What is premature ejaculation
Premature ejaculation is when sexual intercourse lasts less than desired. In this rather vague definition, not a word is mentioned about the norm, simply because there is no such concept for the duration of sexual intercourse.
Of course, there are extreme cases when ejaculation occurs before the penis is inserted into the vagina - everything is clear here. But in the vast majority of cases this concept is individual.
With the average duration of sexual intercourse (with continuous friction) from 2 to 5 minutes , I had patients with a duration of 6-8 minutes who wanted to increase it to 15-20 minutes! That is, we can say that premature ejaculation is not a disease, but an individual feeling of a man, his desire to improve his sex life and make it more intense.
Premature ejaculation is a problem that worries many men who are practically healthy, but who want to improve what nature has given them. And why not, because with the modern level of development of medical technologies and aesthetic surgery, it is not only absolutely safe, but also accessible to everyone!
Premature ejaculation in men is a fairly common problem, especially among young men. According to Prof. N.D. Akhvlediani is encountered by 25-30% of young men . The actual prevalence may be even higher, since many men “hush up” this problem, preferring to put up with the inconvenience or treat themselves, based on advertising or the advice of “experienced” friends.
And some are not at all aware of the existing possibilities of medicine in increasing the duration of sexual intercourse. In this article you will find a lot of useful information that will help you make the right choice.
How common are ejaculation disorders in men?
Ejaculation disorders are divided into:
- premature ejaculation;
- difficult ejaculation;
- lack of ejaculation;
- reverse (retrograde) ejaculation (so-called dry intercourse);
- painful ejaculation.
Retrograde ejaculation
Men usually see a urologist for treatment of premature ejaculation, but other disorders are much less common. According to the literature, 15-20% complain of premature ejaculation. men. This disorder negatively affects the relationship between two partners as it causes sexual disharmony. If a man's sperm is released prematurely, the woman remains dissatisfied, her orgasm comes later, and in the absence of stimulation by the penis, it may not come at all.
Premature ejaculation causes
- Increased excitability of certain brain centers. Ejaculation is a reflex that occurs in the cerebral cortex. When a certain level of stimulation of this zone is reached, ejaculation occurs. In some conditions, the threshold for triggering this reflex is reduced, and ejaculation occurs earlier. Such conditions include, for example, paracentral lobular syndrome. It manifests itself in childhood with bedwetting (enuresis). During puberty, with this syndrome, early emissions are observed, and with the onset of sexual activity, the problem of premature ejaculation arises.
- Increased (excessive) sensitivity of the glans penis. The glans penis is normally an extremely sensitive part of the male body. But in some men, the sensitive head exceeds the average statistical level and borders on pain. This problem is aggravated by excess or narrowed foreskin ( phimosis ), when the glans is almost always closed and has little or no contact with the external environment.
- Short frenulum of the penis. The frenulum, along with the head, is a highly sensitive area. If the length of the frenulum is insufficient during sexual intercourse, it becomes tense, which causes additional stimulation and leads to premature uncontrolled ejaculation.
- Diseases that are accompanied by a decrease in the duration of sexual intercourse. These include: chronic prostatitis , calliculitis, vesiculitis, sexually transmitted infections, urethritis, balanoposthitis , hyperfunction of the thyroid gland, etc. This reason is characteristic of the secondary form of premature ejaculation. Identification and full treatment of these diseases leads to prolongation of sexual intercourse.
Reasons why ejaculation occurs with delay
The reason for delayed ejaculation can be both a psychological disorder and physical health problems. Therefore, if a delay in the emission of seminal fluid is detected, an examination is prescribed by various specialists, not only physical, but also psychological.
The organic cause is a variety of problems with the patient’s physical fitness. Trauma to the scrotum and penis, infections, prostatitis, prostate adenoma, previous prostate surgery, urethritis, and urethral stricture have an impact here. It is also necessary to conduct research on problems in the field of neurology, such as stroke, Parkinson's disease, problems with the patient's spinal cord, diabetic neuropathy.
Hormonal disorders such as hypothyroidism and hypogonadism can also cause delayed ejaculation.
After surgical interventions, during which there was damage to internal organs, especially for operations on the pelvic organs and abdominal cavity, delayed ejaculation may occur.
