All You Should Know about Premature Ejaculation

Premature ejaculation is a phenomenon of regularly or occasionally repeated ejaculation before, during or immediately after the introduction of the penis into the vagina. The ability to control ejaculation increases with age, while poor control over ejaculation timing is a common condition in younger males (especially in adolescence); however, causes that are mostly psychological may affect males in their thirties, forties and even fifties.


The roots of all the problems

Cited below is a comprehensive list of premature ejaculation causes according to International Society of Sexual Medicine and Premature Ejaculation Diagnostic Tool.

● Sexual excesses, excessive masturbation, etc., resulting in cortical mechanisms in the state of sexual excitement are extended
● Fears: fear of failure, fear of infection and fertilization, a sense of inferiority or guilt as a result of dissatisfaction of a partner
● Traumatic brain injury
● Stressful situations
● Endocrine-humoral disorders
● Functional disorders of the spinal cord (spinal erectile dysfunction)
● Deviations from normal sexual life, sexual excess, interrupted sexual intercourse and delays, sexual frustration
● Chronic infections (tuberculosis, syphilis, and others.)
● Intoxication by alcohol, nicotine and other toxic substances
● The consequences of encephalitis
● Tumors
● Hemorrhage
● Injuries, especially the lumbar and sacral spinal cord
● Polyneuritis
● Traumas of the glans penis, prostate, urethra
● Lesions of the pudendal nerve and its branches in surgical procedures (e.g., inguinal hernia surgery), and in fractures of the pelvis
● Secondary lesions receptors in diseases of the genital organs (prostate, posterior urethral colliculitis)
● Certain drugs – antihypertensives, beta blockers, antidepressants
● Surgery on the prostate and bladder neck
● Ejaculation disorders – manifestations with erectile dysfunction (thus, in some patients with premature ejaculation occurs before an intercourse, in other cases, ejaculation does not occur at all).

Diagnosis of Premature Ejaculation

The patient is diagnosed by an urologist or andrologist; as a rule, non-invasive diagnostics methods are practiced. In 9 cases out of 10 it all starts with blood tests and physical examination, and less likely a study of the external genitalia, prostate and rectal sphincter tone reflexes. Neurological samples can be taken to determine the sensitivity of the skin of the scrotum, testicles and perineum. A study of prostate and seminal vesicles secretion is conducted in case any signs of chronic prostatitis is suspected. In case of retrograde ejaculation manifestations urinalysis after ejaculation is initiated. In addition, the following diagnostics methods can be used: neurological examination, digital examination of the prostate and seminal vesicles, ureteroscopy and cystoscopy, transrectal ultrasonography and uroflowmetry.

Premature Ejaculation: Causes and symptoms

Causes and symptoms

Malfunction in the ejaculatory center in the brain: in spite of a normal libido and normal erection, ejaculation and orgasm do not occur during sexual act, no matter how long it lasts. Wet dreams with an orgasm can be observed in this case (an inhibitory effect on the psyche of the ejaculatory center, which is always manifested in wakefulness, is removed during sleep).

With an increasing excitation effect on sexual function premature eruption of semen may also occur (erection is not affected in this case). Sometimes, as a result of excessive excitation impact on the cerebral cortex a premature ejaculation can happen without erection. Diencephalic disorder is another possible cause of the problem, characterized by a combination of erectile dysfunction with a variety of complaints for headaches, ringing in the head and ears, increased sweating, pain in the heart, palpitations, chills, nausea, vomiting, disturbances of appetite, thirst, sleep disturbances, weakness, fatigue, etc.

Sexual dysfunction in spinal erectile dysfunction usually changes over time from symptoms of increased excitability of the centers of erection and ejaculation to their functional exhaustion. Firstly, the more easily excitable erection center is depleted, while the more resistant ejaculatory center remains in the state of excitation.

Neuro-receptor erectile dysfunction, another possible explanation of the problem, represents an ejaculation disorder characterized by a change in the sensitivity of the glans penis. In this case, premature ejaculation can be caused by diseases of the prostate, seminal vesicles and urethra. In case of hypersensitivity of the glans penis erection does not occur. In the complete absence of sensitivity of the balanus, the ejaculation center, during intercourse gets a very weak stimulation. As a result, ejaculation is delayed or doesn’t occur at all, the weakening of erection is likely to take place.

