Microbiome of the Male Reproductive System: The Hidden Factor in Men’s Health

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When most people think about the microbiome, they imagine gut bacteria affecting digestion and immunity. But did you know that the male reproductive system also has its own unique microbiome? This hidden ecosystem of microorganisms plays a surprising role in fertility, hormone balance, and overall sexual health.

What Is the Male Reproductive Microbiome?

The male reproductive microbiome refers to the community of bacteria and other microorganisms living in the penis, testes, prostate, and semen. While it’s less studied than the gut microbiome, research shows that these microbes are crucial for maintaining reproductive health.

A balanced microbiome supports sperm quality, prevents infections, and even influences the immune environment of the reproductive tract. On the other hand, imbalances—sometimes caused by antibiotics, poor hygiene, infections, or lifestyle factors—can lead to fertility issues and other complications.

How the Microbiome Affects Fertility

Studies suggest that an unhealthy male reproductive microbiome may contribute to:

  • Reduced sperm motility – making it harder for sperm to reach the egg.

  • Decreased sperm count – fewer sperm can lower the chance of conception.

  • DNA fragmentation – damaged sperm DNA can affect embryo quality.

  • Inflammation – chronic inflammation in the reproductive tract can impair fertility and sexual health.

Even small changes in microbial balance can have a measurable impact on reproductive outcomes, highlighting why men’s microbiomes deserve attention.

Factors That Influence the Male Microbiome

Several lifestyle and environmental factors can disrupt the delicate balance of microbes:

  • Antibiotic use – kills both harmful and beneficial bacteria.

  • Diet – processed foods, sugar, and alcohol can negatively impact microbial health.

  • Hygiene – poor genital hygiene can allow harmful bacteria to thrive.

  • Sexual activity – sexually transmitted infections can alter microbial balance.

  • Chronic stress – stress hormones can influence bacterial populations and immunity.

Maintaining healthy habits is essential for keeping the microbiome in check.

Supporting a Healthy Male Microbiome

Here are practical ways men can support their reproductive microbial health:

  1. Balanced diet: Include fiber-rich fruits, vegetables, fermented foods, and lean protein.

  2. Probiotics: Supplements or natural sources (like yogurt or kefir) can help maintain beneficial bacteria.

  3. Safe sexual practices: Use protection and get regular STI screenings.

  4. Gentle hygiene: Avoid harsh soaps; washing with mild cleansers is best.

  5. Lifestyle management: Reduce alcohol, quit smoking, manage stress, and exercise regularly.

Why It Matters

The male reproductive microbiome is more than just a scientific curiosity—it’s a critical component of sexual and reproductive health. By understanding and supporting this hidden ecosystem, men can improve fertility, reduce infection risk, and even support hormone balance and overall wellness.

Conclusion:
Men’s health isn’t just about testosterone, erections, or sperm count—it’s also about the microscopic world living inside the reproductive system. Paying attention to the male reproductive microbiome is a small step with potentially big benefits for fertility, sexual function, and overall health.

Book Your Appointment Today

If you’re in need of a urologist in Brisbane, Dr. Jo Schoeman is here to help. With a commitment to patient-centered care and advanced treatment options, Dr. Schoeman is dedicated to improving the lives of her patients. Contact our office today to schedule a consultation and take the first step toward better urological health.

Dr Jo Schoeman, Urologist
Suite 46, Level 4
The Wesley Medical Centre
Wesley Hospital
Auchenflower Brisbane

Subclinical Hypogonadism: Low Testosterone Without Obvious Symptoms

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Testosterone is often called the “male hormone,” and for good reason—it affects muscle mass, mood, energy, libido, and overall male health. But what if your testosterone is low and you don’t even notice obvious symptoms? This is the hidden condition known as subclinical hypogonadism.

What Is Subclinical Hypogonadism?

Subclinical hypogonadism is a mild or early stage of testosterone deficiency. Unlike classic low testosterone, which presents with clear symptoms like fatigue, low libido, or erectile dysfunction, subclinical hypogonadism often shows subtle or nearly invisible signs.

