Premature ejaculation
Summary/Definition
Premature ejaculation is one of the most common sexual dysfunctions in men, because it manifests itself constantly or repeats earlier than we would like, before, during or immediately after the start of sexual intercourse, even with minimal stimulation. This can greatly undermine the partner’s confidence in their sexual capabilities and reduce the degree of satisfaction, which, in turn, can cause feelings of anxiety and depression. In addition, this condition can become a source of psychological stress for the partner and affect the quality of relations between partners. The main causes of premature ejaculation may be related to psychological and neurobiological factors, and may also include endocrine disorders. Psychological factors include stress, anxiety, pressure and negative sexual experiences in the past, while neurobiological factors may include disturbances in the work of the centers regulating ejaculation and nervousness. Premature ejaculation can also occur in the presence of diseases of the penis, urethra, prostate, seminal vesicles, urethral sphincter, bladder or in the presence of endocrine disorders.
Symptoms
Ejaculation usually occurs with little sexual stimulation, and insufficient control over this process can cause feelings of guilt, shame or frustration, which in turn reduces the pleasure of sexual relations.
Diagnostics
First, an assessment and collection of anamnesis in the field of sexual health of the patient is carried out. It is important to find out the history of symptoms, their frequency, duration of premature ejaculation, as well as to assess the degree of sexual activity, the nature of the relationship with a partner and the impact of premature ejaculation on the quality of life of the patient. This analysis can be used as an initial step in screening for premature ejaculation. The time elapsed from the moment of intravaginal injection to the moment of ejaculation is an important indicator that can provide the most objective information about the degree of premature ejaculation in the diagnosis of this condition.
Treatment and course of the disease
Methods of treating premature ejaculation can be divided into drug treatment, surgical treatment and behavioral treatment through topical application or oral medication.
Two methods are used for drug treatment: topical application and the use of selective serotonin reuptake inhibitors. Medications in the form of a gel, spray or cream are used for topical application of a mixture of lidocaine and prilocaine to the genitals. They provide a local analgesic effect, reducing the sensitivity of the penis, increasing the threshold of stimulation of ejaculation and delaying ejaculation. However, it can be uncomfortable and have a negative impact on sexual function and erogenicity. Selective serotonin reuptake inhibitors are drugs that inhibit serotonin reuptake by compensating for serotonin levels, which plays a role in the neurophysiology of premature ejaculation. However, they are characterized by a high price and can cause side effects such as nausea, vomiting, headache, insomnia and anxiety. Non-drug treatment includes behavioral therapy, which aims to delay ejaculation by controlling the stimulation of the genitals before ejaculation. Surgical treatment most often involves cutting the dorsal nerve of the penis.
