Sexual medicine

Sexual medicine treatments

Premature Ejaculation

Until a few years ago, it was believed that premature ejaculation was caused only by emotional and mental factors such as anxiety, depression, daily worries, feelings of guilt or insecurity or non-consensual sexual encounters.

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Premature ejaculation

Table of Contents

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Definition

What is premature ejaculation?

Premature ejaculation is defined as the difficulty (or inability) of a man to delay ejaculation during sexual intercourse. In the worst cases, ejaculation occurs moments before penetration or seconds after starting in most patients.

When suffering from premature ejaculation, it is common to realize that you actually have no control over ejaculation, since it happens involuntarily even in the absence of an erection or with minimum sexual stimulation.

This pathology which is strongly related to erectile dysfunction usually causes serious problems of anxiety and depression in more than a third of the male population of the world who are sexually active.

Esta patología, fuertemente vinculada con la disfunción eréctil, suele ocasionar serios problemas de ansiedad y depresión en más de un tercio de la población masculina del mundo, sexualmente activa.

This pathology which is strongly related to erectile dysfunction usually causes serious problems of anxiety and depression in more than a third of the male population of the world who are sexually active.

In western countries, it is estimated that between 20% and 25% of men between the ages of 18 and 59 suffer from some type of inconvenience when ejaculating with the most common being rapid ejaculations and sudden loss of libido. These inconveniences often decrease the quality of sexual encounters and cause relationship problems, many of which end in the avoidance of intimate couple moments or romantic breakups.

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Premature Ejaculation

Treatment Summary

This is short summary of the whole process: from the appointment request, to receiving the medical discharge after the treatment in some our Andromedi centers in Madrid, Seville or Canary islands (Tenerife)

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Consultations Needed

Several, depending on each patient. Patience is needed to determine the causes and find the best available treatment.

Treatment Type

There is no quick and miraculous therapy but the combination of therapeutic options (drugs, psychotherapy, condoms) always produces positive results.

Previous Advice

Before consultation, the patient can perform the "self-test" detailed in this article and thus help the doctor.

Results and Waiting Periods

Undefined. It all depends on the causes of the ejaculation problem and the treatment the patient receives. They are often positive in only one week.

Resuming Sex Life

Quality sex can be achieved after a few weeks or a couple of months, the patient must be patient.

Further Tips

Relapses can always occur. The patient should be aware of how and to what extent his situation has improved or worsened.

Causes

Causes: what causes it?

Until a few years ago, it was believed that premature ejaculation was caused only by emotional and mental factors such as anxiety, depression, daily worries, feelings of guilt or insecurity or non-consensual sexual encounters.

However, recent renowned scientific studies have supported the hypothesis that there are also biological factors that bring about the development of this sexual dysfunction in males and examples are:

  • Hormonal problems, such as a decrease in serum testosterone or increase in thyroid hormones.
  • Prostate problems, such as prostatitis, benign hyperplasia or prostate cancer.
  • Hypotonic pelvic floor muscles, when the muscles that support the pelvic area (sphincters, constrictors, perineum, levator ani, among others) are not sufficiently toned and, therefore, have problems withholding the release of semen.
  • Recurrent Urinary tract infections
  • Genetic predisposition.
  • Overweight and obesity.

It is generally agreed in the scientific world of today that premature ejaculation usually results from a combination of psychological and biological causes. This implies that the treatment must address several aspects of individual and couple life. Erection problems and emotional stress are among the risk factors that accelerate the onset of premature ejaculation.

Solutions

Symptoms: how do i know if i have premature ejaculation?

Ejaculating in less than one minute after penetration and difficulty in voluntarily delaying the time of ejaculation (which coincides with the period that follows the other partner’s orgasm) are signs that occur in men with premature ejaculation.

The diagnosis of premature ejaculation is often complicated because very few men tend to seek professional help from doctors or provide accurate information about the quality of their sexual experiences. However, the difficulty to delay the moment of ejaculation can happen even during masturbation, and this could be a key indicator of whether or not there is a real problem.

Five questions test

With only five questions that include several aspects related to male sexuality, we can help determine if you have possible premature ejaculation problems;

Each question has a value of four points to give a total of 20. The scoring of each question goes from one to four, being +1 in case the answer is “very little” and +4 points in case the answer is “a lot”.

The 5 questions are:

  • Can I choose the moment of ejaculation or delay it?
  • Do I always ejaculate before they want it?
  • Do I get excited with very little sexual stimuli?
  • Do I feel frustrated or worried about ejaculating before wanting it?
  • How concerned am I about the dissatisfaction of my partner?
  • A total score between 0 and 8 indicates the absence of premature ejaculation
  • Between 9 and 12 serves to confirm that there is premature ejaculation
  • And scoring between 13 and 20 not only confirms premature ejaculation but also indicates that it is severe.
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Solutions

How can i treat premature ejaculation?

