Premature ejaculation is a violation of ejaculation and accounts for 25-60% of all forms of functional sexual disorders in men. PE is not considered an organic disease, it is sexual dysfunction, which is the inability to control ejaculation sufficiently to achieve sexual satisfaction during coitus with both partners.
According to WHO, the problem of PE is faced by at least 40% of men of different ages throughout the world. Different authors consider the time factor for the criteria of PE (the duration of sexual intercourse is less than 1-2 minutes) or the number of frictions (less than 8-15)
The problem of premature ejaculation (PE)
This problem 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 single norm for the duration of sexual intercourse, but the average length of the period of friction varies from 2 to 10 minutes, depending on the characteristics of the organism, the situation during coitus, and the period of abstinence.
However, the subjective opinion of men can cause a false opinion about the problem of PE and short 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.
it is considered if ejaculation occurs regularly earlier than both of the partners received sexual satisfaction, provided that the frictional period was less than 2 minutes. With a long period of foreplay and strong sexual arousal, especially after significant abstinence, ejaculation may occur before genital contact, which is not considered pathology.
Many people take the impossibility of getting vaginal orgasm or anorgasmia in women for PE, since the frictional period, often lasting more than 20 minutes, is not enough to satisfy the partner.
That is, from the medical point of view, premature ejaculation is often repeated ejaculation after minimal sexual stimulation before or after the introduction of the penis into the vagina. The view that uncontrolled ejaculation is premature is wrong, besides, it gives rise to serious and intractable psychological problems
Causes of premature ejaculation
To date, numerous studies in the field of andrology prove that most PE is of a psychogenic nature and refers to a psychogenic form of PE. Lack of sexual experience and theoretical knowledge at the time of the onset of sexual activity, coupled with false reviews of sexual experiences among peers, subsequently form a persistent failure syndrome.
Because once happened unsuccessful sexual intercourse in the development of phobias leads to a repeat of the script. Psychophysical reasons for the development of recurring premature ejaculations lie in the formation of a reflex arc, which, after formation, contributes to PE, and later develop the secondary phenomena of colliculitis (inflammation of the seminal tubercle).
Inflammatory diseases of the appendages of the gonads, especially in the absence of treatment and the addition of psychogenic factors, can form a persistent syndrome of PE.
So, with colliculitis of inflammatory or hypertrophic nature in the seminal mound blood supply is increased, which is especially evident at the moment of sexual intercourse. This enhances the ascending nerve impulses and, in response to irritation of the central nervous system, orgasm and PE occur.
In the absence of treatment, the irritation of this zone increases, resulting in the loss of the quality of the orgasm itself, and frequent premature ejaculations are formed. Often the prostate gland is involved in the inflammatory process, or at first, the inflammation of the prostate is observed, which later passes to the seed hillock. Therefore, when correcting PE, it is important to carry out anti-inflammatory therapy of all the appendages of the gonads.
With neurological changes that are accompanied by hypersensitivity of the glans penis, the number of receptors in the nerve arc increases, resulting in PE. A short frenum, as the cause of PE, is practically not considered, since after a plastic frenulum, sexual life comes back to normal.
Diagnosis and treatment of premature ejaculation
In addition to subjective data based on the patient's questioning, the andrologist performs a series of tests, including a sample with lidocaine and a condom. It is also necessary to conduct a test for the presence of inflammatory diseases in the urogenital sphere, which could cause sexual dysfunction.
And after a comprehensive examination, a course of procedures for correcting sexual dysfunction is assigned on an individual basis. In this case, the goal of treatment is to restore the normal duration of sexual intercourse and remove the psychologically caused failure syndrome.
All patients undergo a psychotherapeutic course on teaching methods of controlling ejaculation. Doctors-sexologists agree that PE of a psychogenic nature is enough for psychotherapy, 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" method for a period of 2 to 10 weeks begins to give its results, but for their consolidation, it takes at least 2-3 months after the end of the procedures.
At the same time, efficiency largely depends on the patience of both partners and on the absence of negative emotions at the time of sexual intimacy.
The termination or slowing down of frictional movements at the same time as conscious relaxation of the muscles at the moment of approaching orgasm allows you to continue the sexual act, besides constant training strengthens the muscles of the pelvic floor, which additionally helps to achieve complete control over ejaculation and solve the problem of PE.
In this case, treatment will be effective only if there is a constant partner, who is not indifferent to the problems of a man and has a positive attitude, together with a reserve of patience and perseverance.
Drug 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 the sensitivity of using an ointment with lidocaine or anesthesin, it is recommended to use a condom. The drug is applied 10-15 minutes before the sexual act on the bridle area, in order to prevent the loss of sensitivity completely and not cause an ejaculation.
This method can be used only in the presence of a permanent partner since 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.
Preparations from other pharmacological groups due to the selective effect on the mechanisms of regulation can also be used to correct PE. But however, no pharmacological group of drugs has been widely used.
So, neuroleptics block dopamine receptors at the central level. The effectiveness of tranquilizers in correcting PE directly depends on the dose, but ejaculation is rather inhibited than controlled. In addition, when the dose is raised, a sedative effect occurs, which is not always appropriate at the time of sexual intercourse.
With the use of alpha-adrenoblockers, inhibition of the ejaculatory reflex occurs due to an effect on the sympathetic link. But, despite this, while maintaining control over PE and maintaining orgasm, the drugs are not widely used because of frequent retrograde ejaculation, when seminal fluid is thrown into the bladder, as its valve does not close.
Premature ejaculation can be inhibited by tricyclic antidepressants, although these drugs are dose-dependent and their efficacy is not more than 15%, which, together with many side effects, has not given antidepressants a wide circulation in the treatment of PE.
The most popular drugs for the correction of premature ejaculation are antidepressants, which increase the serotonin level due to selective blockade of its reuptake. This fluoxetine, sertraline, and other; when taking drugs, there is a good effect and 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 frictional period by lowering the sensitivity of nerve fibers. But, unlike the drugs taken inside, the erection remains after ejaculation, which allows the man to continue the sexual act, feeling more confident.
The surgical treatment of premature ejaculation resorted if the main cause is a short frenum. In such cases, the surgical plastic of the bridle is performed. In the absence of the effect of conservative treatment of premature ejaculation, a microsurgical operation is performed to denervation the glans penis. As a result of surgical interventions.
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