Premature Ejaculation: Causes, Diagnosis, and Treatment Options

Contrary to what many people think, premature ejaculation is not a disease and there are many solutions to solve this problem.
Premature ejaculation is a common sexual problem among men, and the affected person reaches sexual satisfaction and ejaculation earlier than he expects during sex.
In the United States, 1 in 3 men aged 18 to 59 have premature ejaculation, which can be primary or acquired.
For many men, experiencing premature ejaculation can be stressful, and this problem can cause discomfort and embarrassment for these men and their sexual partners.
If premature ejaculation is caused by nervous pressure and stress, it is important to see a doctor.

How does ejaculation take place?

When a person is sexually stimulated, nerve messages are sent from the spinal cord to the brain, and the process of sexual stimulation and ejaculation is controlled by the central nervous system (brain).
If sexual stimulation reaches a certain level of excitement, the brain sends a nerve message to the reproductive system, causing the sudden release of semen and ejaculation.

Ejaculation consists of two stages of stimulation and elimination.

• Stage one stimulation

At this stage, the sperms move towards the prostate and combine with prostate secretions to form semen.

• The second step is ejaculation

Ejaculation occurs with the contraction of the muscles at the base of the penis and the release of semen.
In most cases, sexual satisfaction and ejaculation occur at the same time, although in some people, sexual satisfaction occurs without ejaculation.
After the end of this stage, the erection also disappears.

Definition of premature ejaculation

If the ejaculation occurs earlier than expected by the man or his sexual partner and is less than 2 to 3 minutes, it is called premature ejaculation.
Premature ejaculation is not a cause for concern, but it can be frustrating if it reduces the enjoyment of sex or affects the quality of the relationship.
In men who suffer from erectile dysfunction, premature ejaculation can be a double problem.
erectile dysfunction It is when men are unable to create or maintain an erection sufficient for sexual intercourse.
Since the erection disappears after ejaculation, this point can be used to distinguish premature ejaculation from erectile dysfunction.
In these cases, it is better to treat the erectile dysfunction first, because premature ejaculation may also be solved after the erectile dysfunction problem is solved.

Cause of premature ejaculation

The exact cause of premature ejaculation is not known, but there are many factors that can be involved in premature ejaculation.
There may be structural, chemical or psychological reasons.
Below are some of the more important reasons:

serotonin

serotonin It is a natural substance in the body that is made by the nervous system and helps the brain control and manage mood, emotions, sleep and libido.
High amounts of serotonin in the brain increase the time of ejaculation.
Small amounts can shorten the time of ejaculation and lead to premature ejaculation.

Psychological issues

Psychological or mental health issues can be associated with premature ejaculation and may include:

• depression

• anxiety

• stress

• feeling guilty

• Unrealistic expectations of sex

• Lack of self-confidence

• History of sexual repression

• Emotional relationship problems

Other causes of premature ejaculation

Premature ejaculation can occur at any age.
Aging is not a direct cause of premature ejaculation.
However, erectile dysfunction can occur more with age and may also be associated with low serum testosterone levels.
For some older men, the penis may not be as hard during an erection, or the erection may not last as long as it used to.
These changes can lead to premature ejaculation in men.

The effect of premature ejaculation on sex

Premature ejaculation may make a person angry, ashamed or upset about having sex with his wife and alienate him from his sexual partner.
Premature ejaculation not only affects the individual, but may also affect his life partner.
Therefore, it should be kept in mind that talking about the problem is an important step and counseling can have a beneficial effect.
There are different techniques to prolong sex and it is important that the husband and wife have a calm and stress-free relationship because worry and stress have a negative effect on premature ejaculation.

Diagnosis of premature ejaculation

It is normal for men to have some control over the timing of ejaculation during sex.
Premature ejaculation may be present if a man cannot control the timing of ejaculation and if this causes concern for the man or his sexual partner.
Issues that may help in diagnosis and treatment:

• Has premature ejaculation been there since the beginning or did it start recently?