When confirming a real case of persistent premature ejaculation (not temporary), our team always takes note of the specific factors that cause it to enable them to provide appropriate treatment in the shortest possible time.

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There is no rapid and miraculous solution: combined therapy

Since most cases of premature ejaculation are usually multicausal, therapeutic management usually corresponds to at least two treatments that complement each other, often including sexual psychotherapy which greatly increases the chances of success no matter the case.

It is important to understand that no solution is always effective or works in all cases; each treatment will be personalized and well-followed up.

Medicines (creams, pills, etc)

There are many medications that can help in the treatment of premature ejaculation, and they include:

Anesthetic creams and sprays

With numbing agents such as lidocaine or benzocaine. The effect lasts a maximum of a couple of hours and helps decrease the sensitivity of the penis during sex, thus delaying the erogenous response.

Antidepressants

Such as selective serotonin reuptake inhibitors (SSRIs), including sertraline, dapoxetine, fluoxetine or paroxetine are very useful for improving the emotional state in general and reducing the anxiety caused by sexual problems.

Phosphodiesterase inhibitors

This enzyme is responsible for the flaccid state of the penis after an erection, and these inhibitors could lead to sustained erections. During a rigid erection, the pressure inside the penis can compress the nerves, thus, reducing sensitivity. Some phosphodiesterase inhibitors commonly used against impotence are popular pills such as sildenafil, tadalafil or vardenafil.

Dapoxetine

Is an SSRI (selective serotonin reuptake inhibitors) antidepressant which was first used to treat chronic depression and has shown some effectiveness in recent years when administered to male patients with premature ejaculation with remarkable improvement in their quality of life through sexual performance and better positive experiences observed. 

Most pharmacological therapies in cases of sexual dysfunction and premature ejaculation (over 80 percent) include the use of dapoxetine as an adjuvant, complementing psychotherapy.

Breathing techniques

Some breathing techniques performed during sexual stimulation can help cause the man to relax and decrease the level of excitement, thus delaying ejaculation for a few minutes after coitus resumes.

One disadvantage of this technique is that it is impractical and does not work in the same way in all men with premature ejaculation problems, especially when the causes are more biological than psychological.

Use of condoms

There are special condoms on the market that have been designed with thick latex to help delay ejaculation by decreasing the sensitivity of the genital area.

Some other types of condoms known as retardant condoms contain lubricants with anesthetic drugs, similar to those found in retardant creams or sprays.

The main disadvantage of retardant condoms is that, occasionally, these desensitizing drugs can decrease the ability to perceive sexual stimuli in the vagina of women.

The clear advantage of using this method in combination therapy is that it also serves as a method of protection against unplanned pregnancies and sexually transmitted infections (STDs).

Sexual psychotherapy and lifestyles

Psychological therapy can be an important tool when it comes to treating premature ejaculation because, although not all cases originate from psychological factors, it usually causes emotional imbalances. This often turns the pathological state into an “endless spiral” of guilt or other complications when even thoughts about having sex pop up..

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In almost all cases, urologists or andrologists recommend complementary sexual therapy in the treatment of premature ejaculation. This is also true for us with the immeasurable contributions of Dr. Francisco Cabello, one of the sexologists in our office in Madrid, Seville and Canary Island very much loved by the Andalusian patients.

During the first consultations, the specialist always advise patients to adopt healthy habits such as maintaining a good diet, performing daily physical exercise, resting properly, and creating time for stress-relieving activities such as meditation, yoga or certain sports. All this will help to reduce emotional burden, and the subsequent feelings of guilt and depression. And everything adds up to create a perfect balance, no matter how improbable it may seem at the beginning

Kegel or pelvic floor exercises

The pelvic floor is a set of muscles that contract to support the pelvic organs (bladder, prostate, urinary tract, rectum, etc.). These muscles could lose some firmness progressively, thus, increasing the chances of not being strong enough to prevent semen from being expelled before orgasm is reached during sexual intercourse.

Pelvic floor exercises (also known as Kegel exercises) are toning exercises that help strengthen the pelvic muscles. They involve 3-second contraction and relaxing movements of the musculature of the urinary and rectal sphincters.

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  • VIDEO:   What are they and how to do them correctly?

You can slowly perfect the exercises by performing them while standing or sitting with sustained mental concentration.

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techniques and treatments

Importance of 100% individualized therapy for each case

The medical approach to each case of premature ejaculation should not only find the specific causes (through an accurate diagnosis) but should also provide appropriate treatment for the particular case.

