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Premature Ejaculation

The Priapus Shot® treatment for Erectile Dysfunction and Peyronies Disease. ​

Approved by the New Zealand Medical Council to provide this treatment.

Dr Mark Morunga

Essential Men’s Clinic
FAQ

What is ejaculation?

Essential Men’s Clinic – Your Premier Men’s Sexual Health Clinic.

We specialize in Erectile Dysfunction, Improving Erectile Function, Peyronies Disease & Penile Augmentation.

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Ejaculation is the release of semen from the penis following sexual climax. When a man is sexually stimulated, the brain sends signals to the genital area through nerves in the spinal cord to make the pelvic muscles contract. At the start of this process, waves of muscle contractions transport the sperm, with a small amount of fluid, from the testes through to the vas deferens. The seminal vesicles and prostate gland add extra fluid to protect the sperm.
This mixture of fluid and sperm (semen) travels along the urethra to the tip of the penis where it is released (ejaculated) at the time of sexual climax (orgasm).

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Frequently Asked Questions

What is premature ejaculation?
Premature ejaculation happens when a man is unable to control the timing of ejaculation, and ejaculates before he and/or his partner feels ready for this to happen.
For a heterosexual man, a commonly used definition of premature ejaculation is ejaculating before or within about one minute of his penis entering the woman’s vagina. However, there is no fixed time for ‘too soon.’ Premature ejaculation relates to the loss of control over ejaculation, and the distress it can cause to one or both partners, not the actual time it takes a man to ejaculate.
Premature ejaculation is the most common male sexual problem and affects men of all ages. Premature ejaculation is more common in younger men, as they are often less sexually experienced or secure with the situation in which they are having sex. However, in some cases with time and practice premature ejaculation can happen less often.
The causes of PD are not clear, but it is thought to happen after repeated bending or bumping of an erect penis. The tearing in the lining of the erectile tissue leads to an inflammatory plaque that does not heal normally. Small blood vessels can rupture or burst and interfere with blood flow. Usually this type of injury only swells, or becomes inflamed (red and/or hot), and will heal within a year. However in some men recovery takes longer and scarring can happen. A pre-existing problem with the immune system could explain why some men develop PD after a simple injury to the penis while others recover from the injury. PD usually affects men aged between 45 and 60 years.

There are two different types of premature ejaculation:

  • Primary (Lifelong)​
  • Secondary (Acquired)​


Lifelong premature ejaculation is when a man has not had control of ejaculation from the time of his first sexual experience. If left untreated, the premature ejaculation will continue for the rest of his life.

Acquired premature ejaculation is usually when there has been a period of normal functioning before the premature ejaculation began. Acquired premature ejaculation often happens as a result of psychological (relationship) issues or due to other erectile problems.

The cause of premature ejaculation depends on whether the premature ejaculation is lifelong or acquired. Lifelong premature ejaculation can be caused by a chemical imbalance in important brain centres, which may result in a lower ejaculatory threshold. As these men need less stimulation before they ejaculate, ejaculation can happen sooner than desired. Psychological problems including performance anxiety may be secondary rather than being the primary cause. Anxiety is often the main cause of acquired premature ejaculation. Performance anxiety can be because of anxiety about sexual performance, fear of being caught in a sexual act or anxiety related to a specific situation, such as a new relationship. Some religious beliefs may also make a man feel anxious about having sex. Acquired premature ejaculation can also be caused by erectile problems. This may be because of the need for intense stimulation to get and maintain an erection or from anxiety about the difficulty in getting and keeping an erection.
There are no tests for premature ejaculation as it is a self-reported diagnosis. Your doctor will ask questions about your sexual history (including how long the premature ejaculation has been happening and when it first happened) and will talk about the possible causes of the problem based on your responses.
Treatment for premature ejaculation should be based on the man’s relationship status and the cause of the condition (whether it is lifelong or acquired). If a man is in a relationship, he should think about his own and his sexual partner’s needs when deciding which treatment option may work best.

Sex therapy
Men with acquired premature ejaculation caused by performance anxiety often find counselling with an experienced sex therapist the best treatment. Counselling can help identify and discuss any underlying sexual or relationship issues.
The anxiety that can develop with lifelong premature ejaculation may also be helped by professional counselling.

Behavioral techniques
Semans’ “stop-start” technique involves the man telling his partner to stop stimulation when he feels he is close to ejaculation. When the feeling has passed, stimulation can be started again. These steps of stopping and starting can be repeated as needed.
Masters and Johnson’s “squeeze” technique can be used for delaying ejaculation. With this technique, the end of the penis is squeezed for several seconds just before ejaculation to lessen the urge to ejaculate. This is repeated a number of times until the man and his partner are ready for ejaculation to happen. This technique can help teach a man ejaculatory control.

Reducing penile sensation
Reducing penile sensation can help delay ejaculation. Local anesthetic gels and creams can be used and should be applied up to 30 minutes before sexual intercourse and used with a condom to prevent absorption by the sexual partner.
Using two condoms may also reduce sensation and help a man take longer to ejaculate.

Oral medication
Some antidepressants — tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) — have the side effect of delayed ejaculation and are now commonly prescribed by doctors for premature ejaculation.
A tricyclic antidepressant has been shown to work better than SSRIs in some men. These drugs work only for as long as the man continues to take the medication. Taking SSRIs can have some side effects such as decreased libido (sex drive), nausea, sweating, bowel disturbance, and fatigue.

