Premature ejaculation (ejaculation) - symptoms and treatment

What are the causes of premature ejaculation

There are primary and secondary (acquired) forms. Primary occurs due to anatomical defects of the genital organs or pathological heredity. The debut of early ejaculation occurs during puberty, and does not depend on external factors (partner, situation, psychological state).

Causes of the congenital form:

• hypersensitivity of the penis;
• dysfunction of serotonin receptors;
• short frenulum of the penis;
• cavernous fibrosis.

Secondary premature ejaculation can occur against the background of a man’s full physical health at any time in life. The main reason is chronic urogenital diseases. Hormonal disorders, which are characteristic of endocrine pathologies, can also lead to sexual dysfunction.

Factors that significantly increase the risk of PE include:

• obesity;
• traumatic sexual experience;
• chronic stress;
• family problems (conflicts, emotional coldness between spouses);
• presence of neurological diagnoses - sclerosis, Parkinson's disease;
• irregular sex;
• surgeries on the genitals or pelvic area.

An important factor is good nutrition and maintaining a healthy lifestyle. A man's lack of microelements such as magnesium and zinc negatively affects the quality of the ejaculate. Excessive addiction to alcohol reduces the ability to control the body, which entails unpleasant incidents in bed.

According to statistics, cases of early ejaculation occur more often in men with a low level of education, which may be associated with intellectual development and self-esteem.

Important! In young people who have just begun sexual activity, premature ejaculation is considered relatively normal. Provided there are no infectious diseases of the urogenital system. With sufficient sexual experience, a man will gain confidence, and cases of PE will disappear on their own.

Classifications.

A number of classifications of PE are presented in the world literature (1,2,5).

According to etiological factors: psychogenic; organic; a combination of psychogenic and organic causes.

By period of occurrence (manifestation): initial (primary); acquired (secondary).

According to manifestations: constant; episodic.

Depending on the conditions of coitus: absolute; selective (situational).

Duration of coitus (friction stage):

I degree – from 1 to 2 minutes (30–60 frictions); II degree – 30–60 seconds (15–30 frictions);

III degree – 15–30 seconds (7–15 frictions); IV degree – up to 15 seconds (several frictions);

V degree – ejaculation before introjection.

Initial (primary).

Ejaculation occurs very early, almost immediately after the start of sexual intercourse. Manifestation - almost from the very beginning of sexual life. 80% within 1 minute (more than half within 30 seconds). In 20% - within 1-2 minutes. The rapid onset of ejaculation continues throughout life.

Acquired (secondary).

Early ejaculation occurs at a certain stage in a man’s life. The man had experience of normal ejaculation in the past. Usually occurs in mature men. Ejaculation occurs within 1-2 minutes. Premature ejaculation occurs as a result of problems related to urology, thyroid or psychological factors.

Episodic.

Premature ejaculation may be irregular. The ability to delay the onset of ejaculation is reduced or absent. Manifestation - almost from the first sexual experience or in adulthood. The duration of sexual intercourse can be either short or normal. It is part of the normal cycle of changes in ejaculatory function in men.

Electoral.

Situational self-awareness of insufficiently delayed ejaculations. The ability to delay the onset of ejaculation is reduced or absent. Manifestation - almost from the first sexual experience or in adulthood. The duration of sexual intercourse is within normal limits or longer than usual. Both premature ejaculation in certain situations and normal duration of sexual intercourse can be observed.

Despite the variety of clinical options, it can be argued that they have one thing in common - a deterioration in the quality of life of a man, his partner, and often their relationships.

Premature ejaculation: diagnosis and consultation with a doctor

The main consequences of pathological sexual dysfunction include:

1. Sexual dissatisfaction.
2. Inability of a man to delay and control ejaculation.
3. Conflicts and problems in personal relationships, feelings of guilt and fear of intimacy.

