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Suggest treatment for premature ejaculation

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Posted on Tue, 3 Nov 2015
Question: About 6 years ago, I engaged in urethral play with a former girlfriend. ever since then, I have had chronic premature ejaculation (20 to 30 seconds, worse sometimes). What i found is that the is something after developing along the entire length of the penis. In between the corpus spongiosum and corpus cavernosa, there feels like an 'enlarged muscle', it seems mainly to be on top of the corpus spongiosum. Did I damage a muscle here, sometimes I cant completely feel empty after urinating and always dribble a bit. What is wrong here? what are the possible causes and what type of procedure will fix it. My main concern is with the premature ejaculation, before the incident, I lasted a good 5 minutes and now 20 to 30 seconds. I have tried dapoxetine and they made no difference. Im pulling my hair out on this, feel very worried and feel i may never get it fixed

One thing I forgot to add was I get frequent nocturnal emissions since this happened, especially on a full bladder
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Answered by Dr. Alexander H. Sheppe (33 minutes later)
Brief Answer:
Consultation

Detailed Answer:
Thanks for your question.

You ask a couple things here. One, did you damage a muscle via urethral play, two, what is the cause of your premature ejaculation.

The answer to the first question is you may have damaged the smooth muscle inside the penis. Urethral play is highly dangerous and this may be a consequence of that. In order to really test this hypothesis, you need to visit a urologist to undergo an imaging procedure of the urethra. This may include a scope and/or an MRI. Surgical repair may be needed.

The answer to your second question is this: it is possible nerve damage in the area is causing premature ejaculation. However, it may simply be that there is no connection between urethral play and the development of PE, it may be a coincidence. Chemical imbalances can cause PE as well. Dapoxetine is a decent medication, but if it didn't work you can try SSRIs such as high-dose Paxil or Luvox. This will often solve the problem.

My name is Dr. Sheppe, and I am an XXXXXXX psychiatrist working in New York City. For a personalized comprehensive evaluation, treatment recommendations, or individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers
Above answer was peer-reviewed by : Dr. Neel Kudchadkar
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Follow up: Dr. Alexander H. Sheppe (1 hour later)
There is a direct connection between the urethal play and PE - it never happened before the urethal play and now happens afterwards.

If there is damage to the smooth muscle, what has been damaged and where, is it in the corpus spongiosum or the urethra?

What type of operation/surgery is involved if damage is found - how does smooth muscle get damaged and are there non surgical ways of correcting it. This may be a smooth muscle stricture travelling from the glans to the internal sphincter

also, why is there nocturnal emissions when there wasnt before this
doctor
Answered by Dr. Alexander H. Sheppe (2 minutes later)
Brief Answer:
Follow-up

Detailed Answer:
It is impossible to tell what part of the musculature has been damaged without getting an MRI.

There are surgical ways of stitching torn muscle. If it is a stricture, it may need stenting.

My name is Dr. Sheppe, and I am an XXXXXXX psychiatrist working in New York City. For a personalized comprehensive evaluation, treatment recommendations, or individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers
Above answer was peer-reviewed by : Dr. Neel Kudchadkar
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Dr. Alexander H. Sheppe

Psychiatrist

Practicing since :2014

Answered : 2242 Questions

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Suggest treatment for premature ejaculation

Brief Answer: Consultation Detailed Answer: Thanks for your question. You ask a couple things here. One, did you damage a muscle via urethral play, two, what is the cause of your premature ejaculation. The answer to the first question is you may have damaged the smooth muscle inside the penis. Urethral play is highly dangerous and this may be a consequence of that. In order to really test this hypothesis, you need to visit a urologist to undergo an imaging procedure of the urethra. This may include a scope and/or an MRI. Surgical repair may be needed. The answer to your second question is this: it is possible nerve damage in the area is causing premature ejaculation. However, it may simply be that there is no connection between urethral play and the development of PE, it may be a coincidence. Chemical imbalances can cause PE as well. Dapoxetine is a decent medication, but if it didn't work you can try SSRIs such as high-dose Paxil or Luvox. This will often solve the problem. My name is Dr. Sheppe, and I am an XXXXXXX psychiatrist working in New York City. For a personalized comprehensive evaluation, treatment recommendations, or individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers