Although premature ejaculation is a common sexual disorder, Hardly a man likes to talk about it. Premature ejaculation can be very stressful mentally – not only for the affected man, but for both partners, It can affect so much the partnership.
Premature ejaculation affects many men, but there are different indications. It is estimated that every fourth to fifth man could suffer from premature ejaculation.
Few sufferers seek out a doctor advice, although the level of suffering can be very high. Often the shame to describe the problem with the doctor, simply too big. Thus, the taboo topic “premature ejaculation” often remains unspoken – there are many therapeutic approaches to get a premature ejaculation under control.
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The exact cause of premature ejaculation has not been consistently clarified. Older theories assume a mental disorder or assume that premature ejaculation results from certain behaviors (such as early sexual experiences). Meanwhile, one suspects the cause of an early ejaculation in an imbalance of certain messenger substances of the nervous system , which are involved in the release of orgasm .
While premature ejaculation does not cause physical harm, it often causes psychological distress. The therapy of premature ejaculation involves various approaches, ranging from psychotherapeutic methods through manual ways that control arousal and ejaculation, to taking medications.
Many men manage to control premature ejaculation in this way. However, such methods are only necessary if the man suffers from premature ejaculation . From a medical point of view, there is no reason for treatment in most cases.
What’s Premature Ejaculation ?
There is no uniform definition for premature ejaculation (Ejaculatio praecox). Usually one speaks of premature ejaculation, if the man can not control the time of ejaculation and the orgasm reflex is triggered earlier than desired. Ejaculation occurs before or for up to one minute after penetrating the vagina of the woman ( penetration ). Most definitions of premature ejaculation take into account three key aspects :
- the short duration from vaginal penetration to ejaculation
- the loss of voluntary ejaculation control
- the suffering of the person or the partner
In men with premature ejaculation, more than three-quarters of the ejaculation occurs before or during penetration of the partner’s vagina. Premature ejaculation after penetration is when the time between penetration into the vagina until ejaculation occurs is shorter than the man would like.
It should be remembered that this period is subject to a subjective feeling and is often overestimated. Unaffected men, on average, take 5.4 minutes to reach climax. In men who suffer from premature ejaculation, this so-called latency (intravaginal ejaculation time) is less than one to two minutes in most cases. In some cases, even the thought of a sexual act is sufficient for premature ejaculation to occur.
In some definitions of premature ejaculation, the satisfaction of women also plays a role. Accordingly, premature ejaculation occurs when the man fails to control his ejaculation so that sexual intercourse is satisfactory for both partners. However, the duration of sexual intercourse, so that both partners are satisfied, is individually very different.
Other possible names for premature ejaculation include, for example, early ejaculation , premature ejaculation or premature orgasm . The Latin name is Ejaculatio praecox.
In premature ejaculation, one can distinguish between innate (primary) and acquired (secondary) form . The innate form may be due to physical disorders . The secondary form is more due to mental causes . The acquired disorder is often associated with erectile dysfunction. It can also arise as a result of a reduced sexual desire (loss of appetite).
The data on the frequency of premature ejaculation (Ejaculatio praecox) vary – However, experts assume that about every fourth to fifth man suffering from premature ejaculation. This is the man’s most common sexual disorder . Premature ejaculation can occur in men from puberty at any age.
Premature ejaculation is a psychological burden for many men and their partners. Nevertheless, only a few affected people seek medical attention.
Premature ejaculation (premature ejaculation, ejaculatio praecox) can be innate , that is, since the beginning of the first sexual experience in puberty, or occur later in the course of life (acquired form). The innate form can be based on physical disorders, the acquired form is based more on psychological causes. The latter often occurs at the same time as an erectile dysfunction or arises as a result of reduced sexual desire (so-called loss of appetite).
Many men manage to control premature ejaculation. Often, frequent masturbationhelps to reduce the excitability of sexual stimuli and improve body awareness. It is also helpful to speak openly with the partner. Even if the man himself feels that he comes too early to orgasm , it may well be that this does not bother his partner.
Premature ejaculation can have various causes that have not been sufficiently clarified so far. In addition to psychological causes , researchers also discuss neurophysiological reasons , that is, causes that lie in the transmission of signals between the nerve cells.
Various factors can promote premature ejaculation. These include, for example, erectile dysfunction disease (or impotence), which can occur as a separate sexual disorder or at the same time as premature ejaculation.
Also, how often a man has intercourse affects how well he can control the timing of ejaculation. Sexologists assume that irregular intercourse can promote premature ejaculation . Even sexual inexperience can promote premature ejaculation.
Possible psychological causes of premature ejaculation may include early childhood sexual disorders, impaired sex education, sexual performance thinking and unrealistic notions of sexuality and fear of failure. In addition, anxiety disorders may also be associated with premature ejaculation. However, it is not clear whether they are a consequence or cause of premature ejaculation. For example, the fear of premature ejaculation can significantly affect the sexual intercourse of a couple.
Also, physical conditions such as urinary tract infections and diabetes mellitus can cause premature ejaculation, as well as side effects of various drugs. These include certain painkillers (opiates) and drugs that affect the sympathetic, a part of the autonomic nervous system (sympathomimetics).
Some men with premature ejaculation experience erectile dysfunction. The therapy in this case is aimed primarily at the treatment of erectile dysfunction.
Various messenger substances in the brain (neurotransmitters) influence ejaculation. At the release of ejaculation, the messenger serotonin is involved. Increased serotonin levels in the brain may increase the time to ejaculation. Therefore, in the treatment of premature ejaculation drugs are used, which act on the Serotinonhaushalt in the brain.
