Premature ejaculation is a disorder of sexual function, manifested by untimely ejaculation before or during sexual intercourse and does not bring sexual satisfaction to partners. Leads to a violation of the harmony of sexual relations. It presents a serious psychological problem for a man, leads to the development of feelings of inferiority and self-doubt, which further aggravates sexual dysfunction. The issues of diagnosis of premature ejaculation belong to the competence of a urologist-andrologist and a sex therapist. In order to correct sexual dysfunction, psychotherapy, drug therapy, and sometimes surgical treatment can be carried out.
Premature ejaculation is a ejaculation disorders and accounts for 25-60% of all forms of functional sexual disorders in men. Premature ejaculation is not considered an organic disease, it is a sexual dysfunction, which consists in the inability to control ejaculation sufficiently to achieve sexual satisfaction during coitus by both partners. According to WHO, at least 40% of men of different ages around the world face the problem of premature ejaculation. The criteria for premature ejaculation are considered by different authors to be the time factor (the duration of sexual intercourse is less than 1-2 minutes) or the number of frictions (less than 8-15).
Problem of premature ejaculation
The problem of premature ejaculation is mostly a social problem, since from the point of view of medicine there are no organic changes and there are no obvious reasons for this. There is no uniform norm for the duration of sexual intercourse, but the average duration of the period of frictions ranges from 2 to 10 minutes, depending on the characteristics of the body, the situation during coitus and the period of abstinence. However, the subjective opinion of men can cause a false opinion about the presence of the problem of premature ejaculation and short sexual intercourse, which in turn has an adverse effect on family relationships, reduces the self-esteem of both partners and often leads to the disintegration of the family.
Premature ejaculation is considered if ejaculation regularly occurs earlier than both of the partners received sexual satisfaction, provided that the friction period was less than 2 minutes. With a long period of foreplay, strong sexual arousal, especially after significant abstinence, ejaculation may occur even before genital contact, which is not considered a pathology. Many people take the inability to get a vaginal orgasm or anorgasmia in women for premature ejaculation, since the frictional period, often lasting more than 20 minutes, is not enough to satisfy a partner.
That is, from the point of view of medicine, premature ejaculation is often repeated ejaculations after minimal sexual stimulation before or after the insertion of the penis into the vagina. The opinion that uncontrolled ejaculation is premature is incorrect, besides it generates serious and intractable psychological problems.
To date, numerous studies in the field of andrology prove that most premature ejaculations have a psychogenic nature and belong to the psychogenic form of premature ejaculation. The lack of sexual experience and theoretical knowledge at the time of the onset of sexual life, combined with false reviews of sexual experience among peers, further form a persistent failure syndrome. Because once an unsuccessful sexual act occurs with the development of phobias leads to a repetition of the scenario. The psychophysical causes of the development of recurrent premature ejaculations lie in the formation of a reflex arc, which after formation contributes to premature ejaculation, further secondary phenomena of colliculitis (inflammation of the seminal tubercle) develop.
Inflammatory diseases of the appendages of the genital glands, especially in the absence of treatment and the addition of psychogenic factors, can form a persistent syndrome of premature ejaculation. Thus, with inflammatory or hypertrophic colliculitis in the seminal mound, blood supply increases, which is especially pronounced at the time of sexual intercourse. This increases the ascending nerve impulses and in response to irritation of the central nervous system, orgasm and premature ejaculation occur. In the absence of treatment, the irritation of this zone increases, as a result of which the quality of the orgasm itself is lost, and frequent premature ejaculations are formed. Often the prostate gland is involved in the inflammatory process, or at first there is inflammation of the prostate, which later passes to the seminal mound. Therefore, when correcting premature ejaculation, it is important to carry out anti-inflammatory therapy of all appendages of the genital glands.
With neurological changes that are accompanied by hypersensitivity of the glans penis, the number of receptors in the neural arch increases, resulting in premature ejaculation. A short frenulum, as the cause of premature ejaculation, is practically not considered, since after the plastic frenulum, sexual life returns to normal.
