Premature ejaculation (ejaculation)

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

[1], [2]

Epidemiology

Epidemiological studies, not being exhaustive, suggest that premature ejaculation (ejaculation) - one of the most common sexual dysfunctions - occurs in about 30% of men in the population. According to the materials of the All-Union Scientific and Methodological Center on Sexopathology, among the sexological patients the main syndromes of ejaculatory disorders were in 20.4%.

[3], [4], [5], [6], [7], [8]

Causes of the premature ejaculation (ejaculation)

At present, the term "premature ejaculation (ejaculation)" is universal; other names are excluded, in particular "accelerated ejaculation". However, there is no clear and generally accepted definition of this phenomenon.

The following definition of premature ejaculation (ejaculation) is proposed. Premature ejaculation (ejaculation) (ejaculatio praecox) - ejaculation, constantly or occasionally occurs before the partners achieve satisfaction from sexual intercourse and less than 2 min after introjection and the beginning of incessant frictions of moderate frequency (25-30 per minute) and maximum amplitude , which causes mental discomfort in sexual partners (the first two criteria are mandatory, the third - optional, for one friction only the penile movement is accepted).

The causal role of the development of premature ejaculation (ejaculation) can play both psychogenic and organic factors. The first group should include psychotraumatic effects, education defects, features of sexual experience, neurosis-like conditions, personality traits (accentuation, psychopathy). Organic effects can be the result of various abnormalities from the sexual, nervous and endocrine systems, as well as chronic intoxications, delayed puberty development, and the intake of certain medications. Actively discuss the importance in the genesis of premature ejaculation (ejaculation) of the disorders of serotonin metabolism in the brain and the functioning of 5-HT-receptors.

[9], [10]

Risk factors

Premature ejaculation (ejaculation) is a polyethological phenomenon. No obvious risk factors have been established.

[11], [12], [13], [14], [15], [16], [17], [18]

Forms

The conventional classification of premature ejaculation (ejaculation) does not currently exist, the literature suggests the following classification of premature ejaculation (ejaculation)

• The etiological form.
  • Psychogenic.
  • Organic.
  • Combined (combination of psychogenic and organic reason.
• Period of occurrence
  • Primordial.
  • Acquired.
• Consistency 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 seconds (15-30 frictions).
  • III degree - 15-30 seconds (7-15 frictions).
  • IV degree - up to 15 s (several frictions).
  • V degree - ejaculation before introjection.

[19]

Diagnostics of the premature ejaculation (ejaculation)

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

• whether the patient suffers premature ejaculation;
• severity of premature ejaculation (ejaculation);
• the cause of premature ejaculation (ejaculation), i.e. Caused her pathological condition;
• whether the patient suffers only by premature ejaculation or it is combined with other types of sexual dysfunction.

[20], [21], [22], [23]

Anamnesis

With premature ejaculation (ejaculation), as with other copulative abnormalities, the patient's complaints are often the only or basic data that justify the conclusion. Diagnosis is advisable to begin with a detailed conversation with the patient, collecting information about the state of his health in general and mental status. Analyze the data of the general and sexological anamnesis, as well as the state of the copulative function earlier and at the present time.

The cardinal moment in the first stage is the establishment of the very presence of premature ejaculation (ejaculation). The definition of and the above definition of this phenomenon will contribute to the answer to this question.

Clarify the nature of the violation, its prescription, the impact of certain factors and circumstances. It is important to discuss in detail with the patient not only the duration of the frictional stage of the copulatory cycle, but also characterize the sexual desire, orgasm and the quality of erections. It is necessary to obtain information about the nature of the relationship with the sexual partner, prior consultation and treatment. Talking with the partner's sexual partner is highly desirable. In order to objectify the patient's complaints and quantify the characteristics of copulative violations, including premature ejaculation, and save time, the doctor recommends using special questionnaires: the International Index of Erectile Function, the scale of quantitative evaluation of the male copulatory function,

The analysis of the obtained data allows to confirm with a sufficient degree of reliability the presence of premature ejaculation (ejaculation), to establish its character and to estimate the copulative function as a whole.

[24]

Clinical diagnosis of premature ejaculation (ejaculation)

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

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

[25], [26], [27],

Treatment of the premature ejaculation (ejaculation)

Treatment of premature ejaculation (ejaculation) pursues the goal - the achievement of partners satisfaction from sexual intercourse.

Treatment of premature ejaculation (ejaculation) should be etiological and pathogenetic. If this approach is not effective enough or the violation is recognized as idiopathic, then universal methods of correction of premature ejaculation (ejaculation) are resorted. The general recommendation is. That it is necessary to increase a little the frequency of sexual intercourse, avoiding sexual excesses (ejaculation more often than once a day).

Methods of "compression" and "start-stop"

The method of "compression" suggested by the classics of sexology Masters and Johnson (1970) is that. That a man or his sexual partner at the approach of ejaculation compress the penis with fingers at the level of the coronal sulcus for 3-4 seconds. This causes suppression of the ejaculatory pulse and a slight weakening of the erection. By practicing the method, a man acquires the ability to some extent control the onset of ejaculation. A similar effect is achieved by the "start-stop" method, when a man periodically stops frictions to reduce the level of excitement.

Drug treatment of premature ejaculation (ejaculation)

[28], [29], [30]

Local impacts

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

Oral preparations

At the heart of this therapeutic approach is the property of some  antidepressants to  delay the onset of ejaculation.

In clinical practice, premature ejaculation (ejaculation) has been shown to be effective and use tricyclic antidepressants that inhibit reverse neuronal capture of various neurotransmitter amines, for example clomipramine, and selectively inhibit serotonin reuptake. Which leads to its accumulation in the synaptic structures of the central nervous system and the enhancement of physiological activity. Similar properties have fluoxetine, sertraline, paroxetine, etc. With mental disorders, these drugs are used for long-term treatment. In cases of premature ejaculation (ejaculation), a single, situational intake of antidepressants is successfully used, which makes it possible to weaken the general psychotropic.

Antidepressants used to treat premature ejaculation (ejaculation)

Group	International Nonproprietary Name	Tradename	Doses and mode of admission
Non-selective serotonin reuptake inhibitors	Clomipramine	Anafranil	25 mg for 8-12 hours before sexual intercourse or course of therapy
Selective serotonin reuptake inhibitors	Fluoxetine	Prozac	10-20 mg for 6-8 hours before sexual intercourse or course of therapy
	Sertraline	Zoloft	25-50 mg for 6-8 hours before sexual intercourse or course of therapy
	Paroxetine	Paxil	10-20 mg for 4-6 hours before sexual intercourse or course of therapy

It should be noted that the dose and regimen of antidepressants for the purpose of correcting premature ejaculation (ejaculation) have not been elaborated in detail. It is necessary to consider possible side effects of these drugs. They are appointed with caution to drivers of vehicles and individuals whose occupations are associated with increased concentration of attention.

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

Prevention

Specific prevention of premature ejaculation (ejaculation) is absent.

[31], [32], [33], [34], [35], [36]

Forecast

Individually selected combined treatment of premature ejaculation (ejaculation) allows in most cases to achieve the normalization of the sexual function of patients.

[37], [38]