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Premature ejaculation Causes, Symptoms and Treatment

The ejaculation early or premature is, with erectile dysfunction (= erectile dysfunction), disorder of the most frequent male sexuality. Its causes are varied: they can be psychological, behavioral, neurobiological or genetic.

While definitions vary across countries and medical societies, they all agree on three points. Premature ejaculation results in:

  • an ejaculation that occurs too quickly, before the man or his partner wish and that, consistently or very often;
  • an inability to “hold” or control ejaculation;
  • The psychological impact negative.
It should be noted, however, that premature ejaculation, during first sexual intercourse or a new relationship, is normal . It becomes problematic only if it persists and constitutes a real embarrassment.

We distinguish :

  • The ejaculation early primary that is present in each report, with different partners throughout life.
  • The ejaculation early secondary or acquired appears as it was not present in previous sex. It is usually associated with an underlying disease such as prostatitis, an erectile or neurological disorder, or a psychological problem.

Who is affected by premature ejaculation?

According to many studies, premature ejaculation affects 20 to 30% of men.

However, it is difficult to obtain precise figures, especially since the diagnostic definition has long remained vague. On the other hand, very few men who consider themselves affected by this disorder consult a doctor for this reason.

According to the ISSM (International Society of Sexual Medicine), the prevalence of premature ejaculation would vary between 3 and 30% depending on the studies.

Causes of premature ejaculation

It is now known that premature ejaculation, which has long been considered a purely psychological disorder, is also linked to neurobiological disorders and / or genetic susceptibility.

The exact causes are however unknown.

Several biological factors could promote this disorder, including:

  • hypersensitivity of the glans,
  • a hyper-excitability of the ejaculation reflex,
  • disorders of the transmission of nerve messages in the brain or hypersensitivity of certain nerve receptors (in particular serotonin receptors),
  • inflammation of the prostate (chronic prostatitis),
  • abnormalities of the thyroid gland (hyperthyroidism),
  • A neurological disease, such as multiple sclerosis.

To date, no large-scale study has clearly demonstrated the role of any of these neurobiological causes.

It is clear that certain psychological and environmental factors also have a role to play.

Evolution and possible complications

Premature ejaculation is not a disease in itself. It is a problem that only becomes problematic if it is a source of discomfort, discomfort or distress for the person who complains or for his partner.

Thus, the psychological consequences of premature ejaculation can be very negative, for the subject as for the couple. Men who suffer from it can develop symptoms of depression, anxiety, or even fall back on themselves by avoiding any romantic or sexual relationship.

That’s why it’s important to talk about it, especially as solutions exist, whether medical or not.

SYMPTOMS of  Premature ejaculation

In 2009, the International Society of Sexual Medicine (ISSM) published recommendations for the diagnosis and treatment of premature ejaculation .

According to these recommendations, premature ejaculation has symptoms:

  • Ejaculation occurs always or almost always before intravaginal penetration or within one minute after penetration
  • there is an inability to delay ejaculation during each or almost every vaginal intercourse
  • This situation has negative consequences, such as distress, frustration, embarrassment and / or avoidance of sexual relations.

According to the ISSM, there is insufficient scientific evidence to extend this definition to non-heterosexual sex or intercourse without vaginal intercourse.

Several studies show that among men suffering from permanent premature ejaculation:

  • 90% ejaculate in less than a minute (and 30 to 40% in less than 15 seconds),
  • 10% ejaculate between one and three minutes after penetration.

Finally, according to the ISSM, 5% of these men ejaculate involuntarily even before penetration.

People at risk for Premature ejaculation

Risk factors for premature ejaculation are not well known.
Unlike erectile dysfunction, premature ejaculation does not increase with age. On the contrary, it tends to diminish with time and experience. It is more common among young men and at the beginning of a relationship with a new partner.