If you have such symptoms, it is recommended to consult an andrologist or urologist. During the appointment, the doctor pays special attention to collecting a sexual history. For this it turns out:

• average length of time before ejaculation occurs;
• the impact of PE on the quality of personal and sexual life;
• does the man have endocrine diseases or metabolic disorders;
• How often do cases of premature ejaculation occur?
• at what age did the first case of PE occur?
• whether the man is taking any medications.

A detailed study of the details of a man’s sexual life will allow the doctor to distinguish between congenital and acquired pathologies. Doctors also classify the situational form of PE into a special group. In this case, premature ejaculation occurs only under certain circumstances (with the same partner, in a specific place).

Additional diagnostic methods

Additional tests are performed to determine the severity of sexual dysfunction.

1. Tests with lidocaine.

They are carried out without fail if a congenital type of PE is suspected. A study using an anesthetic allows you to determine the level of sensitivity of the head of the penis during stimulation. If hypersensitivity is detected, a diagnosis of congenital premature ejaculation is made. Treatment includes surgery.

1. Test using antidepressants.

If, when taking medications from this group, the duration of sexual intercourse before ejaculation increases, then the psychological cause of the pathology is determined.

1. General clinical tests - blood for STIs, laboratory testing of urine and seminal fluid.

Also, if necessary, hardware examinations of the urinary tract and genital organs are prescribed.

ICD-10 definition.

F52.4 Premature ejaculation. Inability to control ejaculation sufficiently to ensure that both partners enjoy sexual intercourse. Excluded: premature ejaculation caused by diseases of the male genital organs (N40 - N51); premature ejaculation caused by organic brain damage (F06.82x).

F52.41 Absolute premature ejaculation. The duration of sexual intercourse is less than one minute (less than 20 frictions) against the background of regular sexual activity. Turns on: absolute accelerated ejaculation.

F52.42 Premature ejaculation relative. The duration of sexual intercourse is within the physiological norm (from 1 to 3 minutes). However, this duration of sexual intercourse is not enough to obtain orgasmic release.

partner. Includes: relative accelerated ejaculation.

F52.49 Premature ejaculation, unspecified

Includes: premature ejaculation, unspecified; premature ejaculation NOS.

Treatment of premature ejaculation

In some cases, it is enough to reduce the consumption of alcohol or other stimulating drinks (energy drinks, coffee) to restore a full sex life.

For psychological reasons, a positive result is achieved by establishing friendly communication between partners/spouses. Using a condom or changing positions can help reduce the sensitivity of the penis and increase the duration of intercourse. But such recommendations are effective only in the absence of physical health problems. The choice of therapy depends on the cause of the pathology and its severity.

Conservative treatment of premature ejaculation

This group includes 3 main areas:

• The use of local ointments, creams with anesthetic (mainly lidocaine).

This method is easy to use and helps reduce sensitivity of the glans penis. It is important to choose the dosage correctly and strictly adhere to the treatment regimen indicated by the doctor. In case of an overdose, the opposite result is possible - numbness of the penis and lack of erection.

• Psychosexual therapy

Two behavioral techniques are actively used - “stop-start” and “compression technique”. They help recognize the feeling of imminent ejaculation and slow it down. Therapy is also aimed at controlling the level of sexual arousal. The methods are included in the complex therapy of acquired premature ejaculation.

• Taking medications

Antidepressants and anti-anxiety medications are used. Prescription of selective serotonin reuptake inhibitors (SSRIs) also gives good results. Their side effects lead to delayed ejaculation.

If infectious diseases of the urogenital area are detected, a course of antibacterial and anti-inflammatory medications is prescribed. Additionally, vitamin complexes may be prescribed.

Surgical treatment of premature ejaculation

Surgery is a last resort method, which is used only when congenital PE is detected. To determine the need for surgical intervention, a lidocaine test is required.

1. Denervation of the head of the penis is a microsurgical intervention during which the nerves of the penis are corrected.
2. Frenulotomy (short frenuloplasty).
3. Hyaluronic acid injections.

The main disadvantage of surgical treatment methods is the presence of a recovery period and the possibility of relapse. At the moment, SSRIs are considered the optimal and effective method of therapy. It is also important to improve interpersonal relationships and create a comfortable environment.

Ejaculation disorders that are not associated with diseases of the internal organs are often temporary and completely reversible. To do this, a man only needs to be more attentive to his own health. For timely detection and treatment of infectious diseases, it is recommended to regularly visit an andrologist or urologist. Sometimes an explanatory conversation with a doctor is enough.

It is important to avoid mental stress, enrich your diet with healthy foods, and overcome bad habits. If you cannot cope with psychological discomfort on your own, do not be afraid to seek help from a psychotherapist.

Conclusions.

Therapy for any disease or disorder must be comprehensive and staged. Assessing the effectiveness, safety, naturalness and ease of use, we can conclude that the first line of therapy may be correction with local anesthetics. Among them are cream with lidocaine, SS-cream, as well as a series of products from the Biorhythm Laboratory. The products of this manufacturer meet the highest standards of safety, ease of use, and are economically accessible to the majority of the population, unlike many foreign analogues. You can use both creams and sprays. The spray form allows you to use these products without giving up the stage of oral sex.

Feedback from patients shows high satisfaction with the effectiveness of Biorhythm Laboratory products, and consultations with a sexologist in the field of hygiene of sexual life, improving its regularity and quality make it possible to consolidate the therapeutic effect of these products.
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Psychotherapy for early orgasm

A man’s emotional state is affected not only by premature erection, but also by other problems in his sexual life. Therefore, the help of a psychotherapist will be useful for all sexual disorders.

The course of psychotherapy is carried out taking into account the individual characteristics of the patient in several stages:

Establishing and maintaining contact

Since the problem with erection is a rather sensitive problem, at the first meeting it is very important that a trusting relationship is established between the therapist and the client.

In the first stages, person-oriented therapy, short-term psychodynamic and bodily psychotherapy are used. The patient gets the opportunity to understand the causes and mechanisms of his dysfunction, strengthen the mechanisms for protecting personal boundaries, remove muscle tension, develop skills in managing his own body and create a positive life scenario.

The duration of this stage is determined individually. For some, a few days are enough, while others will visit a psychotherapist’s office for several weeks.

Working with a couple

The psychotherapist's work will be aimed at creating trusting relationships between partners. The partner must actively participate in the therapeutic process. She requires patience and understanding of the situation. Since a man is in anxious anticipation of failure, he must be supported in every possible way.

Quite often during this stage, new therapeutic requests are received from the couple. Working on them allows you to resolve not only problems in the sexual sphere, but also strengthen the relationship between partners in general.

Group therapy

This stage often encounters some resistance from men, so work in groups is carried out only at the request of couples. Group therapy allows you to work through existing problems as much as possible and achieve personal changes and partners.

Today there are a large number of centers where they offer psychotherapy. But the search for specialists should be taken very seriously. There is no need to make an appointment with the first psychologist you come across.

Choose specialists with extensive experience in the field of sexual and sexual disorders. These are the ones who work at the Moscow City Psychoendocrinological Center.

Physiology of ejaculation

The process of ejaculation includes two actions that occur one after another:

1. Emission. This is the name for the phase of accumulation of seminal fluid in the posterior part of the urethra.
2. Direct release of semen. At this stage, the neck of the bladder is blocked and seminal fluid is released.

Each of these processes is controlled by a specific group of neurons located in the spinal cord. Activation of motor neurons occurs after the brain receives a signal that the ejaculation threshold has been reached. When neural connections are disrupted, the entire process fails, which leads to early ejaculation.

Where to start treating PE?