Because the symptoms are mild or non-specific, many men don’t realize something is wrong until complications appear later, such as reduced bone density, low muscle mass, or mood disturbances.

Who Is at Risk?

Subclinical hypogonadism can affect men of all ages but is more common in:

  • Men over 40–50 years old

  • Men with obesity or metabolic syndrome

  • Men with chronic illnesses like diabetes or kidney disease

  • Men with a history of testicular injury or hormonal disorders

Even younger men can experience low testosterone due to stress, poor lifestyle habits, or underlying health conditions.

Symptoms That Are Often Overlooked

Unlike classic hypogonadism, subclinical cases may present with very subtle symptoms, such as:

  • Slightly lower energy levels or fatigue that seems “normal”

  • Mood changes, irritability, or mild depression

  • Difficulty building or maintaining muscle mass

  • Occasional decrease in sexual desire

  • Reduced motivation or mental clarity

Because these changes are gradual, men often dismiss them as part of aging or a busy lifestyle.

Why Early Detection Matters

Even mild testosterone deficiency can affect long-term health. Untreated subclinical hypogonadism may contribute to:

  • Osteoporosis – weaker bones, increased fracture risk

  • Cardiovascular issues – low testosterone is linked to higher risk of heart disease

  • Metabolic problems – weight gain, insulin resistance, and diabetes risk

  • Reduced quality of life – low mood, fatigue, and decreased physical performance

Early detection allows lifestyle interventions and, in some cases, medical treatment to prevent long-term complications.

How Subclinical Hypogonadism Is Diagnosed

Diagnosis requires:

  1. Blood tests – measuring total and free testosterone levels

  2. Symptom assessment – even subtle signs are important

  3. Evaluation of underlying conditions – obesity, chronic illness, or medications may play a role

Because testosterone levels fluctuate naturally, multiple tests at different times may be necessary.

Managing Subclinical Hypogonadism

Lifestyle modifications are often the first line of defense:

  • Regular exercise, especially resistance training

  • Balanced diet rich in protein, healthy fats, and micronutrients

  • Adequate sleep to support hormone production

  • Stress management through mindfulness, meditation, or therapy

In some cases, hormone replacement therapy may be recommended under the guidance of a healthcare professional.

Key Takeaways

Subclinical hypogonadism is a “hidden” condition—men can feel mostly normal while their testosterone is slowly declining. Awareness, early detection, and proactive lifestyle changes are critical to maintain health, energy, and quality of life.

Book Your Appointment Today

If you’re in need of a urologist in Brisbane, Dr. Jo Schoeman is here to help. With a commitment to patient-centered care and advanced treatment options, Dr. Schoeman is dedicated to improving the lives of his patients. Contact our office today to schedule a consultation and take the first step toward better urological health.

Dr Jo Schoeman, Urologist
Suite 46, Level 4
The Wesley Medical Centre
Wesley Hospital
Auchenflower Brisbane

New Premises

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Renovations have started on our new premises. This promises to be modern and fresh.

Opening date: 12 JANUARY 2026

 

Progress so far…

Shell: 7 Oct

Walls are up: 29 Oct

Floors: 8 Nov

Painted: 14 Nov

 

 

Furniture: 26 Nov

 

1 day before sign-off: 9 Dec

Hours before hand over: 10 Dec

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Wishing you and yours a very merry Christmas and a fantastic 2026!

