Premature ejaculation as the most common male sexual disorder
Who is affected by premature ejaculation?
Premature ejaculation (PE) affects 30% to 40% of men aged 18-59. The exact definition of this disorder creates great difficulties, but the characteristic feature of PE is the feeling of an affected man that he has no or almost no control over ejaculation time, which causes problems and frustration. Most often it is assumed that premature ejaculation occurs no more than 1 minute after the beginning of vaginal penetration.
Read more: Ejaculation problems
Premature ejaculation in various forms
According to the time after which the ejaculation occurs PE can be classified as:
- Mild PE, in which ejaculation occurs within 30 seconds to 1 minute after the onset of stimulation or vaginal penetration.
- Moderate PE, in which ejaculation occurs within 15–30 seconds after the onset of stimulation or vaginal penetration.
- Severe PE, in which ejaculation occurs before vaginal penetration, at the time of starting the penetration or less than 15 seconds after the onset of stimulation or vaginal penetration.
Currently, there is also a division of premature ejaculation into:
- Primary (congenital) PE, in which the problem exists since sexual initiation. The causes are neurological disorders, anatomical defects such as a short frenulum, which tightens excessively during erection and friction movements, disorders of regulation of activation of some serotonergic receptors, genetic predisposition (probably higher frequency of premature ejaculation affects men whose close relatives have this disorder).
- Secondary (acquired) PE, when premature ejaculation appears only after some time of successful sexual life. The causes may be: learned reflex of quick ejaculation, psychogenic disorders (partner relationship disorders; anxiety, e.g. associated with the fear that the partner will not be satisfied; fear of pregnancy; neurosis; depression), urogenital disorders, endocrine disorders (hyperactivity thyroid gland), neurological disorders, cardiovascular disorders.
Read more: Premature ejaculation
Diagnosis of premature ejaculation
In most cases the diagnosis of premature ejaculation is based on a thorough history of the patient. Sometimes laboratory tests are needed. When making a diagnosis four symptoms should be taken into account: time of ejaculation, inability to postpone it, suffering and humiliation due to dysfunction, deterioration of relations with the partner.
Premature Ejaculation Treatment
Oral pharmacotherapy is one way to treat premature ejaculation. Three drugs from the group of serotonin reuptake inhibitors (SSRIs) with a similar mechanism of action (paroxetine, sertraline, fluoxetine) are used, as well as clomipramine, which belongs to the group of tricyclic antidepressants. Delayed ejaculation usually occurs after 5-10 days of use. However, after stopping the medication the disorder may recur. SSRIs are also used on an ad hoc basis. Taken 4-6 hours before intercourse are effective and well tolerated. However, the prolongation of the time from the onset of penetration (the moment penis is inserted into vagina) to the beginning of ejaculation is shorter than when used daily. People who have erectile dysfunction may decide to use 5-phosphodiesterase inhibitors.
Local anesthetics (TEMPE spray, EMLA cream) are the oldest form of premature ejaculation therapy. These agents reduce the sensitivity of the penis and increase the time to ejaculation.
Behavioral therapy is also a way to treat premature ejaculation. Here training methods such as the “stop-start” technique, “squeezing” technique, “focusing on sensations” are used.
Sometimes PE treatment is limited to patient education and sexologist counseling.
Individual psychotherapy is suggested in case of people who have psychogenic factors (mood disorders, anxiety disorders) that are the source of the problem. In contrast, couples therapy is needed when patient’s relationship is to be improved.
Read more: Treatment for erectile dysfunction
Author: Mirella Stolarek