Premature ejaculation: an overview to get to know it better

Premature ejaculation is one of the most common sexual disorders in men of all ages: how to diagnose it, and what can be done? The advice of Dr. Castiglione andrologist at Holistic Andrology London

What is premature ejaculation

Premature ejaculation is a very common sexual dysfunction in men, in all ages.

When can premature ejaculation be considered?

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his type of disorder is characterized by an ejaculation which, always or almost always, occurs during sexual activity before penetration and / or within approximately one minute of penetration.

It is associated with the man’s inability to postpone ejaculation in almost all or all sexual relationships, leading to psychological stress that inhibits all forms of sexual intercourse.

The sexual response therefore has a shorter sequence, which occurs faster and with less control than in those who do not suffer from it. The sexual arousal phase is very rapid, with generally normal erections but with rapid ejaculation and orgasm.

Primary or secondary ejaculation?

Although we talk about it in a generic way referring to the phenomenon as unique, premature ejaculation can be divided into two categories:

Primary: occurs from the first sexual intercourse and remains more or less stable throughout the course of life (ejaculation that occurs before penetration and / or within 1-2 minutes after penetration);

Secondary: it is an acquired premature ejaculation and, usually, the time elapsed between the start of sexual intercourse and ejaculation is slightly longer than in the primary form.

Why does premature ejaculation occur? Risk factors

There is no single cause behind this condition, but there are several factors that can cause its onset. Among these we find:

• anxious / depressive syndrome
• hypersensitivity of the penis
• metabolic syndrome
• obesity
• hormonal disorders
• periods of high stress
• performance anxiety
• drug abuse
• erectile dysfunction (many impotence patients develop secondary premature ejaculation due to an anxiety disorder caused by difficulty in obtaining and / or maintaining a satisfactory erection)
• prostatic inflammation (it is very important to proceed with the treatment and resolution of any inflammatory prostatic conditions, such as chronic prostatitis; this therapy alone leads to a substantial increase in ejaculation time compared to untreated patients).

How to defeat premature ejaculation: let’s start with the diagnosis

Precisely because of this wide range of factors, to understand why you suffer from premature ejaculation, the first step of evaluating a patient includes a detailed medical and sexological history of the subject and the couple. In fact, at this stage, the relationship of trust between doctor and patient is extremely important.

During the visit, some validated questionnaires are generally administered in order to frame the problem. A careful clinical examination will then be carried out, also aimed at excluding the presence of any inflammatory prostatic pathologies.

It will be important to evaluate:

the time elapsed between initiation of penetration and ejaculation (IELT)

any decrease in sexual stimulation

the impact of this condition on the couple’s sexual activity and on the quality of life of those involved

On the basis of the medical history and clinical examination, further diagnostic tests will be requested to investigate the problem:

laboratory tests (hormonal profile, lipid profile, liver and kidney function, PSA, culture tests on urine, seminal fluid, etc.);

visits by other specialists (endocrinological visit, psychological and / or psychiatric consultation, etc.).

Is there a treatment for premature ejaculation?

In evaluating the possible treatment of premature ejaculation, it will be important, first of all, to focus on any secondary causes (inflammatory prostatic diseases, erectile deficit, mental disorders).

There are different ways of treating the disorder, including drug therapy, and it will be the task of the andrologist, on the basis of the clinical evaluation, to orient the treatment towards the most appropriate modality, also in relation to the patient’s expectations:

• behavioral strategies: this treatment modality is based on the hypothesis that premature ejaculation is due to the fact that the subject involved is unable to recognize the sensation of imminent achievement of the orgasmic phase. They are usually implemented in agreement with the partner
• Dapoxetine: it is a drug belonging to the category of SSRIs (selective serotonin reuptake inhibitors) and is the only drug approved in Europe for the treatment of premature ejaculation as needed (1-3 hours before the need). There are two dosages (30 and 60 mg) and the drug, during the clinical trial, has been shown to be effective in the treatment of both the primary and secondary form
• selective serotonin reuptake inhibitors: the efficacy of these compounds for premature ejaculation is proven, even if in Italy they are not approved for the treatment of premature ejaculation; for this reason, they can only be prescribed to patients who demonstrate a high intolerance to the drug of choice for this pathology (Dapoxetine) and the therapy must be agreed with the patient and the treating physician.
• local anesthetic creams: they have proven effective in delaying ejaculation even if prolonged use can lead to a loss of erection and / or a decrease in sexual stimulation even at the partner’s genital level with negative consequences on the couple’s relationship.

How to prevent premature ejaculation

Premature ejaculation is the most prevalent sexual disorder in men and is represented in all ages. It is very important that the patient is always evaluated by an expert in order to rule out secondary conditions, and possibly treat these pathologies.

Since this is a disease that in some cases has been present since adolescence, it is very difficult to give advice on how to avoid it and how to delay ejaculation with do-it-yourself remedies. We can say, however, that the problem should not be underestimated, in order not to compromise and / or lead to a deterioration of the couple’s relationship with the onset of psychological problems in the couple. Furthermore, within the couple, helping the partner by talking about it openly and inviting him to contact a specialist can represent an important action to raise awareness of possible strategies to be implemented.

Some essential lifestyle habits remain valid for this pathology as well, which help keep the body in a good state of health. Among these:

avoiding pathological weight gain and / or losing weight if you are obese

avoid leading a life that is too sedentary

avoid using drugs

Dr. Fabio Castiglione is a Urologist and Andrologist in London. He is Director of the HolisticAndrology Clinic. At his centers, a therapeutic approach is used based on the most recent clinical studies, on the guidelines of international scientific societies of sexual medicine and on the extensive clinical experience of Dr. Castiglione.

HolisticAndrology,urology clinic in London, has always been at the forefront to improve the quality of life for all people suffering from Impotence. If you are interested and want more information, do not hesitate to contact us.

Contact HolisticAndrology, andrology clinic in London (tel. +44 (0) 7830398165) to book an andrological consultation with dr. Fabio Castiglione, Urologist London.

SOURCE: UAE (European Association of Urology) GUIDELINES ON MALE SEXUAL DYSFUNCTION