What is premature ejaculation and how is it treated?

Insufficient duration of sexual intercourse due to too fast ejaculation in a man is a common intimate problem, which every fifth man at least occasionally encounters. But only a few men suffering from early ejaculation go to the doctor, although in most cases the problem is solved.

Short information about premature ejaculation

Ejaculation is a complex physiological process that is a result of two processes - emission and ejaculation. The emission phase is the result of a reflex response from the nervous system that develops in arousal. In the phase of emission, sperm is secreted into the urethra due to the contraction of the vas deferens, seminal vesicles, and prostate. While the sensation of approaching ejaculation enhances, the possibility of volitional control progressively decreases, reaching a certain point when ejaculation cannot be stopped.

The emission phase immediately follows the ejaculation - also the result of the unconditional, i.e. uncontrollable reflex. In this phase, the internal sphincter of the bladder closes so that there is no reverse seed reflux. After that, the external sphincter opens, and sperm is thrown out due to the contraction of the muscles of the pelvic floor.

At the biochemical level, this process involves the participation of such substances produced by the body as norepinephrine, serotonin, gamma-aminobutyric acid, and nitric oxide. An increased level of estrogen hormones or a decreased level of testosterone - the main male hormone - can cause ejaculation disorders. If a man has thyroid gland disorder, it also usually leads to problems in the sexual sphere. If the amount of thyroid hormones is increased, there may be premature ejaculation (PE). If reduced, then, as a rule, the erection process is disturbed.

Why does premature ejaculation occur?

The duration of sexual intercourse is reduced in all men in the case of prolonged sexual abstinence - this is a normal physiological reaction during overexcitation. Therefore, if after a long period of sexual rest, a man experiences separate episodes of ejaculation too fast - this is not a reason to worry. This effect is temporary and with a reduction in the intervals of abstinence, the duration of sexual intercourse will again become normal.

So when ejaculation is considered premature?  In the medical literature, there are several different definitions of the disorder.

For example, in 1943, Schapiro B. proposed to divide PE into primary and secondary (acquired).

Primary - when PE occurs during the first 30 seconds - 2 minutes with each or almost every sexual intercourse, and from the very beginning of the sexual activity. Secondary PE occurs after several years of normal sexual activity, and, as a rule, can be associated with the following reasons:

- Mental problems (depression, stress, anxiety, and other conditions or factors that affect normal mental state);
- Erectile dysfunction;
- Prostatitis;
- Diseases of the thyroid gland, accompanied by an increase in its function;
- Testosterone deficiency;
- Taking medications or psychoactive substances that interfere with the ejaculation process (such as marijuana).

A man should be worried if premature ejaculation does not go away even with regular sexual life. Both physiological and psychological factors can provoke it. The latter include stress (provoking an adrenaline rush), overwork, the presence of internal fears and complexes.

Physiological factors are very diverse - premature ejaculation can be caused by:

- Excessive sensitivity of the head of the penis;
- Anatomical features of the genital organ (phimosis, shortened frenulum, curvature);
- Inflammatory processes in the genitourinary tract (prostatitis, urethritis, infectious lesions);
- Damage to the spinal cord (for example, due to spinal injuries);
- The presence of tumor processes;
- Endocrine diseases (diabetes mellitus, thyroid dysfunction, hormonal changes).

A problem can also occur when taking alcohol, drugs, and certain medicines.

How common is premature ejaculation?

A recent study conducted in the USA, Germany, and Italy that involved survey of 12,000 men aged 18-70, showed that the disorder occurs in almost one in four men or 25% of all men.

Besides, the study showed that men with ejaculation disorder more than others also suffer from erectile dysfunction, low libido, depression, anxiety, and orgasm dysfunction. And only one in ten men went to a doctor with this problem.

At what age premature ejaculation usually develops?

According to the same study we said before, in general, the disorder can develop at any age. The slight increase in incidence is observed in men aged 18-24 years but the percentage is statistically insignificant.

Does marital status affects premature ejaculation incidence?

According to the three-country study, married men are 7% more likely to develop premature ejaculation.

Does lifestyle affects premature ejaculation?

Low level of physical activity and unhealthy lifestyle, i.e. smoking, alcohol abuse, drugs use, unhealthy diet, excess weight, and so on, are definitely the lifestyle factors that make premature ejaculation more likely.

Is there a connection between benign prostatic hyperplasia (adenoma) and premature ejaculation?

According to the existing statistics, there is no connection between these two conditions.

Is premature ejaculation related to erectile dysfunction?

According to the statistics, in men with premature ejaculation erectile dysfunction develops 3 times more often. Respectively, if a man has erectile dysfunction or factors predisposing to its development, i.e. unhealthy lifestyle resulting in high cholesterol, excess weight, high blood pressure, diabetes, and so on, you are more likely to develop both erectile dysfunction and premature ejaculation.

To solve this problem and prevent complications, in the first signs of erectile dysfunction, go to a doctor, find the reason of ED and focus on treating it rather than premature ejaculation. However, while you treat underlying conditions, you can also use medicines that have a combined effect, i.e. help developing a healthy erection and delay ejaculation such as Cialis with Dapoxetine (Super Tadarise). But keep in mind that such medicines aren’t a cure, they only help with the symptoms to allow a man affected by these disorders to have a healthy sexual life. But to cure the disorders completely, it is important to eliminate their causes.

