Premature ejaculation. Definition, diagnosis, treatment.

Premature ejaculation (PE) occurs in approximately 26% of men aged 18-64 years (3) and is a very pressing problem. In ICD-10, a separate section F52.4 is devoted to this disorder. It is important to note that the phenomenon of premature ejaculation is not only local in nature, but also has consequences in the form of the development of psychogenic erectile dysfunction, the syndrome of anxious anticipation of sexual failure, and anorgasmia in women. Due to the high importance of successful sexual life for a man and his partner, premature ejaculation can contribute to the development of not only sexual disharmony, but also psychological, which, in turn, can subsequently contribute to adultery, divorce and even suicide. Thus, premature ejaculation goes beyond the format of quality of life and sexual disorder.

ICD-10 definition.

F52.4 Premature ejaculation. Inability to control ejaculation sufficiently to ensure that both partners enjoy sexual intercourse. Excluded: premature ejaculation caused by diseases of the male genital organs (N40 - N51); premature ejaculation caused by organic brain damage (F06.82x).

F52.41 Absolute premature ejaculation. The duration of sexual intercourse is less than one minute (less than 20 frictions) against the background of regular sexual activity. Turns on: absolute accelerated ejaculation.

F52.42 Premature ejaculation relative. The duration of sexual intercourse is within the physiological norm (from 1 to 3 minutes). However, this duration of sexual intercourse is not enough to obtain orgasmic release.

partner. Includes: relative accelerated ejaculation.

F52.49 Premature ejaculation, unspecified

Includes: premature ejaculation, unspecified; premature ejaculation NOS.

Physiology of ejaculation

The process of ejaculation includes two actions that occur one after another:

Emission. This is the name for the phase of accumulation of seminal fluid in the posterior part of the urethra.
Direct release of semen. At this stage, the neck of the bladder is blocked and seminal fluid is released.

Each of these processes is controlled by a specific group of neurons located in the spinal cord. Activation of motor neurons occurs after the brain receives a signal that the ejaculation threshold has been reached. When neural connections are disrupted, the entire process fails, which leads to early ejaculation.

Classifications.

A number of classifications of PE are presented in the world literature (1,2,5).

According to etiological factors: psychogenic; organic; a combination of psychogenic and organic causes.

By period of occurrence (manifestation): initial (primary); acquired (secondary).

According to manifestations: constant; episodic.

Depending on the conditions of coitus: absolute; selective (situational).

Duration of coitus (friction stage):

I degree – from 1 to 2 minutes (30–60 frictions); II degree – 30–60 seconds (15–30 frictions);

III degree – 15–30 seconds (7–15 frictions); IV degree – up to 15 seconds (several frictions);

V degree – ejaculation before introjection.

Initial (primary).

Ejaculation occurs very early, almost immediately after the start of sexual intercourse. Manifestation - almost from the very beginning of sexual life. 80% within 1 minute (more than half within 30 seconds). In 20% - within 1-2 minutes. The rapid onset of ejaculation continues throughout life.

Acquired (secondary).

Early ejaculation occurs at a certain stage in a man’s life. The man had experience of normal ejaculation in the past. Usually occurs in mature men. Ejaculation occurs within 1-2 minutes. Premature ejaculation occurs as a result of problems related to urology, thyroid or psychological factors.

Episodic.

Premature ejaculation may be irregular. The ability to delay the onset of ejaculation is reduced or absent. Manifestation - almost from the first sexual experience or in adulthood. The duration of sexual intercourse can be either short or normal. It is part of the normal cycle of changes in ejaculatory function in men.

Electoral.

Situational self-awareness of insufficiently delayed ejaculations. The ability to delay the onset of ejaculation is reduced or absent. Manifestation - almost from the first sexual experience or in adulthood. The duration of sexual intercourse is within normal limits or longer than usual. Both premature ejaculation in certain situations and normal duration of sexual intercourse can be observed.

Despite the variety of clinical options, it can be argued that they have one thing in common - a deterioration in the quality of life of a man, his partner, and often their relationships.

Where to start treating PE?