Also, a problem with the release of seminal fluid may arise due to disproportion in the genital organs of sexual partners. For example, such a delay in ejaculation appears if a man’s penis is small and his sexual partner’s vagina is wide. In this case, mechanical stimulation of the penis during friction does not occur.
Problems from the sphere of psychology that can cause delayed ejaculation include stress, depression, personality problems, sexual trauma, complexes, and lack of attractiveness of the sexual partner.
A separate set of problems that cause a delay in the emission of seminal fluid is classified as a deviant group of sexual inclinations, such as homosexual, masochistic, sadistic, etc. In addition, there is a phenomenon in which a man receives more satisfaction from the process of masturbation than from sexual intercourse, which also causes problems with the release of seminal fluid.
Delayed ejaculation, which occurs as a side reaction to drugs prescribed for the treatment of depression and mental disorders, is also considered; diuretics and antihypertensive medications. This also includes the cause of delayed ejaculation, such as alcohol and drug abuse.
Diagnosis of premature ejaculation
Diagnosis of premature ejaculation is not difficult and is based on the patient’s complaints of insufficient duration of sexual intercourse. To objectively assess and determine the severity of premature ejaculation, special questionnaires have been developed, which, however, have not found widespread use.
During the examination, it is very important to correctly determine the form of premature ejaculation (primary or secondary), since treatment tactics depend on this. For this purpose, an analysis for sexually transmitted infections, prostate secretions, TRUS of the prostate, and a blood test for thyroid hormones may be required. The scope of the necessary examination is determined by the doctor during a conversation and examination of the patient.
In some cases, it is advisable to consult related specialists - a neurologist or endocrinologist.
How do men react to premature ejaculation?
Men usually react painfully to premature ejaculation, but perhaps more mildly than to erectile dysfunction. Much depends on the partner's reaction. If a woman is unhappy with premature ejaculation, a man experiences this and feels inferior and insecure. Phobias begin, a man may begin to avoid intimacy. Feelings of insecurity can also have a negative impact on your erection.
On the other hand, a weakened erection can speed up ejaculation. In this situation, drugs that improve erection have a good therapeutic effect.
Women's reactions to their partner's premature ejaculation vary. There are those for whom “speed” is suitable, but others remain dissatisfied with short sexual intercourse.
How to get rid of premature ejaculation
In principle, two approaches are possible for this:
1. Reduced sensitivity of the glans penis 2. Inhibition of the corresponding centers of the brain and spinal cord
This is implemented in practice using various methods (or a combination of them).
Non-drug treatment for premature ejaculation
This includes behavioral therapy (synonyms: sex therapy, start-stop, compression, coitus interruptus techniques). The basis of this approach is training to control the time of ejaculation (and, accordingly, the duration of sexual intercourse).
The “start-stop” technique involves pauses in friction shortly before the moment of ejaculation. During the pause, the excitement subsides, which allows sexual intercourse to continue.
With the compression technique, before approaching ejaculation, the penis is compressed at the base (closer to the pubis). This relieves arousal and prolongs sexual intercourse. A combination of these techniques is possible.
Behavioral therapy for premature ejaculation requires concentration, determination and patience from a man , since a positive result is not obtained immediately. The advantage of this method is the absence of side effects and additional costs .
Using gels and lubricants to increase the duration of sexual intercourse
A temporary decrease in sensitivity of the glans penis is achieved using special intimate lubricants or condoms treated with lidocaine. For the same purpose, 10% Lidocaine spray or Emla cream can be used. The cream (or spray) is applied to the skin of the head of the penis 15-20 minutes before sexual intercourse (so that it has time to be completely absorbed), left for 5-10 minutes, and then washed off with water.
I recommend applying the anesthetic not to the entire surface of the head (as this can lead to complete loss of sensitivity, weakening of erection and disappearance of orgasm), but to the most sensitive places (usually the frenulum area, but sometimes the upper part of the head). At the same time, the cream is more convenient for such local application. Although some patients prefer to use a spray. You need to make sure that the remaining lubricant does not get into the woman’s genital tract, otherwise lidocaine will negate all your efforts to give her pleasure.
In general, according to reviews from my patients, the method is very good , and with the right technique it is highly effective . Another advantage of local anesthetics in the treatment of premature ejaculation is their availability, low cost and safety .
