The so-called "early ejaculation" (Ejaculatio praecox-EP) is the most common sexual disorder in men.
By definition, premature ejaculation is a permanent or often recurring ejaculation with sexual stimulation before or within one minute after penetration into the vagina, the inability to always or in most cases delay ejaculation, and the resulting psychological stress, disappointment and avoidance of sexual activity.
Early 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 their differences, most definitions of ejaculation praecox have the following three points in common:
Sometimes the disorder can be attributed to an organic trigger, e.g. inflammation of the urethra or prostate. In most cases, however, no purely organic cause can be found for ejaculation praecox. Ejaculation is a multifactorial process involving various centres in the brain, spinal cord and peripheral nervous system.
For a long time, ejaculation praecox was almost exclusively attributed to psychological causes. For example, a conditioning through "negative" experiences in the area of sexuality, which resulted from fast, fleeting sexual contacts, or a "too early" beginning of sexual life. Also "too little" sex was seen as a trigger.
Low personal sexual experience can be a factor in premature ejaculation, as can fear - be it of sexual failure, emotional attachment or unwanted fatherhood. Therefore, it is 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, are more likely to "suffer" premature ejaculation again and again.
In the meantime, scientific research increasingly regards premature ejaculation as a neurobiological phenomenon: According to this explanatory approach, the sexual dysfunction is caused by irregularities in the household of brain neurotransmitters and by changes in the sensitivity of the receptors of these neurotransmitters. This is supported, on the one hand, by a family accumulation of neurotransmitters and, on the other hand, by the fact that some drugs that interfere with the household of neurotransmitters have been shown to be effective in treating this sexual dysfunction.
The diagnosis "Ejaculatio praecox" is based primarily on the information provided by the persons concerned. During the interview, the doctor should therefore ask the patient in detail about his or her sexual life. The open question about sexuality and satisfaction with sexual life makes it possible to obtain important information during the anamnesis.
In the case of heterosexual men, the time between insertion of the penis into the vagina and ejaculation should be addressed. If the IELT is regularly less than one minute, it is defined as early ejaculation in connection with psychological stress.
It should be distinguished whether it is a primary ejaculatio praecox, i.e. it has always been like this, or a secondary form, i.e. it has only occurred over the years. The differentiation is important, since the therapy options can change in such a way.
Further diagnostic procedures, such as laboratory tests of blood or urine, serve above all to exclude underlying diseases (e.g. prostatitis, etc.) which can cause ejaculation praecox.
After differentiating between primary and secondary ejaculation praecox, the therapy 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 been shown in many studies to significantly prolong IELT. This drug must be taken one to three hours before sexual activity.
In principle, sexual therapy is also useful for the problem of ejaculatio praecox. Experience has shown that many patients seek a quick solution, which is why in many cases it is offered in conjunction with medication.
Other medicines, such as the use of PDE-5 inhibitors, local anaesthetic ointments, opiates, etc., are possible, but the best results have been described with SSRIs. At the same time, in the case of the latter therapy options, it is important to point out to the man that these drugs are off-label applications and that the preparations are generally not approved for them.
Premature ejaculation is undoubtedly one of the problems that can lead to considerable suffering. Although it is the most common sexual disorder in men, many believe to be alone with this problem and try to spread the mantle of silence about it. In this context, openness is important in many ways.
On the one hand, it is important to be open towards one's partner. For example, it can be clarified whether what one perceives as "too early" is also classified as "too early" by the other person - or whether one is possibly wrongly worried. Furthermore, admitting one's insecurity and tackling a possible problem together has often proven to be a first, decisive step towards a solution. In addition, by dealing with the problem together, damage can be averted from a relationship.
But it is not only in the partnership that the open word is required - it is also important to address the difficulties in controlling the orgasm reflex to the doctor. Last but not least, because there are possibilities of treatment, patients should not be afraid to seek professional advice. Urologists, sex clinics or specialised counselling centres can serve as contact points.
Written by Mark Riegel, MD
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