Ejaculation-sparing minimally invasive surgical therapies for benign prostatic hyperplasia – MIST

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Ejaculation-sparing minimally invasive surgical therapies for benign prostatic hyperplasia (BPH) include water vapor thermal therapy (REZUM), prostatic urethral lift (PUL), temporarily implanted nitinol device (iTIND), Aquablation and prostatic artery embolization (PAE) and certain variations of transurethral resection (TURP) that involve selective tissue removal. These treatments aim to relieve symptoms while minimizing the risk of ejaculatory dysfunction, such as retrograde ejaculation, a common side effect of traditional prostate surgeries.
Ejaculation-sparing minimally invasive BPH therapies
  • Water Vapor Thermal Therapy (Rezum): This therapy delivers targeted steam energy to ablate excess prostate tissue. By using convection, the thermal energy minimizes spread to surrounding structures, achieving high rates of ejaculatory preservation (around 70-90%). It is often with general anesthesia.
  • Temporarily Implanted Nitinol Device (iTIND): A temporary device is placed in the prostatic urethra for 5 to 7 days to reshape the channel through localized pressure, then removed. Studies have shown no reports of ejaculatory dysfunction with this approach. 
  • Prostatic Urethral Lift (PUL) (UroLift): This non-ablative procedure uses small implants to pin back the enlarged prostate lobes, opening the urethra without cutting or heating tissue. It boasts one of the highest ejaculatory function preservation rates, often reported around 80-90% or higher, and can be performed in an office setting, typically under local anesthesia.
  • Prostatic Artery Embolization (PAE): Performed by interventional radiologists, this procedure involves blocking the blood supply to the prostate to cause it to shrink. It is associated with a high rate of ejaculatory preservation (around 70-90%), though its efficacy in improving urinary symptoms may be moderate compared to more invasive techniques.
  • Aquablation: This procedure uses a robotically controlled, heat-free, high-velocity waterjet to precisely remove prostate tissue based on real-time imaging. The surgical planning allows for deliberate sparing of the anatomical landmarks responsible for ejaculation, with reported preservation rates of 60-99.6% in various studies. Not readily available in Queensland.
  • Ejaculation-sparing TURP: Modified versions of the traditional TURP can be performed to preserve ejaculation. This involves careful removal of only the obstructing tissue, particularly the middle lobe, while leaving a safety margin around the verumontanum (where the ejaculatory ducts enter the urethra). 
Key Considerations
    • Patient Priority: These procedures are suitable for men who prioritize maintaining sexual and ejaculatory function over maximal urinary symptom relief, as the latter is often better achieved with traditional, but higher-risk, surgeries like Transurethral Resection of the Prostate (TURP).
    • Prostate Size: Different MISTs are suited to different prostate sizes and anatomies (e.g., UroLift for smaller prostates without an obstructive median lobe, Aquablation for a wider range of sizes).
    • Shared Decision-Making: A discussion with a urologist about patient preferences, prostate anatomy, and potential trade-offs is crucial for selecting the optimal treatment. 

 

Links: 
prostatic urethral lift (PUL), 
water vapor thermal therapy (Rezum),
Aquablation,
prostatic artery embolization (PAE).
temporarily implanted nitinol device (iTIND)
Ejaculation-preserving TURP
Information obtained with the help of AI
Dr Jo Schoeman
Functional Urologist
Wesley Hospital
Brisbane Queensland

Trental for Peyronie’s Disease

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Pentoxifylline for Peyronie’s Disease: An Evidence-Based Therapeutic Approach

Pentoxifylline for Peyronie’s Disease: An Evidence-Based Therapeutic Approach – peyroniesdiseasecure.com

 

Peyronie’s disease (PD) involves abnormal scar tissue (plaques) forming in the penile tunica albuginea, causing penile curvature, pain, shortening, and often erectile dysfunction. Affecting 3-9% of middle-aged men, this condition carries physical and psychological burdens. Pentoxifylline (PTX), originally developed for vascular conditions, has emerged as a promising nonsurgical treatment due to its unique antifibrotic properties that target PD’s underlying mechanisms.

