Premature ejaculation

Premature ejaculation (ejaculatio praecox) is a common and poorly understood sexual disorder, often causing sufferers to avoid intimacy as well as sexuality. The term ejacuatio praecox comes from Latin and means "premature ejection".

According to the international ICD-10 disease classification, premature ejaculation is the inability to control ejaculation in a way that allows both partners to have satisfactory sexual intercourse. Ejaculation occurs before or during penetration in more than 75% of those affected.

The condition can be divided into a primary and a secondary form:

1. Primary premature ejaculation has usually existed for a long time when it is first diagnosed by a urologist. It is congenital or the affected person has always had an intravaginal ejaculation time of less than one minute.

2. The secondary form of the disease arises due to various causes such as hormonal changes or changes in the penis. This form is often accompanied by erection problems (erectile dysfunction).

Individual psychosexual well-being plays a major role in premature ejaculation. The average intravaginal ejaculation time of men across all age groups is 7 minutes.

Premature ejaculation can be both physical and psychological. Therefore, physical, medicinal and also psychotherapeutic treatment options should be considered for therapy.

Possible psychological causes of premature ejaculation:

• Sexuality disorders

• Anxiety disorders

• Reflexes from the onset of sexuality in adolescence

• A restrictive upbringing regarding sexuality as a child

• Unrealistic expectations or ideas about sexuality

• Sexual achievement thinking

The secondary form of premature ejaculation is often caused in men by steroid use (e.g., weight training). The excess testosterone causes hormonal changes and eventually premature ejaculation. Medications, such as opioids or sympathomimetics, can also cause premature ejaculation. Organic risk factors for the disease are urinary tract infections or diabetes mellitus.

Affected individuals often suffer from a reduced quality of life and unsatisfactory sexuality and intimacy. Premature ejaculation can put a strain on a partnership and lead to avoidance of sexual activity. Although the condition causes significant distress, few sufferers seek medical help.

There are various options for the treatment of premature ejaculation, whereby different treatments often have to be tried until an improvement is achieved. Initially, the urologist usually prescribes a cream containing a local anesthetic, which is applied before sexual intercourse. Local anesthetics such as lidocaine or prilocaine are active ingredients that numb the skin and reduce sensitivity on the penis. The use of this cream is based on the assumption that the tip of the penis of men with premature ejaculation is too sensitive.

The Squeeze Technique:

A mechanical therapy option for treating the condition is called the squeeze technique. Its application is intended to reduce the bloodiness in the corpus cavernosum by interrupting sexual intercourse and, on the other hand, by applying pressure on the glans. However, most of the time its application alone does not show satisfactory results.
Since premature often has a psychological component as its cause and triggers massive suffering, psychotherapy is an integral part of the therapy.

Psychotherapeutic procedures:

• Sex therapy

• Couples therapy

• Cognitive behavioral therapy (KVT)

• Family therapy

Drug therapy options:

Classic sexual enhancers such as phosphodiesterase V inhibitors (PDE-5 inhibitors) can also be used to treat premature ejaculation. Active ingredients of this group include sildenafil or tadalafil. Their use is currently "off-label", meaning that although an effect is being discussed, the drug is not officially approved for the indication of premature ejaculation. Currently, there are two different theories for the use of PDE-5 inhibitors in premature ejaculation:

1. A central nervous mechanism of action, as it has been demonstrated that within the ejaculatory reflex, the PDE-5 enzyme is important in signal transduction.

2. A peripheral mechanism of action, as smooth muscle cell relaxation results in delayed ejection of seminal fluid into the posterior urethra.

Selective serotonin reuptake inhibitors (SSRIs) such as sertraline or paroxetine, which are used to treat depression, also cause delayed ejaculation as a side effect. However, because they must be used long-term, short-acting SSRIs such as dapoxetine are more suitable for "off-label" treatment of the condition. However, the risk-benefit ratio is critically discussed.

The prognosis of premature ejaculation varies from individual to individual, with the secondary form being more treatable overall. In this case, the symptoms often improve rapidly after the cause has been eliminated (e.g. cessation of steroid use, opioid use or after treatment of penile changes).