Premature Ejaculation Treatment in Singapore

Lifelong (Primary) Premature Ejaculation

This type begins from a man’s first sexual experiences and continues throughout life. Men with lifelong PE typically ejaculate within one minute of penetration in nearly all sexual encounters. The condition often has biological origins, including genetic factors or altered sensitivity of serotonin receptors. Lifelong PE tends to remain consistent over time without treatment.

Acquired (Secondary) Premature Ejaculation

Acquired PE develops after a period of normal sexual function. Men with this type previously had satisfactory ejaculatory control but later developed rapid ejaculation. This form often relates to psychological factors, relationship issues, erectile dysfunction, prostate problems, or thyroid disorders. The onset can be gradual or sudden, depending on the underlying cause.

Variable Premature Ejaculation

Some men experience PE inconsistently, with normal ejaculatory control in some situations but rapid ejaculation in others. This variability might relate to specific partners, stress levels, or environmental factors. Variable PE often responds well to counselling and behavioural interventions.

Subjective Premature Ejaculation

In this type, men perceive their ejaculatory latency as problematic despite having normal or even prolonged ejaculation times (typically 3-6 minutes or longer). This perception issue often stems from unrealistic expectations influenced by media or lack of sexual education.

Biological Causes

• Abnormal hormone levels, particularly testosterone and prolactin imbalances
• Irregular neurotransmitter levels, especially serotonin deficiency
• Inflammation or infection of the prostate or urethra
• Genetic predisposition affecting ejaculatory reflexes
• Hypersensitivity of the penile glans (head of penis)
• Thyroid disorders affecting overall body metabolism

Psychological Causes

• Performance anxiety and fear of sexual failure
• Early sexual experiences that established hasty ejaculation patterns
• Depression or chronic stress affecting sexual response
• Relationship problems or poor communication with partner
• Guilt or religious conflicts about sexual activity
• Traumatic sexual experiences

Risk Factors

• Erectile dysfunction – difficulty maintaining erections may cause rushed sexual activity
• Age – though PE can occur at any age, ageing changes sexual response
• Chronic stress or mental health conditions
• Substance abuse including alcohol and recreational drugs
• Lack of sexual experience or infrequent sexual activity
• Medical conditions like diabetes, hypertension, or neurological disorders
• Certain medications, particularly some antidepressants during withdrawal

Mild Symptoms

• Ejaculation occurring between 1-2 minutes of penetration
• Occasional inability to delay ejaculation
• Mild frustration after sexual activity
• Some avoidance of certain sexual positions
• Minor relationship tension related to sexual satisfaction

Moderate Symptoms

• Consistent ejaculation within 60 seconds of penetration
• Significant distress about sexual performance
• Regular avoidance of sexual intimacy
• Relationship conflicts stemming from sexual dissatisfaction
• Decreased sexual confidence affecting daily life
• Partner expressing frustration or disappointment

Severe Symptoms

• Ejaculation before or immediately upon penetration
• Complete inability to control ejaculatory reflex
• Severe anxiety or depression related to sexual performance
• Avoidance of romantic relationships entirely
• Significant relationship breakdown or divorce considerations
• Development of erectile dysfunction as secondary issue

The symptoms of PE typically manifest consistently over at least six months. Many men also experience anticipatory anxiety hours or days before sexual activity, which can worsen the condition.

You should consult a urologist if premature ejaculation causes distress or relationship problems lasting more than six months. Immediate medical attention is warranted if PE develops suddenly, especially if accompanied by pain, blood in semen, or urinary symptoms, as these may indicate underlying medical conditions. Many men delay seeking help due to embarrassment, but specialists at a urology clinic in Singapore regularly treat this condition with complete confidentiality and professionalism.

During your first consultation, the urologist will conduct a thorough medical and sexual history assessment. This includes questions about ejaculation timing, frequency of occurrence, impact on relationships, and any associated symptoms. Physical examination may include genital and prostate evaluation to rule out physical abnormalities. Blood tests might be ordered to check hormone levels or other underlying issues.

Early intervention often leads to better outcomes. Delaying treatment can result in worsening anxiety, relationship strain, and development of secondary sexual dysfunctions. Seeking help promptly allows you to regain confidence and enjoy satisfying sexual relationships sooner.

Diagnosis of premature ejaculation primarily relies on medical history and patient-reported symptoms. Your urologist will use standardised questionnaires like the Premature Ejaculation Diagnostic Tool (PEDT) or the Index of Premature Ejaculation (IPE) to assess severity and impact. These validated tools help differentiate between PE types and guide treatment selection.

Physical examination focuses on identifying any anatomical abnormalities, signs of infection, or neurological issues. The urologist examines the penis for structural problems, checks prostate health through digital rectal examination, and assesses penile sensitivity. Neurological testing may evaluate reflexes and sensation to rule out nerve damage.