                                     

Pathophysiological Basis: Pentoxifylline’s Mechanism

PD plaques develop through a complex inflammatory process initiated by penile trauma in genetically susceptible individuals. Key pathological events include:

  1. Oxidative Stress: Reactive oxygen species activate nuclear factor kappa-B (NF-κB)
  2. Fibrotic Signaling: NF-κB upregulates profibrotic factors (TGF-β1, PDGF), transforming fibroblasts into collagen-producing myofibroblasts
  3. Matrix Disruption: Excessive collagen deposition with reduced elastin creates inelastic scar tissue, potentially calcifying in 20-31% of cases

Pentoxifylline’s Multitargeted Actions:

  • TGF-β1 Suppression: Reduces collagen synthesis
  • Phosphodiesterase Inhibition: Elevates cAMP, blocking inflammatory cytokines
  • Oxidative Stress Reduction: Neutralizes free radicals
  • Fibrinolysis Enhancement: Improves microcirculation
  • Anticalcification Effects: May stabilize mineral deposition

Table 1: Pentoxifylline’s Actions Against Peyronie’s Pathogenesis

Pathological Process Pentoxifylline Intervention
TGF-β1 Upregulation Inhibits expression & signaling
ROS/RNS Surge Scavenges free radicals
NF-κB Activation Reduces activation via cAMP pathway
PDGF Upregulation Modulates growth factor activity
Fibrin Deposition Enhances fibrinolysis, improves circulation
Elastin Degradation Indirect protection via reduced MMP activity

Clinical Evidence: Efficacy Data

Research demonstrates PTX’s benefits across PD stages:

  1. Curvature and Plaque Improvement:
    • A 6-month RCT showed significant curvature reduction (~10°) with oral PTX (400mg twice daily) versus placebo
    • Combination therapy (oral PTX + perilesional injections + antioxidants) demonstrated 46.9% mean plaque reduction and 10.1° curvature improvement
  2. Calcification Management:
    • Patients with calcified plaques receiving PTX showed 91.9% stabilization/improvement versus 44.4% in untreated controls
    • Case reports document complete resolution of small calcifications after prolonged therapy
  3. Symptom Relief:
    • Combination regimens achieved 67.6% pain resolution
    • Significant improvements in erectile function reported with multimodal approaches
    • PTX with traction therapy improved penile hemodynamics

Treatment Protocols: Optimizing Outcomes

Oral Administration:

  • Dosage: 400mg 2-3 times daily (800-1200mg total)
  • Duration: Minimum 6 months, with benefits extending to 12-18 months
  • Administration: Take with food to reduce GI effects

Advanced Delivery Methods:

  • Perilesional Injections: 100mg around (not into) plaque every 2 weeks (significantly boosts outcomes)
  • Topical Adjuvants: Diclofenac 4% gel applied twice daily

Multimodal Synergy:

  • PTX + Antioxidants: Propolis (600mg), blueberry extract (160mg), vitamin E (600mg)
  • PTX + Traction Therapy: 1 hour daily device use
  • PTX + PDE5 Inhibitors: Particularly for comorbid erectile dysfunction

*Table 2: Evidence-Based Treatment Approaches*

Regimen Clinical Outcomes Therapeutic Advantage
Oral Monotherapy Curvature reduction (~10°), Plaque stabilization Simplicity, cost-effectiveness
Oral + Injections 46.9% plaque reduction, >10° curvature improvement Enhanced efficacy
Oral + Antioxidants Improved pain relief, rigidity Oxidative stress mitigation
Oral + Traction Therapy Curvature reduction, hemodynamic improvement Mechanical plaque modification
Extended Therapy (Calcification) 91.9% stabilization/regression Unique anticalcification effect

Comparative Analysis with Other Treatments

  • Vitamin E: Lacks robust efficacy evidence
  • Colchicine: Limited by gastrointestinal side effects
  • Collagenase (CCH): FDA-approved but high-cost, multiple injections required, not indicated for acute phase or calcification
  • Verapamil: Variable results, less evidence for calcified plaques

PTX Advantages: Lower cost, applicability in acute/chronic phases (including calcification), flexible combination options, and favorable safety profile.