I think we have already partially answered this question (see previous answers). Summarizing the above, we can give a number of simple tips:

Answer yourself this question: at what point in your life did you notice that the process became shorter? If immediately, then most likely you need a sex therapist (or a psychologist who knows sexual problems). But still, this does not exclude everything that relates to secondary or acquired PE.
If PE is secondary, i.e. did not appear immediately, but after some experience of normal sex, then ask yourself this question: what has gone wrong in my life? Maybe it's a relationship with a partner? Or maybe you have gained weight and lead a sedentary lifestyle? How many cigarettes do you smoke? If the answers are positive, do not rush to look for miracle cures - change your lifestyle.
If all of the above does not apply to you, or you have eliminated all risk factors, then proceed to the next stage - examination and examination by a doctor. Here, unfortunately, it is very important what kind of doctor the doctor will be. If you are competent, the chances of prolonging sexual intercourse increase. If he promises to save you from PE, but at the same time he fools you with expensive and unnecessary examinations and treatment regimens, think about it, maybe you need another doctor...
In addition to a general examination and a special one (examination of the genital organs, prostate), a number of laboratory tests are required, primarily hormonal ones (you can read which hormones you need to take in paragraph 2 of our article). Advice: it’s better to have a doctor prescribe tests. In my experience, patients themselves turn to various laboratories, and either get the wrong tests, or in the wrong laboratories.
The last step is the actual treatment or pills...

Review of therapeutic approaches.

Today there is a fairly wide selection of therapeutic strategies, each of them has its own pros and cons.

Psychological tactics.

Sex therapy uses the stop-start, compression method. Can be effective, however, in some couples, stopping may lead to decreased sexual arousal in both partners. Requires fairly high loyalty on the part of the partner. In men with anxious suspiciousness, excessive self-control can lead to the formation of a syndrome of anxious anticipation of sexual failure.

Pharmacological methods of treatment.

Selective serotonin reuptake inhibitors.

An initially identified side effect at the stage of testing the drug in the form of delayed ejaculation was subsequently used as a therapeutic effect in the treatment of PE. However, the question of the appropriateness of pharmacological influence on the balance of neurotransmitters in people with PE, but without indications for correction of the psycho-emotional state, is debatable. Manufacturer studies indicate that SSRIs may cause agitation and suicidal behavior in healthy volunteers. Since 2005, the US Food and Drug Administration has required that SSRI antidepressants be labeled with a black box warning that the drug is associated with suicidal behavior. Therefore, correction of PE using SSRIs requires the prescription and careful monitoring of therapy by a sexologist with basic training in psychiatry.

PDE-5 inhibitors.

The drugs can be effective not only for the treatment of erectile dysfunction (ED), but also for PE. However, drugs in this group may have contraindications for use, form psychological dependence when taken independently, and therefore require medical supervision.

α1-adrenergic receptor blockers.

The total therapeutic effectiveness is lower than in the group of PDE-5 inhibitors, in the presence of side effects, the need for prescription and monitoring by a physician.

Local anesthetics.

They are effective, as a rule, have no systemic side effects, local application reduces the dosage, and do not reduce the emotional component during sexual intercourse. They can cause an unpleasant sensation of numbness during oral sex in the partner’s mouth during foreplay, if there is such an element in the couple’s range of acceptability. Applying quickly absorbed sprays after such foreplay, if continued, can neutralize this side effect. It is important to inform the patient about the need to select the dosage and caution when engaging in sexual activity in the form of oral sex.

Surgical methods for treating PE

They should be prescribed only after the success of therapeutic approaches has been exhausted, and consist of selective resection of nerve bundles and unilateral percutaneous cryoablation with CT guidance. The effect is irreversible after the intervention. In old age, there is often a decrease in the quality of erection due to a critical decrease in the sensitivity of the glans penis during sexual intercourse.

Psychotherapy for early orgasm

A man’s emotional state is affected not only by premature erection, but also by other problems in his sexual life. Therefore, the help of a psychotherapist will be useful for all sexual disorders.

The course of psychotherapy is carried out taking into account the individual characteristics of the patient in several stages:

Establishing and maintaining contact

Since the problem with erection is a rather sensitive problem, at the first meeting it is very important that a trusting relationship is established between the therapist and the client.

In the first stages, person-oriented therapy, short-term psychodynamic and bodily psychotherapy are used. The patient gets the opportunity to understand the causes and mechanisms of his dysfunction, strengthen the mechanisms for protecting personal boundaries, remove muscle tension, develop skills in managing his own body and create a positive life scenario.

The duration of this stage is determined individually. For some, a few days are enough, while others will visit a psychotherapist’s office for several weeks.

Working with a couple

The psychotherapist's work will be aimed at creating trusting relationships between partners. The partner must actively participate in the therapeutic process. She requires patience and understanding of the situation. Since a man is in anxious anticipation of failure, he must be supported in every possible way.

Quite often during this stage, new therapeutic requests are received from the couple. Working on them allows you to resolve not only problems in the sexual sphere, but also strengthen the relationship between partners in general.

Group therapy

This stage often encounters some resistance from men, so work in groups is carried out only at the request of couples. Group therapy allows you to work through existing problems as much as possible and achieve personal changes and partners.

Today there are a large number of centers where they offer psychotherapy. But the search for specialists should be taken very seriously. There is no need to make an appointment with the first psychologist you come across.