I think we have already partially answered this question (see previous answers). Summarizing the above, we can give a number of simple tips:

• Answer yourself this question: at what point in your life did you notice that the process became shorter? If immediately, then most likely you need a sex therapist (or a psychologist who knows sexual problems). But still, this does not exclude everything that relates to secondary or acquired PE.
• If PE is secondary, i.e. did not appear immediately, but after some experience of normal sex, then ask yourself this question: what has gone wrong in my life? Maybe it's a relationship with a partner? Or maybe you have gained weight and lead a sedentary lifestyle? How many cigarettes do you smoke? If the answers are positive, do not rush to look for miracle cures - change your lifestyle.
• If all of the above does not apply to you, or you have eliminated all risk factors, then proceed to the next stage - examination and examination by a doctor. Here, unfortunately, it is very important what kind of doctor the doctor will be. If you are competent, the chances of prolonging sexual intercourse increase. If he promises to save you from PE, but at the same time he fools you with expensive and unnecessary examinations and treatment regimens, think about it, maybe you need another doctor...
• In addition to a general examination and a special one (examination of the genital organs, prostate), a number of laboratory tests are required, primarily hormonal ones (you can read which hormones you need to take in paragraph 2 of our article). Advice: it’s better to have a doctor prescribe tests. In my experience, patients themselves turn to various laboratories, and either get the wrong tests, or in the wrong laboratories.
• The last step is the actual treatment or pills...

Questions about the article

Ilnur

October 14, 2021 at 09:57

Hello! I have a very sensitive head of the penis, because of this, sexual intercourse takes less than a minute, sometimes even before penetration into the vagina. I would really like to do denervation of the penis. I'm from Surgut, how can I solve this problem? Thank you!

Anton Evgenievich Rotov

October 14, 2021 at 09:59

Start with the Lidocaine test. If the result is positive, then denervation can be done - it will solve this problem for a long time

Vadim

September 22, 2021 at 00:18

Hello! Please tell me, if condoms with an anesthetic or Long play prolonging cream from a sex shop help in prolonging intercourse (it was even difficult to achieve ejaculation with them), is it possible to exclude paracentral lobe syndrome in this case?

Anton Evgenievich Rotov

September 24, 2021 at 12:53 pm

It cannot be excluded (although this diagnosis seems unlikely). It can be stated that there is hypersensitivity of the head. In some cases, these two conditions can be combined

Igor

September 12, 2021 at 08:32

Hello. I ejaculate quickly, if I stop sexual intercourse to wait it out, it drops, if I watch porn, mucus starts to come out, maybe it’s due to mesturbation. Tell me how to identify? Thank you.

Anton Evgenievich Rotov

September 12, 2021 at 08:41

In general, what you are describing is a variant of the norm, with the exception of premature ejaculation (if sexual intercourse lasts less than 2 minutes). Excessive masturbation is, of course, harmful and can lead to various sexual dysfunctions. Regarding increasing the duration of sexual intercourse, all methods are described in the article above. If you have any additional questions, write or call, I will be happy to help

Nikolai

September 5, 2021 at 04:12 pm

For me, rapid ejaculation occurs when the penis is squeezed during an erection. That is, as soon as I find myself in a “narrow” place, it becomes difficult for me to control myself and resist ejaculation. At the same time, the head is not hypersensitive, and I don’t see any problems with the frenulum either. When using drugs to improve erection, it improves, the penis becomes harder, the “squeezing” effect decreases and the ability to control the duration of sexual intercourse increases. What can you advise in my case? Thank you!

Anton Evgenievich Rotov

September 9, 2021 at 07:39

In this case, it would be logical to use drugs to enhance erection - Sildenafil, Tadalafil. I would also advise you to donate blood for sex hormones

What if you still have to take SSRIs?

If your doctor prescribes you paroxetine or sertraline, you need to take them regularly, starting with the lowest dose and gradually increasing (your doctor will tell you how to do this!). As a rule, the course lasts at least 3 months.

Why? The fact is that 3 months is the period after which you will get a certain effect that will not increase further. For example, the time to ejaculation before the start of treatment was 1.5 minutes, and after three months it increased to 3 minutes. This means that there will be only 3 minutes further... i.e. the time for which the drug is maximally “capable”. In the future, if there is an effect (and no side effects), you can take SSRIs once, approximately 6 hours before sexual intercourse.