Clinical Implementation: Key Considerations

Adverse Effect Management:

  • GI symptoms (30% incidence): Dose titration, administration with meals
  • CNS effects (headache/dizziness): Evening dosing, hydration
  • Contraindications: Recent hemorrhage, severe cardiac disease, anticoagulant use, methylxanthine hypersensitivity

Adherence Strategies:

  • Gradual dose escalation
  • Realistic expectation setting (3–6-month onset)
  • Emphasizing stabilization benefits

Ideal Candidates:

  • Acute phase (<12 months) with changing plaques
  • Chronic disease with calcification
  • Mild-moderate curvature (<60°)
  • Motivated for long-term therapy

Poor Candidates:

  • Severe curvature preventing intercourse
  • Absolute contraindications
  • Expecting rapid complete resolution

Research Directions and Clinical Integration

While current evidence supports PTX, further investigation should:

  • Establish optimal injection protocols
  • Validate long-term outcomes (>24 months)
  • Identify predictive biomarkers
  • Refine multimodal combinations

Pentoxifylline represents a pathophysiological grounded option in PD management, particularly valuable for:

  • Early disease intervention
  • Calcified plaques
  • Cost-conscious treatment plans
  • Multimodal approaches combining oral and injectable routes

Conclusion: Therapeutic Position

Pentoxifylline offers a unique mechanism-based approach to Peyronie’s disease by targeting multiple pathological pathways. Its efficacy in plaque reduction, curvature improvement, and calcification management—especially in combination protocols—positions it as a valuable conservative option. When integrated with antioxidants, traction therapy, or topical agents, PTX provides urologists with an evidence-supported, cost-effective tool between observation and invasive procedures. Future research will further clarify its optimal role in the PD treatment algorithm.

Indwelling Urinary Catheter

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An indwelling urinary catheter (IDC or Foley catheter) is a flexible tube inserted into the bladder to drain and collect urine continuously. The catheter is held in place by a small, water-filled balloon at its tip to prevent it from falling out. 

Types of Indwelling Catheters

There are two main types based on the insertion method: 
  • Urethral Catheter: Inserted into the bladder through the urethra. This is the most common type.
  • Suprapubic Catheter: Inserted into the bladder through a small incision in the abdominal wall, above the pubic bone. This minor surgical procedure is often used for long-term management or if the urethra is blocked or damaged. 

Indications

Catheterization is a medical procedure and should only be performed when a clear clinical indication is present. Common reasons include:
  • Urinary retention: Inability to empty the bladder.
  • Surgery: To drain the bladder before, during, or after certain surgical procedures (e.g., prostate or hip surgery).
  • Monitoring: To accurately measure urine output in critically ill patients.
  • Incontinence management: When other methods have failed and the patient has severe skin impairment or pressure ulcers.
  • Nerve damage: For individuals with neurological conditions like spinal cord injury or multiple sclerosis who cannot control their bladder.
  • End-of-life care: To provide comfort

Living with an Indwelling Catheter

  • Drainage: The catheter connects to a drainage bag (leg bags for daytime use, larger bags for overnight use) or a catheter valve, which allows for controlled emptying of the bladder.
  • Maintenance: Catheters typically need to be changed every few weeks to three months by a healthcare professional.
  • Daily Care:
    • Wash the area where the catheter enters the body with soap and water daily.
    • Keep the drainage bag below the level of the bladder to ensure proper drainage and prevent urine backflow.
    • Ensure the tubing is free of kinks or twists.
    • Drink plenty of fluids to help flush the urinary system and reduce infection risk

Potential Complications

  • The most common and serious complication is a catheter-associated urinary tract infection (CAUTI), as bacteria can form a biofilm on the catheter surface.
  • Bladder spasms,
  • Blockages,
  • Leakage around the catheter, and
  • Urethral trauma.
It is important to seek immediate medical advice if you notice signs of infection (fever, cloudy/strong-smelling urine, abdominal pain), a blocked catheter, or if the catheter falls out
Dr Jo Schoeman, Urologist
Suite 46, Level 4
The Wesley Medical Centre
Wesley Hospital
Auchenflower Brisbane

Angiomyolipoma – AML

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An angiomyolipoma (AML) is the most common benign kidney growth. It has 3 components:
  • abnormal blood vessels,
  • smooth muscle,
  • and fat cells.