Choose specialists with extensive experience in the field of sexual and sexual disorders. These are the ones who work at the Moscow City Psychoendocrinological Center.

Conclusions.

Therapy for any disease or disorder must be comprehensive and staged. Assessing the effectiveness, safety, naturalness and ease of use, we can conclude that the first line of therapy may be correction with local anesthetics. Among them are cream with lidocaine, SS-cream, as well as a series of products from the Biorhythm Laboratory. The products of this manufacturer meet the highest standards of safety, ease of use, and are economically accessible to the majority of the population, unlike many foreign analogues. You can use both creams and sprays. The spray form allows you to use these products without giving up the stage of oral sex.

Feedback from patients shows high satisfaction with the effectiveness of Biorhythm Laboratory products, and consultations with a sexologist in the field of hygiene of sexual life, improving its regularity and quality make it possible to consolidate the therapeutic effect of these products.
Tags: Sexologist, Sexologist, Accelerated ejaculation, Premature ejaculation, Treatment of accelerated ejaculation, I cum quickly, what to do, how long not to cum

Does lifestyle affect PE?

If you play sports (meaning regular physical exercise, not exhausting professional sports) only a few times a month or less, then the chances of “quick sex” increase. This leads to the following pattern: the less physical activity, the more adipose tissue, and the more you weigh (meaning overweight), the worse it is for sexual function.

Smokers are also much more likely to doom themselves to PE.

Some time ago I had the opportunity to communicate with a colleague from the Netherlands. He told me that there was an epidemic of premature ejaculation in his country. As you know, smoking is prohibited in Holland, but “soft” drugs are allowed there. Marijuana is one of the worst enemies of manhood.

Draw conclusions: you need to start with yourself, with changing your lifestyle. Just in case, I remind you of the ideal weight formula: height in cm minus 100.

Kegel exercise

Pelvic floor muscle training method or Kegel exercise. It is carried out to control the ejaculation process. Kegel exercises consist of three parts: Slow contractions: Tighten the muscles, as if stopping urination. Slowly count to three. Relax.

Contractions: Tighten and relax the sexual muscles as quickly as possible. Pushing: Push as if passing urine or stool.

It is recommended to start training with ten slow compressions, ten contractions and ten push-ups five times a day. Every week, add five exercises to each until there are thirty of them, continuing to perform them five times a day.

However, the best treatment recommendation can only come from a specialist who is able to make an accurate diagnosis. An experienced urologist or sexologist will find an individual way to solve the problem that is optimal for a particular person.

More about psychological reasons

Overstimulation is the most common psychological cause of premature ejaculation. With sexual overstimulation, tension quickly increases in a certain part of the cerebral cortex, which leads to unwanted ejaculation. Another psychological reason for premature ejaculation is fear of failure during sexual intercourse (if intimate contact occurs in a turbulent environment, without the opportunity to relax). Sometimes, with age, psychological problems with ejaculation go away on their own. However, sometimes they only get worse, turning this side of a man’s (and his partner’s) life into sheer torment. With deep-rooted psychological difficulties in adulthood, a sexologist can help in solving sexual problems. And here, of course, a sensitive, patient and loving partner can provide invaluable help.

What if you still have to take SSRIs?

If your doctor prescribes you paroxetine or sertraline, you need to take them regularly, starting with the lowest dose and gradually increasing (your doctor will tell you how to do this!). As a rule, the course lasts at least 3 months.

Why? The fact is that 3 months is the period after which you will get a certain effect that will not increase further. For example, the time to ejaculation before the start of treatment was 1.5 minutes, and after three months it increased to 3 minutes. This means that there will be only 3 minutes further... i.e. the time for which the drug is maximally “capable”. In the future, if there is an effect (and no side effects), you can take SSRIs once, approximately 6 hours before sexual intercourse.

The unwanted side effects listed in paragraph 13 may become an obstacle to continuing to take SSRIs. Agree, if you want to sleep or feel nauseous, is it time to have sex? But the problem of deterioration in potency due to antidepressants will be solved by the same vardenafil. It must be taken together with paroxetine or sertraline.

Advice for men

Sexual life should be regular. It has been proven that long-term abstinence leads to an acceleration of ejaculation in a man, and in a woman it increases the time of orgasm.

It’s great if after a short act the partner can immediately repeat it: now the sex will be longer, and the partner will receive satisfaction faster, since the excitement from the first time will still remain.

To avoid PS, you should eat right, lead a healthy lifestyle, play sports, follow a work and rest schedule - it’s easier to prevent the disease. how to cure it.

If your partner is dissatisfied with sex because she did not have an orgasm, you should not blame yourself for the supposedly early ejaculation. If coitus lasted 5-10 minutes and consisted of the “prescribed” number of frictions, then this dissatisfaction most likely depends on her physiological and psycho-emotional state.