Also referred to as premature or rapid ejaculation, premature ejaculation is ejaculation that persistently or recurrently occurs within one minute of penetration during the course of partnered sexual activity. The most severe form of presentation is when ejaculation occurs before penetration can take place.
This male sexual dysfunction, which can occur along with other sexual dysfunctions such as erectile and sexual desire disturbances, is the most common and affects 20-30% of men.
However, premature ejaculation affects both the man and his partner, as it causes concern and frustration, to the point of avoiding sexual intercourse.
Causes of premature ejaculation
The causes may be psychological (bad experiences at the beginning of sexual activity or anxious personality), neurological (diseases, surgeries or trauma of the nerves that regulate ejaculation), pharmacological, hormonal (hyperthyroidism) or secondary to pathologies or surgeries of the prostate or urethra.
There is also the possibility that it has a genetic origin linked to the brain control of the release of serotonin, a fundamental neurotransmitter in the ejaculatory process. Even so, in most cases it is difficult to determine the specific cause.
How it is diagnosed
On the basis of a detailed clinical history, physical examination and the time elapsed between penetration and ejaculation (TLEI), premature ejaculation can be classified as follows:
- Mild: if the time is less than 2 minutes.
- Moderate: if the time is between 1 and 2 minutes.
- Severe: if the time is less than 1 minute
- Very severe: when ejaculation occurs before penetration.
Treatment for premature ejaculation
Many treatments have been tried throughout history, but there is still no treatment that is effective in all patients with premature ejaculation. Among the therapeutic methodologies that continue to be applied today, the following are worth mentioning:
- Psychological approach: identification of disorders that may be the cause or contribute to worsen the problem, as well as advice and application of certain exercises to delay ejaculation.
- Exercises to interrupt the ejaculatory reflex: During intercourse, the penis is compressed under the glans penis when the patient senses that he is about to ejaculate. This maneuver is repeated several times and can be performed by the patient himself, but it is advisable that the partner is the one who executes it.
- Anesthetic solution for penile skin spraying: Three-level spraying of the penis with anesthetic drugs (Lidocaine, Prilocaine) to reduce the sensitivity of the organ. It is applied before initiating sexual activity.
- Oral drugs (Serotonin reuptake inhibitors – SSRIs): They favor the increase of serotonin levels, which allows cerebral control of ejaculation. These drugs are effective for the treatment of depression, having as a side effect the delay of ejaculation. The only oral drug approved by the health authorities for the treatment of premature ejaculation is Dapoxetine. It is also an SSRI, but with greater specificity on sexual function and is applied between 1 and 3 hours prior to the desire for sexual activity.
- Neurotomy: When all the treatments tried have failed and premature ejaculation causes significant disorders for the patient and his partner, a surgical treatment can be tried which consists of severing small nerves on the dorsum of the penis in order to try to reduce the sensitivity of the organ.
Any of the treatments tried aims to try to delay ejaculation for a certain period of time, never less than 2-4 months. When treatment is discontinued, ejaculatory delay may persist or the problem may reappear.
The ideal situation would be to achieve control to ejaculate at the desired time, although in most successful cases the patient must be satisfied with delaying ejaculation for a few minutes. Currently, the most successful treatment is that which combines drugs and psychological help.