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Premature ejaculation

What is Premature ejaculation?

Premature ejaculation is ejaculation that occurs before sexual contact or after minimal stimulation. This can lead to the affected person feeling ill and the associated impairment of sexuality. Various criteria for differentiation have proven their worth.

There is an unwanted time from vaginal penetration to ejaculation of less than 1-2 minutes.

This period of time is also known as the “intravaginal ejaculation time” and should be measured for diagnostic purposes. For comparison, the average time to ejaculate in healthy men is approximately 5.4 minutes.

This short time until ejaculation is felt to be uncontrollable. The sufferer has the impression that he lacks the control to prevent very early ejaculation.

Negative personal consequences on the part of the person concerned are stated. This can be, for example, dissatisfaction, frustration, or fear, which can lead to avoidance of sexual interaction in the long term. Problems in the partnership can be both the cause and the consequence of the problem.

In addition, it must be ruled out that premature ejaculation is not triggered by external factors such as sexual abstinence, a new sexual situation, or substances such as drugs or medication.

Thus, in addition to the physical, premature ejaculation also has a crucial psychological component that needs to be considered and, if in doubt, treated. Studies have shown that the condition can ultimately lead to greater problems with a partner and often disrupts the relationship. Participants in this study indicated that even if they and their partners were generally satisfied with the sexual intercourse, it hindered their intimacy in the relationship.

How many men are affected by premature ejaculation?

Premature ejaculation is not uncommon, quite the opposite: it is the most common sexual dysfunction in men. Depending on the definition chosen, studies describe that approximately 20 to 30% of all men suffer from premature ejaculation.

The results of the studies differ relatively strongly in some cases, presumably because different definitions and questionnaires are used. A study on the subject showed that premature ejaculation is approximately the same in all age groups, the prevalence in men over 50 was slightly higher.

Despite the prevalence of this condition and various treatment options, very few men seek medical advice or attempt therapy. One study showed that only 9% of those affected consulted a doctor and those who did were not satisfied with the treatment. Why so few men who suffer from premature ejaculation confide in a medical professional is speculative. Perhaps shame plays a role before admitting to having a sexual problem. It is possible that many of those affected simply do not know that urology is a speciality that deals with such topics, amongst other things, and offers various therapy options to solve the problem. Therefore, there should be no hesitation in seeking medical advice and discussing possible therapeutic options together. Those who suffer from premature ejaculation are not alone and have different options to tackle the problem.

Causes of premature ejaculation

The causes of premature ejaculation are divided into psychogenic and physical.

Miscommunication, arguments, and stress with the relationship or sexual partner and the associated fear can lead to premature ejaculation. Unresolved conflicts can have a long-term negative impact on the prognosis with a psychological component.

Organic causes include a malfunction of the nervous system, which means, for example, excessive sensitivity of the glans. Premature ejaculation can also occur as a result of another underlying condition, such as prostatitis, erectile dysfunction, or thyroid disease.

In the case of erectile dysfunction, i.e. the limited or missing ability to get an erection and then maintain it, premature ejaculation is often an additional component. There is also a study that found that the time to ejaculation was reduced in participants with a certain innate variant of the transmission of the neurotransmitter serotonin. This is the so-called “happiness hormone”. This indicates that this limitation is at least partially inherited.

How is premature ejaculation diagnosed?

The primary means of diagnosing premature ejaculation is the individual’s medical and sexual history. For this purpose, the definition criteria mentioned above should be queried.

Of course, the time to ejaculation must be determined as a fixed value. It is said that this must be 1-2 minutes after entering the vagina to be able to make the diagnosis. Even if a slightly longer time is often perceived as unpleasant or insufficient by the person concerned, this is not considered premature ejaculation, strictly speaking.

In addition, however, the psychological component of the disease, for example, the self-perceived level of suffering, must also be used as a decisive criterion for making a diagnosis. For those affected, this is often the much bigger problem, which affects self-confidence and inner contentment.

Various questionnaires, which can be used to differentiate the disease relatively well, have proven to be useful tools for diagnosing premature ejaculation. This also makes it easier to choose between the different therapy options. It should be noted that in some cases an online diagnosis cannot replace personal contact with the doctor and that you should consult your family doctor or urologist in the event of acute symptoms.

Treatment by medications

Other medications used to treat premature ejaculation include long-acting serotonin reuptake inhibitors, which have an onset of action after 1-2 weeks. Thus, just like in the treatment of depression, these must be taken permanently for the desired effect.

In addition, the effectiveness of certain tricyclic antidepressants, which should be taken about 5 hours before sexual intercourse, has also been shown.

Studies have also examined the combination or sole therapy with PDE5 inhibitors, which are normally used for erectile dysfunction. A clear effectiveness, based on the extended time until ejaculation, could not be shown. However, they increased self-confidence, self-perceived ejaculation control, and overall sexual satisfaction, thereby reducing anxiety. They also shortened the time it takes to regain an erection after ejaculation.


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