Premature ejaculation (ejaculation)

Among the various ejaculation disorders, the most common is premature ejaculation (ejaculation) (ejaculation), and less common is the phenomenon of anejaculation.

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Epidemiology

Epidemiological studies, while not exhaustive, indicate that premature ejaculation (ejaculation) is one of the most common sexual dysfunctions, occurring in approximately 30% of men in the population. According to the All-Union Scientific and Methodological Center for Sexopathology, among all sexological patients, the main syndromes of ejaculation disorders were found in 20.4%.

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Causes premature ejaculation

Currently, the term "premature ejaculation" is universal; other names, in particular "accelerated ejaculation", have been excluded. However, there is no clear and generally accepted definition of this phenomenon.

The following definition of premature ejaculation is proposed. Premature ejaculation (ejaculation) (ejaculatio praecox) is an ejaculation that occurs constantly or episodically before the partners achieve satisfaction from sexual intercourse and less than 2 minutes after introjection and the beginning of continuous frictions of moderate frequency (25-30 per minute) and maximum amplitude, which causes psychological discomfort in sexual partners (the first two criteria are mandatory, the third is optional; only the forward movement of the penis is considered one friction).

Both psychogenic and organic factors can play a causal role in the development of premature ejaculation. The first group includes psychotraumatic effects, defects in upbringing, features of sexual experience, neurosis-like conditions, personality traits (accentuation, psychopathy). Organic influences can be a consequence of various disorders of the sexual, nervous and endocrine systems, as well as chronic intoxications, delayed puberty, and the use of certain medications. The significance of serotonin metabolism disorders in the brain and the functioning of 5-HT receptors in the genesis of premature ejaculation is actively discussed.

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Risk factors

Premature ejaculation is a polyetiological phenomenon. No obvious risk factors have been established.

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Forms

There is currently no generally accepted classification of premature ejaculation (ejaculation). The following classification of premature ejaculation (ejaculation) has been proposed in the literature:

• Etiological form.
  • Psychogenic.
  • Organic.
  • Combined (combination of psychogenic and organic causes.
• Period of occurrence
  • Original.
  • Acquired.
• Constancy of manifestation.
  • Constant.
  • Episodic.
• Dependence on the conditions of sexual intercourse.
  • Absolute.
  • Selective (situational).
• Degree (duration of the frictional stage of the copulatory cycle).
  • I degree - 1-2 min (30-60 frictions).
  • II degree - 30-60 sec (15-30 frictions).
  • III degree - 15-30 sec (7-15 frictions).
  • IV degree - up to 15 sec (several frictions).
  • Grade V - ejaculation before introjection.

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Diagnostics premature ejaculation

As a result of diagnostic measures, it is important to establish the following:

• does the patient suffer from premature ejaculation;
• the degree of severity of premature ejaculation;
• the cause of premature ejaculation, i.e. the pathological condition that caused it;
• whether the patient suffers only from premature ejaculation or it is combined with other types of sexual dysfunctions.

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Anamnesis

In premature ejaculation, as in other copulatory disorders, the patient's complaints are often the only or main data justifying the conclusion. It is advisable to begin diagnostics with a detailed conversation with the patient, collecting information about his general health and mental status. General and sexological anamnesis data are analyzed, as well as the state of the copulative function previously and at present.

The cardinal point at the first stage is the establishment of the very presence of premature ejaculation. The definition of this phenomenon formulated and given above will contribute to the answer to this question.

The nature of the disorder, its duration, the influence of individual factors and circumstances are specified. It is important to discuss in detail with the patient not only the duration of the frictional stage of the copulatory cycle, but also to characterize sexual desire, orgasm and the quality of erections. It is necessary to obtain information about the nature of the relationship with the sexual partner, previous consultations and treatment measures. A conversation with the patient's sexual partner is highly desirable. In order to objectify the patient's complaints and quantitatively characterize copulatory disorders, including premature ejaculation, as well as to save the doctor's time, it is recommended to use special questionnaires: the International Index of Erectile Function, the scale of quantitative assessment of male copulatory function, etc.

Analysis of the obtained data allows us to confirm with a sufficient degree of reliability the presence of premature ejaculation, establish its nature and assess the copulative function as a whole.