Herbal preparations to prolong sexual intercourse
Premature ejaculation can be prevented by quite a few herbal preparations (herbal medicines) designed to strengthen erections and increase the duration of sexual intercourse. I will not list them here, since it is quite difficult to compare them with each other and evaluate their effectiveness. Most of these drugs are essentially dietary supplements, the effects of which have not been tested in serious clinical studies.
I'm not saying they are ineffective. On the contrary, many of my patients noted an excellent effect from one or another herbal medicine. But the fact of the matter is that this drug helps one person, but not another!
The effectiveness of herbal remedies for the treatment of premature ejaculation is very individual , and this is their main problem. Since there is no proven predictable effectiveness of herbal remedies, I do not use them in my practice.
The vegetable SS cream stands out. Its action is similar to the group of local anesthetics (Lidocaine, etc.), but it is of plant origin. It should be applied to the skin of the head of the penis an hour before sexual intercourse, and rinsed with water before sexual intercourse. SS cream has shown quite high effectiveness in the treatment of premature ejaculation. The disadvantages of SS cream include its low availability in Russia.
Psychotropic drugs for the treatment of premature ejaculation
Increasing the duration of sexual intercourse can be achieved with the help of psychotropic drugs taken some time (usually an hour) before the intended sexual intercourse. This method is good if sexual intercourse occurs from time to time, occasionally ( because taking psychotropic drugs every day is not at all recommended! ).
In addition, the drugs can reduce the reaction rate when driving a car and cannot be combined with alcohol. The only specialized and certified drug in this group in Russia is Dapoxetine .
It belongs to the group of antidepressants from the group of neuronal serotonin reuptake inhibitors, differing from them in a relatively short period of action and fewer side effects.
Dapoxetine is sold in pharmacies with a doctor's prescription. Tramadol (a potent synthetic painkiller from the opiate group) has a similar effect For the treatment of premature ejaculation, Tramadol is recommended for use in European countries.
But in Russia this drug is strictly registered, and prescribing it can be problematic.
The ability of alcohol to prolong the duration of sexual intercourse has been known among people for a long time. Here, however, it is important to know when to stop, since excessive doses of alcohol lead to a significant weakening of erection (“increases the desire, but reduces the possibility”)
Surgical methods for treating premature ejaculation.
Urologists (at the suggestion of patients) have long been concerned with the search for effective surgical methods for increasing the duration of sexual intercourse. And some progress has been achieved, especially in recent years. Let us consider the current methods of surgical treatment of this problem.
Circumcision to prolong sexual intercourse
It is the oldest of the methods that help reduce the sensitivity of the glans penis.
The logical explanation for the effectiveness of circumcision on premature ejaculation is quite convincing. The delicate and sensitive skin of the head after circumcision gradually becomes rougher, and accordingly, its sensitivity gradually decreases.
To achieve the same effect, some patients simply move the foreskin and wear the glans constantly open. In many cases, this method really helps, although the latest recommendations of the European Association of Urology do not include circumcision in the list of effective treatments for premature ejaculation.
This was done based on a comparison of the duration of sexual intercourse in circumcised and uncircumcised men (no statistically significant difference was found). But the experience of many patients suggests the opposite. The greatest benefit from circumcision can be expected in patients with excessive foreskin development. For more information on circumcision methods, see here .
Frenum plastic surgery (frenuloplasty)
As already mentioned, a short frenulum is one of the causes of premature ejaculation. Accordingly, plastic surgery or complete excision of the frenulum in some cases can eliminate this problem. There are various options for frenuloplasty, which are described in detail here .
When combined with phimosis or excess foreskin, frenuloplasty is performed together with circumcision. In general, with correctly established indications, frenuloplasty is an effective way to prolong sexual intercourse.
Introduction of hyaluronic acid
The popularity of various surgical techniques associated with the introduction of hyaluronic acid gel is explained by the relative simplicity and availability of the drug, ease of training, lack of the need for general anesthesia, reversibility of the action (in this regard, it is sometimes used as a “trial” treatment option ; this is also important when complications).
For premature ejaculation, hyaluronic acid gel is injected under the skin of the glans penis under local anesthesia. By introducing the gel between the surface of the skin and the nerve endings (located deeper), a “cushion” is created. Stimulation of nerve receptors and sensitivity of the head decrease, the duration of sexual intercourse increases.