In the best of scenarios, a clinical treatment with antidepressant or retardant drugs, accompanied by psychotherapy and good health habits can reverse the problems related to ejaculation while achieving optimal sexual performance. Don’t feel frustrated if you don’t get the expected results during the first stages of treatment. Success rates are usually higher around the mid-term of treatment with the exception of very severe cases.

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Additional tips, tricks, or remedies that can help with premature ejaculation

Partners can and should be of great help in overcoming the problems of premature ejaculation. The communication between both parties is fundamental in creating an environment of trust that enables the combatting of the situation without extra needs, obligations, frustrations and anxieties that usually end up worsening the patient’s condition.

In addition to the Kegel exercises, there are other muscular techniques that can help delay ejaculation. They are usually very advantageous since they can be performed by the couple. An example of such an exercise is the stop and squeeze technique.

This technique involves initiating sexual activity as usual until sexual stimulation (with or without penetration) is reached, right up to the point where you feel that ejaculation is imminent. At this point, the couple completely stops the stimulus before firmly compressing the tip of the penis, at the junction of the glans and the body of the penis until the excitement decreases and the desire to ejaculate disappears.

The stop and squeeze exercise can be repeated as many times as necessary during several sexual encounters. Many people have reported great improvement after a constant and determined routine. The more it is done, the longer the recovery time of the stimulus will be, as the moment of ejaculation is progressively delayed.

Some men with premature ejaculation problems practice the habit of masturbating hours before sexual intercourse to “numb” the response time and increase the performance time. This technique is not ideal because it can cause irregularity in normal daily habits, but can be beneficial if done with self-control and self-knowledge, especially during the early stages of treatment. 

Frequently asked questions at the Andromedi centres in Madrid, Seville and Tenerife

I’ve read that premature ejaculation is incurable, and can only be controlled. Is this true?

To say that premature ejaculation has a definitive cure would be quite inaccurate, not only because it usually results from multiple causes (which must be treated individually) but also because the experience is usually as subjective as it is difficult to explain.

There are cases of men with premature ejaculation who do not present with significant problems when performing sexually, mainly because they know how to “compensate” the short coitus durations with satisfactory foreplay or manual stimulation of other erogenous zones.

Controlled premature ejaculation makes a smooth sex life possible while allowing the opportunity for medical treatments to take effect. Is this a total cure? Well, looking only at the present and not in the future where some regression or a stage of relapse could occur, it heals and can be considered a cure.  

Is There Something Similar In Women?

The various stages of sex in women are different from what men experience. Orgasms in females are usually less intense but more durable compared to the male orgasm (which ends in ejaculation).

“Female ejaculation” is an extremely rare sexual phenomenon, even though it can occur. In such cases, the ejaculation occurs towards the end of orgasm, suddenly decreasing sexual desire.

Very few cases have been reported of female ejaculation occurring so abruptly that it leads to low sexual performance. That said, psychotherapy may help to delay orgasms in women as is the case in men.

Is There A Relationship Between Erectile Dysfunction And Premature Ejaculation?

Erectile dysfunction doesn’t necessarily appear with premature ejaculation, although the anxiety and worry from one could lead to the other. The prevalence of this “combined” condition is usually very low, with the treatment even more complex and profound, includingsexual psychotherapy in combination with drugs that delay ejaculattion.

Why Do I Have Premature Ejaculation During Sexual Relationships, But Not When I Masturbate?

When this happens, the premature ejaculation is most likely caused by emotional irregularities like inferiority complex, problems related to other people, or feelings of guilt.

In such cases, the psychotherapist specialized in human sexology can provide you with the tools needed to overcome the specific problems (learn to think and feel) and reach an optimal state of mental health.

Could Premature Ejaculation be a Temporary problem which occurs sporadically?

At certain points in time, episodes of premature ejaculation may occur and then disappear during other sexual encounters.

For the specialist tasked with treating such cases, it is often very difficult to determine (or check) whether the premature ejaculation responds to a specific factor or is a subjective experience of the patient. For instance, when the expectations of the sexual relationship in time and quality do not correspond to the actual performance.

A complete medical examination, ranging from the patient’s lifestyles, to the level of sexual performance should provide sufficient understanding about the actuality and extent of the problem.

MEDICAL REFERENCES AND BIBLIOGRAPHY
Este contenido médico ha sido actualizado y revisado por revisado por el comité científico de Andromedi en la siguiente fecha: 17 June 2022

Author

Dr. Natalio Cruz


Natalio Cruz MD, with 25 years of medical experience, has been until 2016 Head of the Andrology Unit in the Urology Service of the Virgen del Rocío Hospital in Seville, National Coordinator of Andrology in the Spanish Association of Urology (AEU) and General Secretary in the ESSM, positions that he has narrowed to focus squarely on this exciting project of offering a high-level private medical consultation in Marbella, Seville, Madrid and Tenerife.

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