Risk factors

Several factors can promote premature ejaculation:

  • anxiety (including performance anxiety),
  • having a new partner,
  • low sexual activity (infrequent),
  • The withdrawal or abuse of certain drugs or drugs (including opiates, amphetamines, dopaminergic drugs, etc.),
  • Alcohol abuse.

Prevention and medical treatments of premature ejaculation

Can we prevent premature ejaculation?
Often, when premature ejaculation is transient or not important, the treatment is based primarily on psychosexual counseling. Thus, several measures or techniques can help delay the time of ejaculation, including:

  • bring the partner to stimulate the penis until ejaculation is imminent, then pause to relieve the excitement before continuing
  • Apply manual pressure to the base of the glans during the report (“squeeze”), when the signs of ejaculation are felt. It is advisable to press the glans between thumb and forefinger (thumb placed on the brake) for 2 or 3 seconds so as to stop the ejaculation reflex.

These “exercises” must be repeated several times in order to manage to hold about twenty minutes without ejaculating. Little by little, they will better control ejaculation.

Medical treatments for premature ejaculation

The recent recommendations of the International Society of Sexual Medicine advocate a combined management combining, if necessary:

  • pharmacological treatment
  • A psychosexual intervention.

Pharmacological treatment of premature ejaculation

The arrival on the European market in 2013 of the first drug specifically to treat premature ejaculation, dapoxetine , has changed the management of this disorder.

Dapoxetine belongs to the class of selective serotonin reuptake inhibitors (SSRIs). It is marketed under the name Priligy for the treatment of premature ejaculation in men aged 18 to 64, since the end of March 2013 in France and in 25 countries.

In North America, dapoxetine has not been approved yet.

Dapoxetine is not considered an antidepressant because it is quickly eliminated by the body: there is no trace of the drug in the blood about twenty hours after taking.
Thus, it acts quickly (one or two hours after taking). It allows, according to clinical studies, to increase by about 3 the time between penetration and ejaculation, after a treatment period of 12 weeks. Note, however, that taking a placebo tablet also increased, according to these trials, this delay by a factor of 1.5 to 2.

In France, dapoxetine exists in two dosages (30 and 60 mg), in tablet form to be taken on demand, 1 to 3 hours before sexual activity.

The treatment is issued on medical prescription and is not covered by the Health Insurance. The most common side effects are nausea, headache, diarrhea and dizziness.

Note  : It has long been known that selective serotonin reuptake inhibitors, which are a widely used class of antidepressants, have the effect of delaying ejaculation. Until dapoxetine is on the market (and probably still today, especially where dapoxetine is not available), the various drugs in this class are often prescribed to men with premature ejaculation, but Marketing Authorization (AMM), that is, in a context different from that recommended by the manufacturer and the health authorities.

IRSS other than dapoxetine (paroxetine, clomipramine, sertraline and fluoxetine in particular) are all relatively effective against premature ejaculation.
Finally, other molecules, such as phosphodiesterase 5 (IPDE5) inhibitors, used in the treatment of erectile dysfunction, may have some efficacy in the treatment of premature ejaculation.

Local treatment of premature ejaculation

Highly used, apart from official prescription authorizations, the application of a local anesthetic on the glans helps to delay ejaculation by “numbing” the penis.

The products used are generally based on lidocaine , gel or spray. To avoid numbing the partner, the anesthetic can be applied for about twenty minutes and then washed out with water before the report. In 2010, a spray combining lidocaine and prilocaine, to be applied 5 minutes before sexual intercourse, showed good efficacy in delaying ejaculation. It could be commercialized shortly.

Psychosexual care

A follow-up in sexotherapy or psychotherapy is also advised, especially when the psychological consequences of premature ejaculation are important, that there is a strong anxiety of performance or a problem of couple.

The French Association of Urology advises a behavioral therapy which consists in practicing a voluntarily interrupted sexual activity, “before the occurrence of the anxiety of result”. After several weeks, it becomes easier to feel the arrival at a point of no return before ejaculation, which allows a better control.

The effectiveness of these measures, however, is unpredictable.

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