An additional “bonus” of the introduction of hyaluronic acid for premature ejaculation is an increase in the size of the glans penis. Considering the reversibility of the action of hyaluronic acid, the effect of introducing the gel into the head is temporary. The duration of action depends on the type (density) of the gel, but rarely exceeds 6 months.
If necessary, the procedure can be repeated, or you can immediately move on to the most effective method of increasing the duration of sexual intercourse, described below.
Microsurgical denervation of the glans penis
A radical method of treating premature ejaculation, which can permanently reduce the sensitivity of the glans penis and significantly increase the duration of sexual intercourse, is microsurgical denervation of the glans penis. By crossing the nerves, a long-term decrease in the sensitivity of the head is achieved. You can evaluate the effectiveness of denervation of the head in advance, before surgery, using the Lidocaine test ( details at the link )
After 6-8 months, the nerve fibers grow together, sensitivity is restored, but during this period (subject to regular sexual activity) a persistent reflex to a longer duration of sexual intercourse is formed. Denervation is performed under both local and general anesthesia, in most cases on an outpatient basis .
In my experience, premature ejaculation (primary form) is most effectively treated with microsurgical denervation of the glans. The operation is easily tolerated, does not require hospitalization and has a short recovery period.
Of the several hundred similar operations I have performed, fortunately, I have never had to deal with complications , and the results of the operation, in the vast majority of cases, fully met expectations.
Now attention! The “gold standard” of surgical treatment of premature ejaculation (microsurgical denervation of the glans + circumcision + frenuloplasty) is now under special conditions! Details of the promotion.
My experience in treating patients with premature ejaculation allows me to guarantee maximum results and an individual approach depending on your preferences!
Questions about the article
Dmitriy
June 23, 2021 at 01:03 pm
Hello, I have been suffering from this problem for many years. I tried various SSRIs, including dapoxetine, unfortunately it does not help, it gives side effects, incl. and for erection. Paxil helped at a dosage of 40, but after 2 weeks the effect disappeared, plus problems with erection and side effects in the form of apathy and weight gain increased. I tried Velaxin, but it didn’t help at all, and there was just a terrible withdrawal syndrome when getting off it. Circumcision was done, but the effect was zero. Lidocaine and various ointments also do not help. Anything else you can think of? I don’t want to have the operation, and apparently there’s no point because... The lidocaine test fails. You wrote about tramadol, is there any possibility of prescribing it?
Anton Evgenievich Rotov
June 25, 2021 at 06:18 pm
I'm afraid that Tramadol cannot be prescribed in Russia for the treatment of premature ejaculation
Vlad
April 15, 2021 at 05:31
Hello, I have a circumcised penis and sometimes I masturbate. I have increased sensitivity of the head. Sexual intercourse ends quickly, even alcohol does not help. I'm 20. What do you recommend? Are there any tablets that are cheaper? And will action remain forever? Are there any side effects? Answer please.
Anton Evgenievich Rotov
April 15, 2021 at 10:51 am
In principle, all existing methods of treating premature ejaculation, their pros and cons are described on the corresponding page. Read and choose the one that suits you
Vladimir
March 31, 2021 at 07:12 pm
Hello, Doctor! What is the probability that after the operation the duration of sexual intercourse will increase? And how to sign up for the operation? I live in Sochi.
Anton Evgenievich Rotov
March 31, 2021 at 09:01 pm
If the Lidocaine test gives a positive result, then you can expect a positive result from denervation (the probability is almost 100%, just for some the result is better and for others it is worse). For maximum effect, it is better to combine it with circumcision (if you haven’t done it before). You can make an appointment for an operation, discuss any details you are interested in, and agree on a date and time by calling 8(926)789-9787 or by mail
Konstantin
February 26, 2021 at 06:43 pm
How to apply, and where, that is, in what area of the genital organ, Emla cream, and in general, if I apply it, it will then stand up,))
Anton Evgenievich Rotov
February 26, 2021 at 06:44 pm
Start from the frenulum area, under the head of the penis. Apply a thin layer of ointment, in a strip about 2-3 cm wide, and leave for about 5 minutes. After this, rinse with water and proceed to the test. Next time, try applying the ointment the other way around on the top of the head, in the same way. Compare which method gives the best result for you and use it in the future