• Does the problem only happen in a certain situation or all the time?

• Does premature ejaculation happen every time you have sex?

• The distance between sexual relations?

• How has premature ejaculation changed a person's sexual activity?

• How are the person's emotional relationships?

• Is there anything that makes premature ejaculation worse or better (eg, drugs, alcohol, etc.)?

Laboratory tests are needed only if the doctor has a specific diagnosis in mind.

Treatment of premature ejaculation

Psychotherapy, behavioral therapy (sexual exercises) and drugs are the main treatments for premature ejaculation.
The patient and the doctor can work together to choose the best treatment method.
Many people try more than one treatment at the same time.

psychotherapy

Psychotherapy works by influencing the feelings and emotions that may lead to problems in sexual relationships.
The goal of this type of treatment is to find the source of the problems and find solutions that may help cure premature ejaculation.
Psychotherapy helps couples become emotionally closer to each other and can reduce anxiety.
Psychotherapy also has a positive effect on the quality of sexual relationships by focusing on self-confidence and greater understanding about sexual issues.
This type of treatment can be used as the only treatment or it may be used along with drug or behavioral therapy.

behavioral therapy

Behavioral therapy includes exercises to help delay ejaculation.
These exercises include the method of pressing the head of the penis and the stop-start technique.
These methods usually work well, but they may not be a permanent answer and may not work for everyone.

The method of pressing the head of the penis

The purpose of this method is to make the person aware of the feelings that lead to orgasm.
In this method, when a person is close to ejaculation, squeezing the head of the penis will delay ejaculation and reduce erection.
This method can be useful in better control and delayed ejaculation.

Stop-start method

In this method, sex stops before satisfaction and resumes when control is gained.
This process is repeated three times and ejaculation happens on the fourth time.
Repeating this method over time gives a person more control over ejaculation.

Drug treatment of premature ejaculation

No drug has yet been approved for the treatment of premature ejaculation.
However, there are a number of numbing medications, creams, and sprays that can improve premature ejaculation.
Antidepressants cause delayed ejaculation and some doctors use these drugs to treat premature ejaculation.
Medicines such as clomipramine, fluoxetine, paroxetine, sertraline and tramadol affect serotonin levels and can also affect sex.
If one medication doesn't work, your doctor may suggest you try another.
Drugs used to treat prostate enlargement can also be used for premature ejaculation, these drugs may cause ejaculation dysfunction such as retrograde ejaculation.

Premature ejaculation drugs can be taken every day or just before sex.
The doctor will suggest the time to take the medicine based on the level of sexual activity of the person.
The best time to take the medicine is not known, most doctors suggest two to six hours before sex.
If these drugs are stopped, premature ejaculation can return.
Most men with premature ejaculation need to take these drugs continuously.

Numbing creams or sprays

Numbing creams and sprays can be used on the penis about 20 to 30 minutes before sex.
If the numbing cream or spray is used for longer than recommended, the erection may be lost.

Also, numbing cream or spray should not be left on the penis during vaginal sex because it may cause vaginal numbness, and to prevent this from happening, the numbing agent should be washed off the penis five to ten minutes before sex.
Using a condom can also prevent vaginal numbness and protect against sexually transmitted diseases and pregnancy.

Summary

Premature ejaculation is one of the common sexual problems in men that can negatively affect the quality of sex and the satisfaction of couples.

This problem occurs for various reasons, including psychological, biochemical and sometimes structural factors. There are various treatment methods, including psychotherapy, behavioral therapy, and drug therapy, that can help reduce or eliminate this problem.

Also, the use of special techniques, such as the stop-start method and the method of pressing the head of the penis, are effective in controlling ejaculation better. Since premature ejaculation can have emotional and social consequences, it is very important to consult a doctor and follow up with appropriate treatment.

Frequently asked questions