While typically benign, the main risk is the potential for the blood vessels to dilate and rupture, leading to serious, life-threatening internal bleeding (hemorrhage). 

Symptoms

Most angiomyolipomas are asymptomatic, and the tumors are often discovered incidentally during imaging for other conditions. However, if the tumor grows large or bleeds, symptoms may include:

  • Pain or discomfort in the abdomen, back, or side (flank pain).
  • A palpable mass in the abdomen.
  • Blood in the urine (hematuria).
  • Nausea and vomiting.
  • High blood pressure (hypertension).
  • Anemia (due to chronic blood loss or acute hemorrhage). 
Acute, severe pain, sometimes with signs of shock, can indicate a spontaneous rupture and is a medical emergency.

Causes and Risk Factors

The exact cause of sporadic AMLs is not known, but they are linked to genetic mutations. 
  • Sporadic cases: Account for 80% of cases, typically affecting women over 40 with a single tumor.
  • Associated with genetic syndromes: The remaining cases are often linked to genetic disorders like 
    • Tuberous sclerosis complex (TSC). In TSC patients, AMLs tend to be multiple, bilateral (in both kidneys), larger, and present at a younger age. 
    • Lymphangioleiomyomatosis (LAM). 

Diagnosis

Diagnosis primarily relies on imaging studies, as the fat content in the tumor gives a characteristic appearance.
  • Computed Tomography (CT) scans are the standard diagnostic tool for identifying the fat component.
  • Magnetic Resonance Imaging (MRI) is useful for cases where CT results are inconclusive, particularly in detecting fat-poor lesions.
  • Ultrasound can be used for initial screening or monitoring, but its findings can sometimes overlap with other kidney conditions.
  • Biopsy may be necessary if imaging cannot definitively differentiate the mass from a potentially malignant tumor, such as renal cell carcinoma.

Treatment and Management

Management depends on the patient’s symptoms, the tumor’s size and growth rate, and the risk of hemorrhage.
  • Active Surveillance: For small (<4 cm) and asymptomatic AMLs, routine monitoring with imaging is generally recommended.
  • Embolization: This minimally invasive procedure seals off the blood vessels in the tumor to prevent or treat bleeding. It is a first-line treatment for acute hemorrhage or for preventing rupture in high-risk cases (e.g., aneurysms >5 mm).
  • Surgery: Nephron-sparing surgery (partial nephrectomy) is often the preferred surgical option to remove the tumor while preserving kidney function.
  • mTOR Inhibitors: Medications like everolimus (Afinitor) are approved for treating TSC-associated AMLs (typically >3 cm) and can shrink the tumors and their associated aneurysms, reducing the risk of bleeding.
Dr Jo Schoeman, Urologist
Suite 46, Level 4
The Wesley Medical Centre
Wesley Hospital
Auchenflower Brisbane

Meatal Stenosis: Lichen Sclerosis

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Lichen sclerosus (LS) affecting the penile meatus causes white, atrophic plaques and scarring that can narrow the meatus. This leads to lower urinary tract symptoms and in severe case urinary retention.  This condition can also lead to phimosis, where the foreskin becomes tight, and can cause difficulty with urination and sexual function. Treatment typically starts with topical corticosteroids, and surgery such as circumcision or meatotomy may be necessary for more severe or stubborn cases. 

Symptoms and effects

  • Narrowed meatus: The meatus can narrow to the point of causing urinary retention, potentially damaging the bladder and kidneys over time.
  • Phimosis: In uncircumcised men, LS can cause the foreskin to become so tight that it cannot be retracted.
  • Urinary problems: A less powerful stream, spraying of urine, and urinary frequency are common symptoms.
  • Pain and scarring: It can cause pain during urination and intercourse, and lead to scarring of the glans, foreskin, and frenulum.
  • Other symptoms: Blisters, sores, and itching can also occur, though these are less common. 

