli), both sharing the neurobiological assumption of serotonergic mediation. Premature ejaculation can be iatrogenic (amphetamine, cocaine, dopaminergic drugs) or secondary to urological diseases (prostatovesiculitis, frenulum breve) or to neurological diseases (multiple sclerosis, peripheral neuropathies, medullary expansion processes).

Johnson and Johnson premature ejaculation medication
In 2009, Johnson & Johnson won approval in Sweden and Finland for the first prescription pill to treat premature ejaculation, three years after U.S. regulators rejected the drug. Johnson & Johnson expects to win clearance for dapoxetine, to be sold as Priligy, in more European nations and has applied for approval in Canada, Australia, Mexico, Turkey and several other countries. The premature ejaculation pill is taken a few hours before intercourse. The U.S. Food and Drug Administration turned down J&Jís application to sell dapoxetine in 2006 without explanation. Dapoxetine neutralizes a chemical messenger in the brain called serotonin, the neurotransmitter also affected by SSRI antidepressants.

emails
Q. I am 50 years old and been suffering from premature ejaculation since I am 17 years old. I had tried all kinds of aphrodisiac herbs including tongkat ali but it does not help at all. My partner is very disappointed with my sexual performance. I have no problem with my erection but my sexual act lasts for a few seconds only. My second ejaculation can last longer like 10 to 15 minutes.

Q. I am 29 years old and have had a sever case of premature ejaculation for most of my sexual life. I last about10-15 seconds and thats if I actually penetrate. I know part of the reason is performance anxiety, but I also belive part of the reason is neurological. It seems like its an involuntary reflex and that i can't control it. I was hoping you can give me your take on it? Supplements, drugs, relaxation techniques?

Q. I am taking a supplement called Deferol which is supposed to cure premature ejaculation. I am also taking Passion Rx to help with ED. After reading some parts of your website, I noticed that you mentioned 5-HTP can cause ED. I believe Deferol works by using 5-HTP. My question is, am I defeating my own efforts by taking both (is the Deferol working against the Passion RX), and if so, what can I do to assist with the premature ejaculation problem without running the risk of increasing the ED problem. Do you have a Deferol review?
   A. A search on the internet reveals Deferol is Manufactured by IDlST Laboratories, LLC. The proprietary blend of Ingredients in Deferol are: Each capsule contains: Passiflora Coerulea leaf extract, Griffonia seed extract, Pyridoxyl 5-phosphate 12.5 mg, Pyridoxine HCl 20 mg, Folic Acid 0.4 mg. We really don't know much about this product or the dosages of some of the ingredients, so we don't have a Deferol review and can't advise you. We don't know if Deferol is effective for premature ejaculation. In general, though, we don't suggest using other supplements at the same time as Passion Rx.

Q.  I have a very serious problem of premature ejaculation for about last 7 years. SSRI especially paroxetine and then fluxotine has a little effect on me, but this last only for 1-2 month after its starting. I also trid some herbs from herballove.com (Via growth3 + MoodMax + Dopa fibra). I was unable to find any information regarding this disease. Although im fit but this make me a bit depreesed. Kindly adivse me any herb from your site. thanks.

Q. First of all I just wanted to say you have very informative information on your website keep up the good work. Secondly I wanted to know if you recommond anything for premature ejaculation problem? And if there is something for premature ejaculation problem is it permenant or I have to take it everyday? One other thing about Passion Rx do I have to take this everyday or is it something that once you reach your goal you can stop using it?
   A. Passion Rx can be used as needed, and each person is different on how often and how much they will need to take Passion Rx to enhance sexuality.

Q. Your literature describes supplements to promote harder and longer erections, but does not mention retarding the urge to ejaculate. I have heard this urge is controlled by hormones or by neurotransmitters, and is independent of the blood flow that maintains an erection. Is there a product that reduces this urge? I can maintain an erection indefinitely if thereís no friction stimulation, but get an overwhelming urge for premature ejaculation as soon as friction begins.

Q. I wanted to know does passion rx or any other supplements that you know of help cure premature ejaculation? And what would you recommend for premature ejaculation? Your help in this regard is greatly appreciated.

Q. I was wondering if premature ejaculation can be controlled by passion Rx. I have premature ejaculation and I don't last more than 20-30 seconds when I am fully aroused. I am a healthy 26 year old male, with no other health problems. No stress either. This will be the first time I will be using a sexual enhancement product. Also, I was thinking of using an external spray called Indian God Lotion.
   A. We are not familiar with Indian God Lotion. Some people find benefit for premature ejaculation with Passion Rx, others from kava or 5-HTP, but it is difficult to predict who will respond to what supplement.