Erectile dysfunction treatment
If a man has erectile problems and premature ejaculation, treating the erectile problems first can help bring back normal ejaculatory control. Treatments for erectile dysfunction are commonly oral medications. Other treatments include vacuum devices, injections, and penile prostheses.

Management
What role do partners play in the treatment of premature ejaculation?
If a man is in a relationship, both the man and his sexual partner can be affected by premature ejaculation. Partners can give valuable support and help decide the best treatment option, and it is helpful to involve them when talking with your doctor.

Premature ejaculation does not usually cause infertility (in a couple), although sometimes it can cause problems for couples trying to become pregnant. Many men who have premature ejaculation feel embarrassed when ejaculation happens before vaginal penetration. If this is the case, a doctor may use a treatment to delay ejaculation or refer the couple to a fertility specialist.
Many men who have premature ejaculation feel embarrassed about the condition. Premature ejaculation can cause great anxiety and men often feel more anxious when they try to find ways to manage the problem. Partners of men with premature ejaculation may find it difficult to deal with their partner’s anxiety, particularly if they do not feel comfortable speaking to others about their concerns. Emotional responses to premature ejaculation are quite normal and discussing these feelings with a partner and/or doctor can help.

Other forms of ejaculatory problems can affect men such as no ejaculation, delayed
ejaculation, retrograde ejaculation and painful ejaculation.

c/o Monash Institute of Medical Research Victoria Australia
Andrology Australia is an initiative funded by the Australian Government Department of Health and Ageing.
This information has been provided for educational purposes only. It is not intended to take the place of a clinical diagnosis or proper medical advice from a fully qualified health professional. Andrology Australia urges readers to seek the services of a qualified medical practitioner for any personal health concerns.

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P-Shot® Data Information

Mechanism
The P-Shot® uses Platelet-Rich Plasma (PRP) activated as a Platelet-Rich Fibrin Matrix (PRFM), that harnesses the power of the patients own platelet growth factors to regenerate new connective, vascular and neural tissue. It is a minimally invasive autologous medical treatment used across multiple medical specialties – including cosmetic rejuvenation.

Safety
There have been no serious long term effects found with PRP when administered appropriately with an FDA approved kit. A recent retrospective study in the Investigative Clinical Urology, Ethan 2018, concluded that PRFM injections for Erectile Dysfunction (ED) and Peyronie’s Disease (PD) are feasible and safe (1)

Providers
The P-Shot® is a trademarked procedure created by Dr Charles Runels. All global providers are registered members of the Cellular Medicine Association which includes urologists, surgeons, cosmetic physicians and general practitioners (2).

Patient Satisfaction Rates. 
A retrospective study of 1220 patients by Kumar CS; “Combined Treatment of Injecting Platelet Rich Plasma With Vacuum Pump For Penile Enlargement”; J Sex Med 2016, 11, 174, concluded that penile length and girth enhancement using PRP and Vacuum Device for patients suffering from small penis, severe ED, significant shortening with or without Peyronies disease is a safe cheap effective procedure that can be performed in an outpatient department. With erection satisfaction rates of 70% reported (3). Important variables such as patient medical history, presence chronic illness, medications-anti platelet therapy, lifestyle-smoking, type of PRP kits, harvesting technique, quality of PRP, doctor skill and patient expectations are contributing factors towards patient satisfaction and dissatisfaction rates (2a).

Demographics
In New Zealand there are more than 1 in 3 men who suffer from erectile dysfunction in their lifetime (4,5) the majority of whom present with mild-to-moderate erectile symptoms, which worsen with age (4). We recommend that any complicated cases that have not previously been investigated be referred to the appropriate clinicians such as an urologist before proceeding with any treatment.


References:
1) Ethan L Matz, Amy M Pearlman, Ryan P Terlecki; Investig Clin Urol 2018 Jan; 59 (1): 61-65
2) Website www.priapusshot.com/members/directory
​and 2a) Website www.priapusshot.com
3) Kumar CS; “Combined Treatment of Injecting Platelet Rich Plasma With Vacuum Pump For Penile Enlargement”; J Sex Med 2016, 11, 174
4) Quilter M, Hodges L, von Hurst, P, et al; “Male Sexual Function In New Zealand: A Population-Based Cross-Sectional Survey Of The Prevalence Of Erectile Dysfunction In Men Aged 40-70 Years”; J Sex Med 2017; 14:928-936
5) Berrada S, Kadri N, Mechackra-Tahiri S, Nejjari C; “Prevalence Of Erectile Dysfunction And Its Correlates; A Population-Based Study In Morocco”; Int J of Impotence Res 2003; 15:S3-S7
6) Virag R; “A New Treatment Of Lapeyronie’s Disease By Local Injections Of Plasma Rich Platelets (PRP) and Hyaluronic Acid . Preliminary Results.” E-Memoires de l’Academie Nationale de Chirurgie 2014; 13(3):96-100
​7) Virag R; “Evaluation Of The Benefit Of Using A Combination Of Autologous Platelet-Rich Plasma and Hyaluronic Acid For The Treatment Of Peyronie’s Disease”; Sex Health Issues 2017 1(1):1-8
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