The most common of all sexual dysfunctions in men is premature ejaculation. Until recently there was no cure. The diagnosis of premature ejaculation is established by patient history. Efforts to distinguish premature ejaculation from erectile dysfunction need to be made. The classic history is that a man with premature ejaculation can get a rigid erection, but loses the erection because of inability to control ejaculation. Men with erectile dysfunction typically have a less rigid erection initially, and lose their erection without ejaculating. Men who have erectile dysfunction from venous leakage, however, can have a relatively rigid erection initially and ejaculate without control before losing the erection due to the erectile dysfunction. Thus, in some cases, it is virtually impossible to distinguish the two sexual dysfunctions, and the assumption is that the patient has both erectile dysfunction and premature ejaculation.
An objective measure that can be used in the diagnosis of premature ejaculation is intravaginal ejaculatory latency time (IELT). This is the time recorded by stopwatch from when a man penetrates to when he ejaculates. On average for sexual intercourse, the IELT is approximately seven minutes, whereas the IELT of a man with premature ejaculation is one to two minutes. There are also validated questionnaires that may be completed for assessment of premature ejaculation.
Normal erectile function test results in a man with symptoms consistent with premature ejaculation will help confirm the premature ejaculation diagnosis. Here at San Diego Sexual Medicine we have recently determined that many men have premature ejaculation because there is an area on the penis or frenulum that is extremely sensitive. If that area can be located and anesthesized, ejaculatory time can be lengthened to normal. Using a genuine shockwave device, we determine the amount of energy tolerated on the penis. While that is normally 0.12- 0.14 mJ/mm2, in the area of sensitivity that tolerance is significantly lower. A penile anesthesia test, numbing only that area of sensitivity so that normal sensation can be felt everywhere else, extends ejaculation time to greater than 10 minutes. Patients can then choose whether to numb that area at home or have it surgically removed for a permanent cure of their premature ejaculation.