Q. I just wondering, if you know any herbs or homeopathic medicine for premature ejaculation.
   A. We have not seen studies but kava could be tried. As far as homeopathy, we are not aware of homeopathic medicines treating premature ejaculation.

Q. I need to know if using Passion RX and yohimbe bark 500mg will solve premature ejaculation. Since i can not perform sex more than a minute. I have good erection.
   A. We have not tested Passion Rx for premature ejaculation, so we don't know.

Q.  I am very much interested in Herbal Products. I would like to ask you kindly whether increasing the level of serotonin in the brain helps stop premature ejaculation.
   A. There is a possibility that some people find they can stop premature ejaculation by raising serotonin levles which can be done with SSRI drugs such as Prozac and Paxil, or through natural a supplement such as 5-HTP.

Q. I am looking for a treatment or premature ejaculation cure. It has been stated that the Passion Rx improves sexual function. I cannot find any reference to benefits received or not received as a premature ejaculation cure.
   A. We have not found Passion Rx to make a major difference one way or the other.

Q. I have a premature ejaculation problem and I had recently started taking 5HTP for my problem, I am taking 100mg caps 3 times daily, morning afternoon and evening. But after a period of almost 2 months continuous use now, I still don't feel that I have any significant improvement in my condition.

Q. Histamine and premature ejaculation. From your wealth of experience do you have anything to add to the possibility that excessive histamine levels could accelerate ejaculation and that reducing histamine with L-methionine, quercetin or mangosteen would have any part to play in alleviating this condition. I attach the following two excerpts which have fueled my interest in this matter. "Dr. Pfeiffer noted that males who had excessive L-Histidine levels had the problem of premature ejaculation. He gave these men supplementation of 500 mg. of L-Methionine along with 500 mg. of magnesium and 50mg. of vitamin B6. This helped normalize the levels of histidine, and alleviated the problem of premature ejaculation. Those taking L-Methionine should also take a B complex with folic acid to help prevent excessive homocysteine levels. (Take 2 Montiff B Complete daily - 1 in the morning and 1 in the evening to get sufficient folic acid and B 6.)." "Supplementing with L-Histidine will increase histamine levels as proved by Carl Pfeiffer, M.D., and Ph.D. in his research on non-orgasmic women. He administered doses of 500mg. of L-Histidine before each meal (for a total of 3 per day) restoring sexual pleasure in women. (He also helped women who had irregular periods become regular by giving doses of 4g. per day)."
   A. I am not familiar with this approach to treating premature ejaculation but if you try it we would appreciate your feedback.

I am a male aged 34 staying in India. I am suffering from Premature ejaculation since I can remember. I am not married and I also have low sex drive. I have been going to many doctors and every one saying that it`s not as serious as others, but strangely after I eat the medicine the only difference I can see is thickning of the semens. I have tried many things but to no avail. The are times it is as bad as touching it once and then having a orgasm. A friend of mine told me to get in touch
with a chinese doc who wld definitely be able to help. This is a distressed call as I am really depressed as what to do and where to go. Sir I wld be greatfull if you can tell me and solve the problem what medicine and how .I have gone through the web page and have got a ray of hope in you and your medicine. I live in India so please tell me if you have a agency where I can buy te medicine from there.

i suffer from PE. Does winter cherry help me in this problem?
    We are not aware of winter cherry research regarding this condition.

Do you carry Delay Cream for men?
    Sorry, we don't have Delay Cream for Men, we are not familiar with this product.

I've been taking a dietary supplement called Delay to help fix my problem with premature ejaculation. It has worked very so far but I'm concerned about any potential side effects of the pills. I take simvastatin for high cholesterol and Centrum multivitamin. The pills consist of: Withania Somnifera extract 150mg Mucuna Pruriens extract 135mg Cnidium Monnieri extract 50mg Tribulus Terrestris extract 50mg Passiflora Incarnata extract 50mg Curculigo Orchioides extract 50mg Cardamom extract 15mg Zinc 5mg Piperine 5mg.  

We have developed an Over the Counter drug called Promescent. It is a topical desensitizing spray that is applied 10 minutes prior to sexual activity, is highly efficacious and now available. My name is Nick Abraham and I work for a company called Absorption Pharmaceuticals which makes this over the counter spray for Premature Ejaculation. Promescent was developed by our Chief Medical Officer, Ron Gilbert, a board certified urologist in conjunction with the department of pharmacologyat the University of Georgia. Promescent is currently (as of 2011) in the final stages of its initial clinical trial being conducted by the Editor of the Journal of Sexual Medicine and renowned expert in the field of sexual dysfunction Dr. Irwin Goldstein.
    A search on Medline in May 2011 did not reveal any published studies with this product. We look forward to the published results when they are available.