Treatment

  • Medical therapy: The first-line treatment is often an ultrapotent topical corticosteroid, such as clobetasol propionate, applied to the affected areas.
  • Circumcision: This is often curative for LS confined to the foreskin and glans.
  • Meatotomy: In some cases, a surgical procedure to widen the meatus may be required.
  • Dilation: Daily self dilations
  • Other treatments: Depending on the individual case, other treatments may be considered, including phototherapy or laser treatments.
  • Surgical reconstruction: Some patients may require more extensive reconstructive procedures. 

Wes Meatal Dilatation

 

Dr Jo Schoeman, Urologist
Suite 46, Level 4
The Wesley Medical Centre
Wesley Hospital
Auchenflower Brisbane

Premature Ejaculation

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Premature ejaculation (PE) is the most common male sexual dysfunction. It is defined as the inability to delay ejaculation long enough to satisfy oneself or your partner. This causes personal distress.  While most men experience occasional rapid ejaculation, frequent occurrences may indicate a treatable medical condition.

Causes

The exact cause of PE is a complex interaction of psychological and biological factors.
Psychological factors:
  • Anxiety and Stress: Performance anxiety, general anxiety, and high-stress levels (from work or relationships) are common contributors.
  • Relationship Issues: Communication problems or unresolved conflicts with a partner can play a significant role.
  • History: Early sexual experiences characterized by haste (e.g., to avoid being caught), a strict upbringing about sex, or a history of sexual trauma can establish a pattern.
  • Depression and Confidence: Feelings of guilt, depression, or poor self-esteem can affect sexual function.

Biological factors:

  • Chemical and Hormone Levels: Irregular levels of certain brain chemicals (neurotransmitters) like serotonin and dopamine, or hormones such as testosterone and those related to the thyroid, may be involved.
  • Inflammation or Infection: Problems with the prostate or urethra can contribute to PE.
  • Erectile Dysfunction (ED): Men with ED may rush through sex to ejaculate before losing their erection, forming a difficult habit to break.
  • Genetics: Lifelong PE may have a genetic predisposition.
  • Penile Sensitivity: Increased sensitivity of the penis has been suggested as a possible cause in some cases.

Treatment and Management

Treatment for PE often involves a combination of approaches and may include the partner for the best outcome.
  • Behavioral Techniques: These are often the first line of treatment and aim to build tolerance and control over ejaculation.
    • Start-and-Stop Method: The man or partner stimulates the penis until the man feels he is near orgasm. Stimulation is stopped until the sensation passes, then resumed. This is repeated multiple times before allowing ejaculation.
    • Squeeze Technique: Similar to the start-and-stop method, but when the man is close to ejaculating, the partner or the man himself gently squeezes the head of the penis for several seconds until the urge to ejaculate lessens.
    • Other self-help options: Masturbating an hour or two before sex, using thicker condoms to reduce sensation, or trying to distract oneself (though this may reduce pleasure for both partners).
  • Medications: Oral medications or topical numbing agents can help delay ejaculation.
    • Topical Anesthetics: Creams or sprays containing lidocaine or prilocaine can be applied to the penis 10 to 15 minutes before sex to reduce sensation. A condom should be used to prevent the numbing effect from transferring to the partner.
    • Oral Medications: Certain selective serotonin reuptake inhibitors (SSRIs), which are a type of antidepressant, can be prescribed off label to delay orgasm. Dapoxetine (Priligy) is an SSRI developed specifically for on-demand use for PE and is available in some countries.
    • Other Medications: Tramadol (a pain reliever) or medications for erectile dysfunction may also be used in some cases, often in combination with SSRIs.
  • Counseling and Therapy: Talking with a mental health professional, certified sex therapist, or couple’s counselor can help address underlying psychological or relationship issues, reduce performance anxiety, and improve communication.
Dr Jo Schoeman, Urologist
Suite 46, Level 4
The Wesley Medical Centre
Wesley Hospital
Auchenflower Brisbane