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Premature ejaculation is an ejaculation disorder and accounts for 25-60% of all forms of functional sexual disorders in men. Premature ejaculation is not considered an organic disorder, it is a sexual dysfunction that consists of an inability to control ejaculation sufficiently to achieve sexual satisfaction during coitus by both partners. According to the WHO, the problem of premature ejaculation is faced by at least 40% of men of all ages worldwide. Different authors consider the time factor (duration of intercourse less than 1-2 minutes) or the number of frictions (less than 8-15) to be the criteria for premature ejaculation.
The problem of premature ejaculation
The problem of premature ejaculation is mostly a social problem, because from the medical point of view there are no organic changes and no obvious reasons for it. There is no unified standard for the duration of intercourse, but the average duration of friction varies 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 the false opinion that there is a problem of premature ejaculation and short intercourse, which in turn has an adverse effect on the family relationship, reduces the self-esteem of both partners and often leads to family breakdown.
Premature ejaculation is considered if ejaculation regularly occurs before both partners have 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 pathological. Many people mistake an inability to have a vaginal orgasm or anorgasmia in women for premature ejaculation, because the friction period, which often lasts more than 20 minutes, is not enough to satisfy the partner.
That is, in medical terms, premature ejaculation is a frequently repeated ejaculation after minimal sexual stimulation before or after the insertion of the penis into the vagina. The notion that uncontrolled ejaculation is premature is incorrect, in addition, it causes serious and intractable psychological problems.
Causes of premature ejaculation
To date, numerous studies in the field of andrology prove that most premature ejaculation is psychogenic in nature and refers to a psychogenic form of premature ejaculation. Lack of sexual experience and theoretical knowledge at the time of the beginning of sexual life, combined with false accounts of sexual experience from peers later form a persistent failure syndrome. This is because a single failed intercourse in the development of phobias leads to the repetition of the scenario. Psychophysical reasons for the development of repeated premature ejaculation lie in the formation of a reflex arc, which after formation contributes to premature ejaculation, subsequently developing secondary phenomena of colliculitis (inflammation of the seminal tubercle).
Inflammatory diseases of the genital appendages especially in the absence of treatment and the accession of psychogenic factors can form a persistent syndrome of premature ejaculation. Thus, in colliculitis of inflammatory or hypertrophic nature in the seminal tubercle increases blood supply, which is especially evident at the time of intercourse. This increases the ascending nerve impulses and in response to irritation of the central nervous system orgasm and premature ejaculation occur. If left untreated, irritation of this area intensifies, resulting in a loss of quality of the orgasm itself, and frequent premature ejaculation is formed. Often the prostate gland is also involved in the inflammatory process, or first there is inflammation of the prostate, which later passes to the seminal mound as well. Therefore, when correcting premature ejaculation, it is important to carry out anti-inflammatory therapy of all the appendages of the sex glands.
With neurological changes that are accompanied by hypersensitivity of the penile head, the number of receptors in the neural arch increases, resulting in premature ejaculation. Short frenulum as a cause of premature ejaculation is practically not considered, because after frenulum plastic surgery, sexual life comes back to normal.
Diagnosis and treatment of premature ejaculation
In addition to subjective data based on the interview of the patient, the andrologist conducts a number of tests, including a test with lidocaine and a condom. It is also necessary to examine for the presence of inflammatory diseases of the urogenital sphere, which may have caused sexual dysfunction. And after a comprehensive examination, a course of procedures is prescribed on an individual basis to correct.
Inflammatory diseases of the genital appendages especially in the absence of treatment and the accession of psychogenic factors can form a persistent syndrome of premature ejaculation. Thus, in colliculitis of inflammatory or hypertrophic nature in the seminal tubercle increases blood supply, which is especially evident at the time of intercourse. This increases the ascending nerve impulses and in response to irritation of the central nervous system orgasm and premature ejaculation occur. If left untreated, irritation of this area intensifies, resulting in a loss of quality of the orgasm itself, and frequent premature ejaculation is formed. Often the prostate gland is also involved in the inflammatory process, or first there is inflammation of the prostate, which later passes to the seminal mound as well. Therefore, when correcting premature ejaculation, it is important to carry out anti-inflammatory therapy of all the appendages of the sex glands.
With neurological changes that are accompanied by hypersensitivity of the penile head, the number of receptors in the neural arch increases, resulting in premature ejaculation. Short frenulum as a cause of premature ejaculation is practically not considered, because after frenulum plastic surgery, sexual life comes back to normal.
Diagnosis and treatment of premature ejaculation
In addition to subjective data based on the interview of the patient, the andrologist conducts a number of tests, including a test with lidocaine and a condom. It is also necessary to examine for the presence of inflammatory diseases of the urogenital sphere, which may have caused sexual dysfunction. And after a comprehensive examination, individually prescribed course of procedures for the correction of sexual dysfunction. The aim of treatment is to restore the normal duration of sexual intercourse and remove the psychologically conditioned failure syndrome.
All patients Total Ejaculation Control information course to learn how to control ejaculation. Sexopathologists agree that with premature ejaculation of a psychogenic nature, psychotherapy is sufficient to successfully form the recognition of pre-orgasmic sensations. However, the effect of psychotherapy is observed only with the conscious and adequate participation of the permanent partner. The method of "stop-start" for a period of 2 to 10 weeks, begins to give results, but for their consolidation requires at least 2-3 months after the end of the procedure. In this case, the effectiveness depends largely on the patience of both partners and the absence of negative emotions at the time of sexual intimacy.
Stopping or slowing down friction movements simultaneously with conscious relaxation of muscles at the moment of approaching orgasm allows to continue sexual intercourse, besides constant training strengthens pelvic floor muscles, which additionally helps to achieve full control of ejaculation and solve the problem of premature ejaculation. In this treatment will only be effective if you have a constant partner who is not indifferent to the problems of a man and a positive attitude, along with a stock of patience and perseverance.
Drug treatment of premature ejaculation is shown in inflammatory processes in the prostate gland and the seminal tubercle, as well as with hypersensitivity of the penis head. To reduce sensitivity, an ointment with lidocaine or anesthesin is used, with the use of a condom recommended. The drug is applied 10-15 minutes before intercourse on the frenulum area, so as not to allow the loss of sensitivity completely and not to cause an ejaculation. This method can only be used in the presence of a permanent partner, as it involves psychological and physical discomfort during preparation for coitus, but when using ointments, a good clinical effect is achieved and a minimum of adverse reactions is observed.
Drugs from other pharmacological groups can also be used to correct premature ejaculation due to their selective effect on regulatory mechanisms. However, none of the pharmacological groups has been widely used for the treatment of premature ejaculation.