How can I control premature ejaculation

Premature ejaculation (Premature ejaculation, Ejaculatio praecox)

The so-called "premature ejaculation" (Ejaculatio praecox, EP) is the most common sexual disorder in men.

Short version:

  • Ejaculation is premature if ejaculation occurs within one minute of penetration.
  • Premature ejaculation is a disease when the problem recurs.
  • The causes of premature ejaculation can be both physical and emotional.
  • The diagnosis "Ejaculatio praecox" is made in a conversation between doctor and patient.
  • Premature ejaculation can be treated with medication.

By definition, premature ejaculation is understood to be a permanent or frequently recurring ejaculation during sexual stimulation, before or within a minute after penetration into the vagina, the inability to always or in most cases delay the ejaculation, and the resulting psychological impact Stress, disappointment, and avoidance of sexual activity.

Premature ejaculation is not considered a sexual disorder until the above criteria are met. The causes lie in a neurobiological phenomenon, which can lead to rapid ejaculation, and are not purely psychological problems.

Despite all the differences, most definitions of ejaculatio praecox have the following three points in common:

  • insufficient control of ejaculation
  • Psychological distress in one of the partners (regardless of whether they are heterosexual or homosexual)
  • Shortened intravaginal latency (i.e. the effusion in the vagina after penetration is less than a minute)

+++ More on the topic: How early is too early? +++

What are the causes of ejaculatio praecox?

Sometimes the disorder can be traced back to an organic trigger - e.g. an inflammation of the urethra or the prostate. In most cases, however, no purely organic cause for ejaculatio praecox can be found. Ejaculation is a multifactorial process in which various centers in the brain, spinal cord and peripheral nervous system are involved.

For a long time, ejaculatio praecox was attributed almost exclusively to psychological causes. For example, on conditioning through "negative" experiences in the area of ​​sexuality, which resulted from quick, fleeting sexual contact, or on a "too early" beginning of sexual life. “Too little” sex was also seen as a trigger.

Little personal sexual experience can be a factor in premature ejaculation, as can fear - be it of sexual failure, emotional attachment, or unwanted fatherhood. It is therefore now assumed that psychological components such as excessive sexual performance thinking, the idea of ​​being a bad lover or the fear of "coming too early" again tend to contribute to "suffering" premature ejaculation again and again.

In the meantime, premature ejaculation is increasingly viewed by scientific research as a neurobiological phenomenon: According to this explanation, the sexual dysfunction is caused by irregularities in the household of the neurotransmitters and by a changed sensitivity of the receptors of these neurotransmitters. This is supported on the one hand by a familial accumulation of EP and on the other hand by the fact that some drugs that interfere with the neurotransmitter budget have proven effective in the treatment of this sexual dysfunction.

How is ejaculatio precox diagnosed?

The diagnosis "Ejaculatio praecox" is based primarily on the information provided by the person concerned. During the conversation, the doctor should therefore ask the patient in detail about his or her sexual life. The open question about sexuality and satisfaction with sex life makes it possible to obtain important information as part of the anamnesis.

In heterosexual men, one of the issues that should be addressed is the length of time between insertion of the penis into the vagina and ejaculation. If the IELT is regularly less than a minute, by definition, in connection with psychological stress, one speaks of premature ejaculation.

A distinction should be made whether it is a primary ejaculatio praecox, i.e. it has always been, or a secondary form, i.e. one that has only occurred over the years. This distinction is important because the therapy options can differ in this regard.

Other diagnostic procedures, such as laboratory tests of blood or urine, are primarily used to rule out underlying diseases (e.g. prostatitis) that can cause ejaculation praecox.

How can premature ejaculation be treated?

After differentiating between primary and secondary ejaculatio praecox, the treatment options should be discussed after intensive consultation with the patient. The only drug approved to date for the treatment of EP is dapoxetine, a serotonin reuptake inhibitor (SSRI), which has shown a significant prolongation of the IELT in many studies. This medication must be taken one to three hours before sexual activity.

+++ More on this: Treatment of premature ejaculation +++

In principle, sex therapy also makes sense for the problem of ejaculation praecox. Experience has shown that many sufferers seek a quick solution, which is why this is offered in many cases to accompany medication.

Other drugs, such as the use of PDE-5 inhibitors, local anesthetic ointments, opiates, etc., are possible - however, the best results have been described with the SSRIs. At the same time, in the case of the last-mentioned therapy options, the man must be informed that these drugs are off-label applications and that the preparations are generally not approved for them.

Make the problem an issue!

Premature ejaculation is undoubtedly one of those problems that can lead to considerable distress. Although it is the most common male sexual disorder, many believe they are alone with this problem and try to cover it with silence. In this context, openness is particularly important in several ways.

On the one hand, it is important to be open to your partner. For example, it can be clarified whether what you yourself perceive as "too early" is also classified as "too early" by the other person, or whether you are worried wrongly.

Admitting your insecurity and tackling any problem together has often proven to be a first, decisive step towards a solution. Furthermore, by dealing with the problem together, damage to a relationship can be averted.

But it is not only in partnerships that the open word is required - it is important to address the doctor about the difficulties in controlling the orgasm reflex. Not least because there is a possibility of treatment, those affected should not shy away from seeking professional advice. Urologists, sex clinics or specialized counseling facilities can serve as contact points.

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Ulrich Kraft, doctor and medical journalist, Philip Pfleger
Medical review:
Prim. Univ. Doz. Eugene Plas
Editorial editing:
Dr. med. Matthias Thalhammer, Thomas Auinger

Status of medical information:

Hellstrom, W .: Emerging Treatments for premature ejaculation. Neuropsychiatric Disease and Treatment, Vol. 5, 2009, pp. 37-46.

Jungwirth, A. et al .: Guideline Ejaculatio praecox. Journal of Urology and Urogynecology. Special issue 6, 2008, pp. 15-16.
Kreutzer, N et al: Premature ejaculation - A study of average ejaculation time and overview of the literature. In: Current Urology 32 (2001) 7, pp. 435-438.

Mathers, M. J. et al .: Introduction to the diagnosis and therapy of ejaculatio praecox. Deutsches Ärzteblatt 104 (2007) 50, pp. A3275-3480.

Porst, E. et al .: The Premature Ejaculation Prevalence and Attitudes (PEPA) Survey, Comorbidities, and Professional Help-Seeking. European Urology, 51, 2007, pp. 816-824.

Sommer, F. and Schmäges, J .: Ejaculation disorders. Blickpunkt DER MANN 2007; 5 (2007), pp. 21-27.

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