Laboratory tests aren’t always necessary but may include hormone panels checking testosterone, prolactin, and thyroid function. Urinalysis and urine culture can identify infections. For men with sudden-onset PE, additional tests might investigate prostate health through PSA testing or ultrasound. Some cases require specialised tests like penile biothesiometry to measure nerve sensitivity or Doppler ultrasound to assess blood flow if erectile dysfunction coexists.

Results typically become available within a few days to a week. Your urologist will explain findings and their implications for treatment planning during a follow-up consultation.

Behavioural Techniques

Behavioural methods form the foundation of PE treatment, teaching men to recognise and control their arousal levels. The stop-start technique involves stimulation until near ejaculation, then stopping until the urge subsides. The squeeze technique applies pressure to the penis head when approaching climax. These methods require practice and partner cooperation but can significantly improve ejaculatory control when performed consistently over several weeks.

Topical Medications

Anaesthetic creams and sprays containing lidocaine or prilocaine reduce penile sensitivity when applied 15-30 minutes before intercourse. These medications work by slightly numbing nerve endings, allowing longer-lasting sexual activity. Modern formulations minimise partner transfer and maintain adequate sensation for pleasure. Application technique and timing optimisation usually occur over several uses.

Oral Medications – SSRIs

Selective serotonin reuptake inhibitors (SSRIs) like dapoxetine, paroxetine, or sertraline effectively delay ejaculation by altering serotonin levels in the nervous system. Dapoxetine, specifically designed for PE, works on-demand when taken 1-3 hours before sexual activity. Other SSRIs require daily dosing for several weeks before achieving full effect. Your urologist will monitor for side effects and adjust dosages accordingly.

Oral Medications – PDE5 Inhibitors

Phosphodiesterase-5 inhibitors like sildenafil or tadalafil, primarily used for erectile dysfunction, can help some PE patients, especially those with concurrent ED. These medications improve confidence and reduce performance anxiety by ensuring firm erections. They may indirectly improve ejaculatory control by reducing the psychological pressure to climax quickly while maintaining an erection.

Psychological Counselling

Sex therapy and cognitive behavioural therapy address psychological factors contributing to PE. Therapists help identify triggers, manage anxiety, improve communication with partners, and develop coping strategies. Couples therapy can be particularly effective when relationship issues contribute to the condition. Treatment typically involves weekly sessions over several months, with homework exercises between appointments.

Pelvic Floor Rehabilitation

Strengthening pelvic floor muscles through targeted exercises can improve ejaculatory control. Physiotherapists teach proper muscle identification and contraction techniques. Regular practice of these exercises, similar to Kegel exercises, strengthens the muscles involved in ejaculation. Biofeedback devices may help ensure correct technique. Most men see improvements after 12 weeks of consistent practice.

Combination Therapy

Many patients benefit from combining treatments, such as using topical anaesthetics with behavioural techniques or combining SSRIs with counselling. This multi-modal approach addresses both physical and psychological aspects of PE. Your urologist will customise combinations based on your specific situation, response to individual treatments, and personal preferences.

Untreated premature ejaculation can progressively worsen, creating a cycle of anxiety and sexual dysfunction. Performance anxiety intensifies with each unsatisfactory encounter, potentially leading to complete avoidance of sexual intimacy. This avoidance behaviour can severely damage romantic relationships, with studies showing higher divorce rates among couples affected by untreated PE.

Mental health consequences include development of clinical depression, generalised anxiety disorder, and severely diminished self-esteem. Men may withdraw from social situations, fearing judgment or rejection. The stress can manifest physically through insomnia, appetite changes, and concentration difficulties affecting work performance.

Relationship complications extend beyond sexual dissatisfaction. Partners may feel rejected, unattractive, or blame themselves for the problem. Communication often breaks down as couples avoid discussing the issue. Female partners may develop their own sexual dysfunctions, including difficulty reaching orgasm or decreased sexual desire. Fertility can be affected when PE prevents successful vaginal ejaculation, causing additional stress for couples trying to conceive.

While not all cases of premature ejaculation are preventable, certain strategies can reduce risk or prevent worsening. Regular sexual activity helps maintain normal ejaculatory reflexes and reduces performance anxiety. Open communication with partners about sexual preferences and concerns creates a supportive environment reducing psychological pressure.

Stress management through regular exercise, adequate sleep, and relaxation techniques like meditation or yoga can improve overall sexual function. Limiting alcohol consumption and avoiding recreational drugs prevents their negative effects on ejaculatory control. Maintaining general health through proper diet and managing conditions like diabetes or hypertension supports sexual health.

Practising masturbation with focus on prolonging arousal rather than quick release can train better ejaculatory control. Using thicker condoms during intercourse may reduce sensitivity naturally. Regular pelvic floor exercises, even before problems develop, strengthen muscles involved in ejaculation. Addressing relationship issues promptly through communication or counselling prevents them from manifesting as sexual problems.