What is premature ejaculation?
Premature ejaculation affects about 30% of men and is the most common sexual dysfunction in men less than 60 years of age. According to the scientific societies of sexual medicine (European and American), we talk about premature ejaculation when one or more of the following characteristics are present:
ejaculation always or almost always occurs within one minute of penetration
Inability to delay ejaculation before or after penetration
discomfort, embarrassment, anxiety, frustration and relationship difficulties, which can lead to avoidance of sexual activity
I suffer from premature ejaculation. What can I do?
The good news is that with current treatment protocols most of our patients are able to increase ejaculation time, regardless of the underlying causes of the disorder. In case of premature ejaculation, the visit with the andrologist is necessary to make a correct diagnosis and identify the underlying causes of the problem.
Thereafter, the therapy will allow you to immediately improve your ejaculation time, so that you can immediately resume normal sexual activity.
Causes of premature ejaculation
Understanding the causes and identifying the type of disorder means taking the first step in treating premature ejaculation.
Type of disturbance 1
Congenital premature ejaculation
It comes with one or a combination of the following characteristics:
Disorder present from the first sexual experience (as a child)
Intravaginal ejaculatory latency time (IELT - time from the beginning of intercourse to ejaculation) less than 1-2 minutes
· Inability to postpone ejaculation in all, or almost all, vaginal penetrative intercourse
Discomfort, embarrassment, anxiety and frustration associated with the tendency to escape sexual intimacy
Premature ejaculation called "ante portam", in which ejaculation occurs before vaginal penetration, is the most severe form of premature ejaculation.
Causes
Primary premature ejaculation is usually biological (medical) and not psychological in nature. Unfortunately, the mechanisms underlying the disease have not yet been identified exactly, although there are several theories about it.
Type of disturbance 2
Acquired premature ejaculation
It comes with one or a combination of the following characteristics:
Symptoms of premature ejaculation occur after a period of normal ejaculatory function, causing a significant reduction in the intravaginal ejaculatory latency time (IELT - time from the start of intercourse to ejaculation)
· Intravaginal ejaculatory latency time (less than 3 minutes
· Inability to postpone ejaculation in all, or almost all, vaginal penetrative intercourse
Discomfort, embarrassment, anxiety and frustration associated with the tendency to escape sexual intimacy
Causes
Cutaneous hypersensitivity of the genitals and hyperexcitability of the ejaculatory reflex, caused by neurobiological factors such as hypertension, diabetes, metabolic syndrome and alcohol abuse
Hormonal causes such as hyperthyroidism / hypothyroidism / decreased prolactin / increased leptin
Psychological factors (anxiety / depression, relationship problems, performance anxiety, masturbation addiction, first negative sexual experiences)
Short frenulum
Phimosis
· Erectile dysfunction
Chronic prostatitis
Chronic pelvic pain syndrome
· Drug use
Some drugs such as sympathomimetics
Type of disturbance 3
Episodic or situational (mixed) premature ejaculation
It is not considered a true sexual dysfunction, but a variation in the context of normal sexual performance. It manifests itself in the following conditions:
· Sexual abstention for long periods of time
In relation to the partner: a new partner, a very attractive or unattractive partner, a wrong partner (e.g. a prostitute), a conflict with the partner
Intense expectation and emotional charge in relation to sexual activity (for example, the first sexual experience4
Type of disturbance 4
Subjective (premature-like) ejaculatory dysfunction
Patients with this disorder believe they suffer from premature ejaculation despite having an intravaginal ejaculatory latency time (IELT - time from the beginning of intercourse to ejaculation) of more than 3 minutes.
Subjective premature ejaculation is characterized by one or more of the following:
· Subjective perception of fast (premature) ejaculation that occurs during sexual intercourse
· The individual's concern about an ejaculation that is imagined as too fast
· Intravaginal ejaculatory latency time normal or even longer than normal
Poor control of ejaculation
Treatment of Ejaculation
Early
My treatment approach for premature ejaculation is based on the latest clinical studies, guidelines from international scientific societies of sexual medicine and our extensive clinical experience.
Our therapeutic protocol follows a personalized and multimodal approach which consists of a combination of the following elements:
Patient information and education
The patient suffering from premature ejaculation receives an adequate explanation of the main characteristics of their disorder. Patient education is a fundamental phase for the success of the treatment, especially in the case of subjective and variable premature ejaculation.
It is important to know that:
Secondary Premature Ejaculation: Treatment and Control of Risk Factors
Initial treatment aims to correct identified risk factors. >> see 2. Acquired or secondary premature ejaculation - causes
a) Behavioral therapy
You can improve ejaculation control and ejaculation time with techniques such as "Start-Stop" and "Start-Stop-Squeeze".
This type of therapy may be more useful for those suffering from secondary, episodic and subjective premature ejaculation.
b) Local anesthetics
One of the leading theories on the causes of premature ejaculation is genital hypersensitivity. The application of local anesthetics on the glans may therefore be helpful for some patients. The options include:
Creams (eg. EMLA)
· Spray
Condoms with local anesthetics
It is important to use local anesthetics correctly in order to achieve an optimal dosage and to avoid completely numbing (anesthetizing) the partner's penis or genitals.
c) Antidepressant drugs - selective serotonin reuptake inhibitors (SSRIs)
Several antidepressants cause delayed ejaculation by increasing the intravaginal ejaculatory latency time (IELT):
paroxetine: increases by 9 times
escitalopram: increases by 5 times
fluoxetine: increases by 4 times
sertraline: increases by 4 times
When using SSRIs, it is important to evaluate the dosage and type of intake, as needed (eg before sexual intercourse) or every day. It is important to follow the instructions of the specialist which may vary according to the type of disorder.
d) drug therapy
Priligy (dapoxitine)
Dapoxetine (Priligy®) is a drug specially developed for the treatment of premature ejaculation and is therefore the initial treatment for almost all patients. Its advantage is that it has a fast effect and has a short duration, which means that it can be taken shortly before sexual intercourse (1-2 hours).
Uroselective alpha-blockers
Some scientific studies report that the daily use of alpha-blockers (such as tamulosin and silodosin), usually used for the treatment of disorders related to prostatic hypertrophy, can improve ejaculation time. This type of drug is usually prescribed to patients who have not benefited from dapoxetine (and who also have urinary disorders)
PDE-5 inhibitors
PDE-5 inhibitors can be an excellent option in patients suffering from premature ejaculation secondary to erectile dysfunction. If premature ejaculation does not improve after treatment for erectile dysfunction, PDE-5 inhibitors should be supplemented with other treatment options.
e) Intracavernous injection therapy
In more severe cases of premature ejaculation, such as ante-portam ejaculation (i.e. even before starting intercourse), where other treatments have not been successful, alprostadi injection therapy can allow the patient to maintain an erection. even after ejaculation and to resume intercourse.
This therapeutic modality may not be particularly pleasant for patients, but it can improve the sexual satisfaction of the partner and, in some cases, help to better control ejaculation.
f) Combined therapy
Many patients with premature ejaculation do not respond to individual therapeutic modalities and require combination therapy.
g) Surgery
Patients suffering from ejaculation due to a genital problem such as short frenulum or phimosis can benefit from surgical correction of the problem.
Circumcision should not be considered as a routine treatment for premature ejaculation, as it may not do any good if you have a healthy foreskin.