Premature ejaculation diagnosis and treatment
In addition to subjective data based on the patient’s survey, an andrologist conducts a number of tests, including a sample with lidocaine and a condom. It is also necessary to conduct an examination for the presence of inflammatory diseases of the urogenital sphere that could cause sexual dysfunction. And after a comprehensive examination, a course of procedures is individually prescribed to correct sexual dysfunction. At the same time, the goal of treatment is to restore the normal duration of sexual intercourse and to remove the psychologically conditioned failure syndrome.
All patients undergo a psychotherapeutic course on teaching methods of ejaculation control. Sex therapists agree that with premature ejaculation of a psychogenic nature, psychotherapy is sufficient for the successful formation of recognition of pre-orgasmic sensations. However, the effect of psychotherapy is observed only with the conscious and adequate participation of a permanent partner. The “stop-start” technique begins to give its results for a period of 2 to 10 weeks, but it takes at least 2-3 months after the end of the procedures to consolidate them. At the same time, the effectiveness largely depends on the patience of both partners and on the absence of negative emotions at the time of sexual intimacy.
Stopping or slowing down frictional movements simultaneously with conscious relaxation of the muscles at the moment of approaching orgasm, allows you to continue sexual intercourse, in addition, constant training strengthens the pelvic floor muscles, which additionally helps to achieve complete control over ejaculation and solve the problem of premature ejaculation. At the same time, treatment will be effective only if there is a permanent partner who is not indifferent to the problems of a man and a positive attitude, along with a reserve of patience and perseverance.
Medical treatment of premature ejaculation is indicated for inflammatory processes in the prostate gland and in the seminal tubercle, as well as with increased sensitivity of the glans penis. To reduce sensitivity, an ointment with lidocaine or anesthetic is used, while it is recommended to use a condom. The drug is applied 10-15 minutes before sexual intercourse to the frenulum area in order to prevent loss of sensitivity completely and not cause anejaculation. This method can be used only in the presence of a permanent partner, as it is associated with psychological and physical discomfort during preparation for coitus, however, when using ointments, a good clinical effect is achieved and a minimum of adverse reactions is observed.
Drugs from other pharmacological groups, due to their selective effect on the mechanisms of regulation, can also be used to correct premature ejaculation. However, no pharmacological group of drugs has been widely used. So, neuroleptics block dopamine receptors at the central level. The effectiveness of tranquilizers in the correction of premature ejaculation directly depends on the dose, but ejaculation is inhibited rather than controlled. In addition, when the dose is increased, a medicinal sedative effect occurs, which is not always appropriate at the time of sexual intimacy.
When using alpha-blockers, the ejaculatory reflex is inhibited due to the effect on the sympathetic link. But, despite this, while maintaining control over premature ejaculation and maintaining orgasm, drugs have not been widely used due to frequent retrograde ejaculation, when seminal fluid is thrown into the bladder, since its valve does not close.
Premature ejaculation can be inhibited by tricyclic antidepressants, although these drugs are dose-dependent and their effectiveness is no more than 15%, which, together with many side effects, did not give antidepressants widespread use in the treatment of premature ejaculation.
The most popular drugs for the correction of premature ejaculation are antidepressants that increase serotonin levels due to selective blockade of its reuptake. These are fluoxetine, sertraline and others; when taking drugs, there is a good effect, a small number of adverse reactions. It is the drugs of this pharmacological group that are promising for the effective correction of premature ejaculation.
Intracavernous injections, which have gained popularity recently, significantly increase the friction period by reducing the sensitivity of nerve fibers. But, unlike drugs taken internally, an erection persists even after ejaculation, which allows a man to continue sexual intercourse, feeling more confident.
Surgical treatment of premature ejaculation is resorted to if the main cause is a short frenulum. In such cases, surgical plastic surgery of the frenulum is performed. In the absence of the effect of conservative treatment of premature ejaculation, microsurgical surgery is performed to denervate the glans penis. As a result of surgical interventions, the sensitivity threshold of the glans penis changes and a positive effect is observed in 90% of patients, with a primary increase in the duration of sexual intercourse by 2-4 minutes. The postoperative period spent in the hospital is no more than 2 days, and after the operation, complete psychological rehabilitation of patients is possible.