Premature ejaculation: Causes and treatment

Premature ejaculation – During the physiological sexual response of a man, ejaculation is certainly the most complex “phase”. In general , ejaculation disorders  can be classified as due to hyperexcitability or related to a production or expulsion deficit. The most common problems belong to the first category and  premature ejaculation is the best known and most frequent clinical example.

Premature ejaculation
Premature ejaculation

The causes of premature ejaculation can be different: psychological, urological, for example from pathological stimuli related to irritative or inflammatory lesions of the prostatic urethra or seminal vesicles, neurological from excessive peripheral stimulation or decreased inhibition of the central nervous system.

As already mentioned,  premature ejaculation is considered the most frequent male sexual disorder; in an epidemiological survey, carried out a few years ago, in which 1500 random couples were interviewed, that is, not “selected”, it emerged that this problem was present in about 20.7% of men. In a more recent US epidemiological study it was even estimated that about 40% of men under the age of forty complained of this sexual disorder.

The causes of premature ejaculation

Premature ejaculation has been “historically” considered as a sexual disorder caused above all by psychological problems, however, according to more recent neurophysiological and urological findings, it has been seen that this dysfunction can be triggered by precise alterations of an organic nature .

Neurological investigations , such as sacral evoked potentials, showed that the magnitude of the electromyographic response, at the level of the perineal plane, was significantly more important in men who complain of this sexual disorder.

Other causes, often underestimated, are the  presence of irritative or inflammatory lesions of the uroseminal tracts , in particular of the prostatic urethra. Precise and targeted culture tests on urine, prostate secretion and seminal fluid can constitute a decisive diagnostic element, especially in non-primary premature ejaculations, i.e. those that appear after a period of time in which the man had never complained of this sexual problem.

Premature Ejaculation Therapies

Until a few years ago the therapy, in the presence of an ejaculation premature, it was pretty much focused towards  interventions psychological or, in some cases, was also shown psychoanalysis;  today, in addition to the newest sexual therapies, consisting of integrated behavioral techniques, some pharmacological perspectives also find an important space.

Previously, drugs that reduced the control of the autonomic nervous system  had already been used in the treatment of this sexual disorder and among these we remember the tricyclic antidepressants and phenothiazines, which act by controlling the sympathetic nervous system and therefore slow down the first phase of ejaculation. Some alpha-lytic drugs have also been used, these act through a mechanism that blocks the adrenergic receptors in the smooth muscle of the genito- sexual system and block their contractions. 

On the pharmacological side, then in recent years the use of a new molecule has been proposed, the only one to have an indication in the treatment of this disorder:  Dapoxetine ; this is a substance that always acts at the level of the central nervous system by raising the levels of serotonin , an important “natural brake” of ejaculation. This drug is taken as needed, ie at least one hour before intercourse; the side effects reported seem to be minimal and limited to occasional nausea and sudden drops in blood pressure.

The use of a dedicated anesthetic spray  (based on lidocaine and prilocaine) to put on the glans  has recently been added to these pharmacological strategies ;  in this case one must be careful to allow an appropriate time to pass before intercourse, to avoid that the partner is also anesthetized.

Premature ejaculation: the role of the partner

Today, it is not surprising that in a culture like ours, premature ejaculation is an ever-increasing problem. The andrologist who deals with these sexual problems often observes how the difficulty in ejaculatory control is associated with the presence of anxiety , stress and all this often creates a vicious circle of the type: premature ejaculation, anxious performance and again  Premature Ejaculation and so on. up to in some cases to have then also a fall of desire and a disturbance of the erection.

At the beginning, the partner shows understanding and also gives psychological support  to the premature ejaculator and this attitude can help, in some cases, to resolve the symptom: the man becomes confident and familiar with his partner and thus gets to improve significantly the quality and timing of his relationship. However, if the problem persists and the woman is continually left in a frustrated situation, her initial encouragement often turns into aggression.  On the other hand, this has negative effects for humans, such as the increase in anxiety and its feeling of inadequacy.

Psychotherapeutic treatment for premature ejaculation

We know that the treatment of this dysfunction has for some time involved the use of empirical techniques, aimed at decreasing the level of arousal and sexual sensations. These techniques included  using condoms , applying ointments or anesthetic substances, advising them to focus on other thoughts and not on their own sexual activity.

The introduction of the use of drugs that moderate the sympathetic nervous system, responsible for the ejaculatory event, was certainly useful, if supported also by other psychotherapeutic strategies; among these those considered most effective are:

  • the compression technique proposed by sexologists Masters and Johnson, that is to squeeze the glans between thumb and forefinger before ejaculation;
  • the quite similar technique, called ” stop-start “, first identified by the urologist Semans and later re-evaluated by the sexologist Helen Kaplan.

These techniques essentially require the man to achieve an erection; at this point he lies on his back and tries to concentrate on the sensations he feels while being stimulated; when she feels close to orgasmic pleasure, she has to tell her partner to stop. When the “ejaculatory urgency” ceases, the man again invites the partner to resume the stimulation and then stop again when an excessive “intensity of pleasure” reappears; this process is repeated four or five times. 

Finally, in the presence of an organic cause (inflammatory or neurological), therapy must always be aimed at solving these clinical problems and therefore it is necessary in these cases to use both antibiotics, anti-inflammatory or alpha-lytic drugs.

Dr. Ashwani Kumar is highly skilled and experienced in treating major and minor general medicine diseases.