The unwanted side effects listed in paragraph 13 may become an obstacle to continuing to take SSRIs. Agree, if you want to sleep or feel nauseous, is it time to have sex? But the problem of deterioration in potency due to antidepressants will be solved by the same vardenafil. It must be taken together with paroxetine or sertraline.

KEGEL METHOD.

This technique is based on the assertion that if a man suffers from early ejaculation, then his innervation of the pelvic organs is to some extent impaired. Accordingly, you can perform exercises that will help restore it. During Kegel exercises, a man learns to regulate the tension and relaxation of certain pelvic muscles. As a result, the skill of controlling ejaculation is simultaneously trained.

You need to choose the right doctor, to whom you will turn with such a delicate question, to whom you will trust the details of your intimate life. But to provide effective assistance, the doctor will need to talk about everything. And the doctor must be a specialist in this area.

AND TODAY, PEOPLE STRIVE FOR LONG-TERM INtimacy.

And these days, sex shops are overflowing with means to prolong sexual intercourse, mainly ointments, which, unfortunately, bring little benefit.
But they do not bring and cannot bring any benefit, because... Premature ejaculation has basically nothing to do with the receptors of the penis that these ointments are aimed at. And those who create and sell them know this very well, but without a twinge of conscience they “push and sell” their drugs to gullible customers. As a rule, these drugs are thrown into the trash bin after two or three attempts to use them, because... There is no slowdown in ejaculation. Research by one of the Western companies producing such products shows (as A. Poleev writes) that every tenth Muscovite and St. Petersburg resident has already bought an ointment to prolong sexual intercourse. In the Russian outback, these drugs are much more popular: every fifth man bought them. These dubious drugs are especially popular among Caucasians living in Russia. Before starting treatment at Professor Azizov’s Clinic in Makhachkala, the plan for examination and treatment of the interaction between spouses is discussed in detail and the choice of one or another option is justified.

Does lifestyle affect PE?

If you play sports (meaning regular physical exercise, not exhausting professional sports) only a few times a month or less, then the chances of “quick sex” increase. This leads to the following pattern: the less physical activity, the more adipose tissue, and the more you weigh (meaning overweight), the worse it is for sexual function.

Smokers are also much more likely to doom themselves to PE.

Some time ago I had the opportunity to communicate with a colleague from the Netherlands. He told me that there was an epidemic of premature ejaculation in his country. As you know, smoking is prohibited in Holland, but “soft” drugs are allowed there. Marijuana is one of the worst enemies of manhood.

Draw conclusions: you need to start with yourself, with changing your lifestyle. Just in case, I remind you of the ideal weight formula: height in cm minus 100.

How often do men have problems with ejaculation?

Some time ago, more than twelve thousand men aged 18 to 70 were surveyed in the USA, Germany and Italy, and it turned out that premature ejaculation is a problem for almost every fourth! (more precisely, it occurs in 22.7% of men).

As it turns out, men who experience problems with ejaculation are more likely than others to complain of erectile dysfunction, decreased libido, depression, anxiety, and orgasmic disorders. At the same time, only every tenth person consulted a doctor, and of those who tried treatment, more than 90% were not satisfied with the results.

Causes and predisposing factors of rapid ejaculation

Reasons for rapid ejaculation include:

• prolonged abstinence from sex or low frequency of sexual intercourse, resulting in increased sexual excitability.
• discomfort during sexual intercourse associated with anxiety due to the expectation of rapid ejaculation and possible sexual dissatisfaction of the partner.
• a psychological disposition towards early ejaculation, usually formed at a young age during the first sexual intercourse and caused by the fear of being caught by strangers.
• individual constitutional features of the innervation of the penis, which determine increased sexual sensitivity.
• features of the central part of the ejaculatory reflex, leading to the formation of a low threshold of the ejaculatory reflex.