How is premature ejaculation diagnosed?

Men with premature ejaculation are not always aware of a health problem. Inaccuracies in determining the duration of normal sexual intercourse complicate the situation - a number of researchers consider the duration of intercourse to be less than 6 and a half minutes insufficient. But men rarely go to a doctor if the problem is not so obvious that ejaculation occurs within a minute after the start of intercourse.

Modern diagnosis of premature ejaculation establishes pathology in the following cases:

- Ejaculation occurs in the first minute of sexual intercourse;
- The duration of sex does not change when the situation changes (absence of periods of abstinence, change of partner, etc.);
- The duration of sexual intercourse increases with the use of lubricants or special wipes with anesthetic;
- There is no possibility of control of ejaculation;
- A man has negative emotions after sexual intercourse.
To diagnose the causes of the problem, a whole set of tools can be used:
- Laboratory tests - to search for signs of infectious and inflammatory processes;
- Biotensiometry - measuring the sensitivity of the penis;
- Dopplerography of the vessels of the penis - ultrasound examination of blood flow in the vessels of the penis
-Ultrasound of the prostate gland - to exclude prostatitis and prostate adenoma.

If the causes of premature ejaculation are outside the urological sphere, the doctor appoints consultations with other specialists: neurologists, endocrinologists, etc.

How is treatment of premature ejaculation made?

The method of treatment depends on the cause that provoked premature ejaculation, therefore, in most cases, therapy requires an individual approach.

- If the problem is provoked by psychological factors, psychotherapeutic methods are used, consisting in identifying and neutralizing fears/phobias. In addition, the patient learns special techniques that help to control the process of achieving an orgasm. Prescription of antidepressants, serotonin uptake inhibitors and stress relieving drugs are possible.
- In the presence of anatomical features - they are eliminated. With phimosis and a shortened bridle of the glans penis, circumcision is performed, with Peyronie's disease (curvature of the penis due to the growth of fibrous plaques), a special operation is also performed.
- If the patient suffers from increased sensitivity of the penis head due to excessive innervation, selective surgical denervation is performed - part of the nerves responsible for the sensitivity of the head are dissected. As a result, the patient's penis becomes less sensitive and more time is needed to achieve ejaculation. Alternatively, Dapoxetine, a medication that delays ejaculation by suppressing the serotonin transporter and elevating serotonin's action at the post synaptic cleft can be used. If a man suffers both from premature ejaculation and erectile dysfunction, a combination medication based on Tadalafil (Cialis) and Dapoxetine can be used. A generic form of the medication is called Super Tadarise. It is used around 40 minutes before the anticipated intercourse. The price of one pill of this drug is $2.62. Worth noting that even Tadalafil on its own can partially help with premature ejaculation without erectile dysfunction as it is proven that hypererection delays ejaculation.
- If the problem is caused by infectious or inflammatory processes, endocrine pathologies, hormonal imbalance, or other organic diseases, then medication is prescribed to eliminate these diseases. With their curing or at least taking under control, in most cases, the sexual function of a man is restored. Antibacterial and antiviral drugs may be used to treat infectious diseases. Inflammatory processes are removed by taking anti-inflammatory drugs and undergoing physiotherapeutic procedures.

Endocrine or neurological pathologies are eliminated with the participation of relevant specialized specialists - an endocrinologist and a neurologist.

How can be premature ejaculation prevented?

In most cases, the development of premature ejaculation can be avoided - it is enough to monitor the health of the body in general and men's health in particular.

- The first condition is regular annual examinations by a urologist for all men over 25 years of age, which must be performed even if there are no complaints or disturbing symptoms. This allows you to identify urological diseases at the earliest stages and treat them before causing damage to the genital area.
- The second condition is the timely treatment of identified diseases. If you are diagnosed with a urological disease or you notice signs of urological disorders (increased urination, painful urination, clouding of urine, pain in the pelvic or genital area), you need to contact a urologist, undergo diagnostics and treatment.

Not a single urological disease goes away on its own - all of them only go into the chronic stage and are aggravated. And even if the patient experiences temporary relief, over time it will be replaced by an even more severe exacerbation. The more the disease is started, the longer and more expensive the treatment will be, the higher the risk of developing complications of the disease.

- The third condition is maintaining a healthy lifestyle. Physical exercising to level the effects of sedentary work, moderation in food, limitation of bad habits will help maintain the general condition of the body at the proper level.
- The fourth condition is measured sex life. Long periods of sexual abstinence, as well as sexual excesses (excessive sexual activity) do not benefit male health.
- The fifth condition is maintaining a proper level of psychoemotional state. The psyche, like the body, needs regular hygiene: a measured work schedule, lack of stress and consultations with a psychotherapist for a long time in a depressed or anxious state are as important for a full sexual life as maintaining physical health.

Post by: John Johansson, M.D., sexologist, Amsterdam, Netherlands