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Clinical diagnosis of premature ejaculation

The examination includes a general clinical assessment of the patient's condition, examination of his genitals and sexual constitution. It allows to detect or suspect the presence of urological diseases, in particular, inflammatory lesions of the genitourinary system, as well as hypogonadism or delayed puberty. Then a urological examination is performed, including a total urethroscopy, in order to detect or exclude chronic urethroprostatitis and colliculitis. If changes are detected that can cause premature ejaculation, and there are no signs of other diseases with a similar potential, then the examination is completed.

In situations where the urological factor is excluded, but there are manifestations of hypogonadism or delayed puberty, appropriate hormonal tests are carried out and then, possibly with the participation of an endocrinologist, a conclusion is made. If there are no diseases of the genitourinary and endocrine systems, the patient is subject to an in-depth neurological and psychological examination using modern functional tests. In the absence of disorders, premature ejaculation is recognized as idiopathic.

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Treatment premature ejaculation

Treatment of premature ejaculation (ejaculation) aims to achieve satisfaction from sexual intercourse by partners.

Treatment of premature ejaculation should be etiological and pathogenetic. If this approach is not effective enough or the disorder is recognized as idiopathic, then universal methods of correction of premature ejaculation are used. The general recommendation is that the frequency of sexual intercourse should be increased slightly, avoiding sexual excesses (ejaculation more often than once a day).

Compression and start-stop methods

The "squeezing" method proposed by the classics of sexology Masters and Johnson (1970) consists of the man or his sexual partner squeezing the penis with their fingers at the level of the coronary groove for 3-4 seconds as ejaculation approaches. This causes suppression of the ejaculatory impulse and a slight weakening of the erection. By practicing the method, a man acquires the ability to control the onset of ejaculation to a certain extent. A similar effect is achieved by the "start-stop" method, when a man periodically stops friction to reduce the level of arousal.

Drug treatment for premature ejaculation

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Local impacts

The essence of this approach is the use of anesthetics to reduce the sensitivity of the nerve structures of the penis. Medicines containing local anesthetics [benzocaine (anesthesin), lidocaine, etc.] in the form of ointment, gel or spray are applied in a thin layer to the penis in the area of the coronary groove (mainly in the frenulum area) 15-20 minutes before sexual intercourse. The method has a number of negative properties.

Oral medications

This therapeutic approach is based on the property of some antidepressants to delay the onset of ejaculation.

In clinical practice, tricyclic antidepressants that inhibit the reverse neuronal uptake of various neurotransmitter amines, such as clomipramine, and selectively suppress the reuptake of serotonin, have proven effective in premature ejaculation (ejaculation), and are used. This leads to its accumulation in the synaptic structures of the central nervous system and increased physiological activity. Fluoxetine, sertraline, paroxetine, etc. have similar properties. In mental disorders, these drugs are used for long-term course treatment. In cases of premature ejaculation (ejaculation), a single, situational intake of antidepressants is successfully used, which allows for the weakening of the general psychotropic effect.

Antidepressants used to treat premature ejaculation

Group	International Nonproprietary Name	Trade name	Dosage and administration regimen
Non-selective serotonin reuptake inhibitors	Clomipramine	Anafranil	25 mg 8-12 hours before sexual intercourse or course of therapy
Selective serotonin reuptake inhibitors	Fluoxetine	Prozac	10-20 mg 6-8 hours before sexual intercourse or course of therapy
	Sertraline	Zoloft	25-50 mg 6-8 hours before sexual intercourse or course of therapy
	Paroxetine	Paxil	10-20 mg 4-6 hours before sexual intercourse or course of therapy

It should be noted that the doses and regimen of taking antidepressants for the purpose of correcting premature ejaculation have not been developed in detail. It is necessary to take into account the possible side effects of these drugs. They are prescribed with caution to drivers of vehicles and persons whose professions are associated with increased concentration.

Complex treatment of premature ejaculation using the above methods is more effective due to the normalizing effect on all links in the pathogenesis of premature ejaculation.

Prevention

There is no specific prevention for premature ejaculation.

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Forecast

Individually selected combination treatment for premature ejaculation allows in most cases to achieve normalization of patients' sexual function.

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