Signs & Symptoms
Premature ejaculation is characterized by the following symptoms:
- The ejaculation occurs before, during or very shortly after the penetration (less than one to two minutes) in the woman.
- The man is unable to control the timing of his ejaculation.
Premature ejaculation usually becomes a problem only when it occurs in the majority of sexual contacts and one of two partners finds the sexual act unsatisfactory.
Unaffected men need an average of 5.4 minutes to reach climax. In men who are affected by premature ejaculation, the time between getting into the woman and ejaculation is usually less than 1 to 2 minutes.
Only a few men who are affected by premature ejaculation seek medical treatment.
The right person to contact can be a urologist. So that the doctor can make the diagnosis , he will first ask the man some questions, such as:
- for sexual development,
- to sexual experiences that the man has made and
- the course of the sexual reaction in the person affected.
In addition, the doctor determines if fear of premature orgasm is a potential cause . In many cases, the medical history can already say a lot about the cause of premature ejaculation, because it provides insight into the victim’s inner attitude and can show how he experiences his orgasm. These factors are particularly important in terms of therapy.
Usually, the doctor will diagnose premature ejaculation if there is less than two minutes between the insertion of the penis into the vagina and the ejaculation , the man can not control the time of ejaculation, and the partnership is impaired.
Premature ejaculation does not necessarily require treatment from a medical point of view, for example if the person affected and his partner do not suffer from it. However, when the suffering is great, treatment can be helpful. Depending on the cause , the treatment of premature ejaculation may be based on physical, medicinal or psychotherapeutic therapeutic approaches.
In some men with premature ejaculation, frequent masturbation or an orgasm preceding sexual intercourse may delay ejaculation. Using techniques such as the Stop-Start method and the Squeeze method , sufferers can also learn how to better perceive and control the timing of ejaculation.
If psychotherapy and manual techniques do not provide sufficient success in case of premature ejaculation, medical therapy may be useful.
Serotonin reuptake inhibitors (SSRIs) act on messenger substances in the brain . Doctors use them primarily for the treatment of depression , but they can also delay the ejaculation reflex and thus the timing of ejaculation. Serotonin reuptake inhibitors that produce the desired effect include the so-called long-acting SSRIs fluoxetine , sertraline and paroxetine, and the short-acting dapoxetine .
However, with the exception of dapoxetine, these agents are not expressly intended for the treatment of premature ejaculation. Nevertheless, they are sometimes used because of their effectiveness (ie they are used off label). The long-acting selective serotonin reuptake inhibitor of the person concerned must take each day over a longer period of time to achieve the desired effect beyond.
Since mid-2009, dapoxetine has been on the market, a drug that is specifically approved for the treatment of premature ejaculation and can delay ejaculation. Dapoxetine should usually be taken on-demand only about one to three hours before sexual intercourse. The active ingredient dapoxetine is fast acting and is promptly eliminated from the circulation. Dapoxetine is a prescription and should not be taken more than once a day . The statutory health insurance companies usually do not cover the costs.
So-called phosphodiesterase-5 inhibitors (PDE-5 inhibitors) are primarily intended for the treatment of erectile dysfunction . The active ingredient sildenafil may also delay the ejaculation in addition.
Also, special OTC numbing creams and gels containing a local anesthetic (such as Emla Cream) are sometimes used for premature ejaculation. The man applies to the means before sexual intercourse on the glans, which thus becomes less sensitive. However, these remedies can not only delay ejaculation, but also reduce the partner’s excitability. Therefore, it is recommended to use condoms in conjunction with these products.
Treatment with medication may delay ejaculation, but the cause of premature ejaculation can not be treated by drugs . The therapy relieves the symptoms in this case (so-called symptomatic therapy).
In the congenital form of premature ejaculation, the drugs at the point of origin of the sexual disorder – directly in the nervous system metabolism – and thus counteract the physical cause.
Psychotherapeutic treatment for premature ejaculation includes the following procedures:
- sex therapy
- behavior therapy
- Couples therapy or family therapy
It is advantageous if the partner also participates in the therapy.
Psychotherapy can be used to reduce anxiety and break the vicious circle between anxiety and premature ejaculation. In addition, the therapy may aim to change patterns of thinking and behavior or reduce sexual performance .
Manually Delay Ejaculation
There are some ways men can manually delay their ejaculation .
Through the stop-start method, the man should learn to control his arousal better and thus delay the ejaculation . To do this, the man masturbates and stops just before the critical threshold (the inevitability point), until the excitement subsides. Then he starts again with the masturbation . He repeats this process until he can better control the timing of ejaculation.
The so-called squeeze method is a continuation of the stop-start exercise and also serves to delay the time of ejaculation . On the one hand, the man interrupts the sexual act shortly before the climax in order to more accurately perceive the time of unwanted ejaculation and to be able to influence it better in the episode. In addition, he exerts pressure on the penis in the area of the glans with his thumb . The aim is to reduce the amount of blood in the penis and to interrupt the ejaculation reflex, so as to delay the ejaculation.
Frequently, an open conversation can also be helpful and considerably reduce the mental pressure – and thus increase the chance of a fulfilling love life!
Above all, it is important that you do not put yourself under pressure , because sexual pressure to perform can increase the problem. Some men can prevent a premature ejaculation by masturbating before the actual sexual act and thus reduce the excitability.