Premature Ejaculation Treatment

Psychotherapy is ordinarily performed regardless of the nature of disease. Importantly, any effective treatment course implies having enough sleep, quitting smoking and reducing alcohol consumption to the minimum. If a possible cause of premature ejaculation is a drug intake, the treatment course is either canceled or the dose is reduced. Sexual abstinence may be used, the method is applied especially in patients with increased excitability of spinal sexual centers, which also prohibits any sexual stimulation. Patients with intense sexual desire and increased sexual activity at the time of abstinence are prescribed soothing agents.

In case of hypersensitivity of the glans penis for 1-2 hours before sexual intercourse tetracaine ointment (5-10%) is applied. In conditions where the ejaculation center is affected, stop-and-go is an effective tactics to take advantage of. The treatment of patients with erectile dysfunction caused by urological diseases is narrowed to the treatment of inflammation in the prostate, urethra and seminal tubercle (antibacterial drugs, taking into account the nature of pathogens and their sensitivity to antibiotics, prostate massage).

In the delayed ejaculation behavioral therapy may be useful –partner can stimulate introduction of the penis into the vagina, and then at the entrance to the vagina, and finally inside the vagina. The method of ‘stop-and-go’ can, too, be used here, based on stimulation of the penis (by hand or during sexual intercourse), as long as the patient does not feel the approach of ejaculation. When ejaculation is anticipated, stimulation should be stopped. After 20-30 seconds, the procedure is repeated. First, the partners should rehearse the process described using manual stimulation, and only then proceed to implementing it during intercourse. Usually, up to 5 stops are completed before ejaculation is initiated (this method boasts stunning effectiveness and works in 95% of cases).

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Drug treatment

Premature Ejaculation Treatment

The most widespread solution to erectile dysfunction problems is PDE-5 line-up (tadalafil, sildenafil, vardenafil and other active ingredients that lie in the foundation of Viagra, Cialis and a range of other ED preparations – a selection of drugs you can purchase at My Canadian Pharmacy at www.mycanadianpharmacyrx.com with no prescription). These medications are prescribed in 74% of cases and considered to be the first line preparations in ED treatment (regardless of the nature of the problem). The significant effectiveness of treatment is confirmed in 64% of cases on average, while at least minor improvements are reported in 76% of cases.

Let’s consider the classic example of Viagra, based on sildenafil citrate (read more here). sildenafil is a selective inhibitor of phosphodiesterase type 5, it enhances blood flow to the genitals, promoting the erection.

Studies on the effectiveness of sildenafil have been conducted in different countries, and we’ll pay attention to the official clinical trials conducted in the 37 medical centers in the US. The total amount of participants was 828 males, whose average age was 54 years (the participants should not have had anatomical curvatures of the penis, peptic ulcer disease, diabetes, mental disorders, heart attack or stroke in the past six months).

To conduct an average a number of conditions were set: the presence of erectile dysfunction in the last 6 months, sexual activity during the same period with a woman. The experiments lasted for 20-28 weeks.

The efficacy of sildenafil versus placebo

Participants were issued sildenafil and harmless pills to study the placebo effect. Sildenafil citrate-based medications were used in all the marketed forms – 25, 50 and 100 mg, while placebo tablets were given in 50 mg dose. All the males were divided into 4 groups (the first three groups members were given sildenafil portions, while the fourth group received a placebo). The use of tablets took place every 3 days.

During the investigation, it was found that the patients treated with 25, 50 and 100 mg of sildenafil, enhanced their abilities to introduce the penis into the vagina by 60, 84 and 88%, respectively. In those on placebo, the rates grew by only 10 – 22%. The ability to maintain an erection in men taking sildenafil increased by 115, 129 and 130%, while placebo test participants patients demonstrated a modest 26%-growth result.

Side effects were still there (and they are indicated in the labels). Most often, the men complained of headache, dizziness, facial flushing due to the flushing and dyspepsia.

Just like indicated in the annotation, the efficacy of sildenafil depends on the conditions of its reception. The study showed that the best efficacy of sildenafil is observed if the tablet is taken at least 25-30 minutes before sexual intercourse on an empty stomach. The maximum dosage of 100 mg per day should not be exceeded to avoid the non-desired side effect, with no more than 1 dose per every 24 hours.

In addition, the study gave the answer that the greatest sildenafil efficiency is achieved not after a single use, but after regular use of medication (the best performance is observed after 7-10 intakes).