Early ejaculation or ejaculatio praecox (PE) indicates premature semen expulsion in men. The duration of the erection is usually insufficient for a normal relationship. In extreme cases, ejaculation occurs even before penetration into the vagina, which can be a hindrance to normal fertilization.
The International Society for Sexual Medicine (ISSM) has given a new definition of premature ejaculation; as sexual dysfunctions of men, in which ejaculation occurs always or almost always less or within one minute after vaginal penetration. This means the inability to delay ejaculation in all or almost all vaginal penetrations.
This condition has negative subjective consequences, such as frustration, restlessness and avoidance of sexual relations.
The frequency of early ejaculation varies from study to study which has been due to different definitions of premature ejaculation until now. The highest frequency of 31% in men aged 18 to 59 was found in a 1999 US NHSLS study. The British questionnaire shows a frequency of 14%, and the lowest percentage of 9% was shown by a Swedish study also from 1999.
According to the length of duration, they are divided into long-term (from the beginning of sexual activity) and acquired, which occurred after a period of normal sexual activity. The latter are usually of a milder intensity, in other words, the relationship is nevertheless longer compared to long-term ones.
Although it has a significant effect on quality of life, a small percentage of men seek professional advice, most often for the sake of shame or realization that there is no cure for this ailment.
Little is known about patophysiology PE. Multiple hypotheses were raised, such as anxiety, hypersensitivity of the penis and dysfunction of 5-HT receptors in the central nervous system. It is relatively common in patients who have erectile problems, with patients citing less frequent or weaker penile stiffening. The causes of weaker potency can be numerous (neurogenic, vascular, hormonal, psychogenic or their combination). By solving the cause and achieving a good erection, the problem of early ejaculation usually disappears. Isolated early ejaculation, with an otherwise neat erection, is a relatively less common problem. It is too strong stimulation of the ejaculation center in the cortex of the brain and the part of the brain called the hypothalamus.
The diagnosis is primarily based on the patient’s history. The clinical examination focuses on the diagnosis of possible accompanying causes such as urethritis or prostatitis, Peyronie’s disease or endocrine disorders. Laboratory analyses are directed in the diagnosis of these conditions, while specific treatment for PE is not recommended.
Treatment is symptomatic.
The first is psychological – behavioral counseling as recommended by Masters and Johnson. There are two techniques here. Start-stop technique, whereby a partner is expected to stop sexual activity immediately before ejaculation.
Squeeze the technique, in which it is necessary to squeeze the glans tightly with your fingers just before ejaculation and wait for the stimulus to pass. Both techniques require the cooperation of a partner, and therefore are rarely applicable in younger patients who have transient connections. One option for this group is masturbation before intercourse, which makes the penis less sensitive at the next relationship. The overall success of these methods is seen in about 50% of patients, but the exact number is probably lower, since a certain part of the subjects take other drugs for this problem.
The second are surface anesthetics:
1. Lidocain-prilocain cream
Several independent randomized studies have shown that smearing penis glans 20-30 minutes before intercourse can lead to an extension of ejaculation time from 1.49 to 8.45 minutes (6.7 minutes). A condition for use is the use of condoms during intercourse or penis rinsing immediately before intercourse, so that the preparation does not cause vaginal insensitivity. Frequent use of this agent can result in impotence due to reduced sensitivity of the glans.
2. Another drug from this group is SS cream, which is a herbal extract of 9 herbs. One study showed that it extends ejaculation time from 1.3 to 10.7 minutes.
3. Selective serotonin resorption inhibitors (SSRIs) are the third. These are drugs that have been widely used in the treatment of depressive conditions since 1970. It has been observed that taking these drugs every day favorably affects the change in the patient’s mood, but also that they extend the time until ejaculation. Today they represent the first drug of choice in the treatment of PE. Most often used fluoxetine, paroxetine and sertraline, which all have a similar action, but not the same effect. Paroxetine and sertraline are better than fluoxetine. In various studies it has been shown that these drugs can extend the time to ejaculation 2.6 to 13.2 times. The effect is seen already a few days after the start of taking it, but it is better expressed after a week or two. These drugs are intended for multi-year intake, but it has been observed that after 6-12 months the effect begins to weaken to develop resistance to the drug. Inconvenient sides of these drugs include malaise, dizziness, yawning, nausea and vomiting, dry mouth, diarrhea and sweating. All these phenomena are usually of mild intensity and spontaneously decrease 2-3 weeks from the beginning of taking.
The latest from this group of drugs is dapoxetine, which is used as needed, not continuously. So, it is recommended to take the drug 1-3 hours before intercourse. Different studies offer a different effect of this drug on the extension of the erection from 1.9 to 3.5 minutes, depending on the dose. Better results are observed 12-24 weeks from the beginning of use of the drug. Like the previous SSRIs, this one can cause nausea, dizziness, headache and diarrhea, but they are of low intensity. An essential advantage of this drug is the speed in achieving the maximum concentration in plasma, that is, rapid elimination from the organism, thereby significantly reducing the intensity of any side effects. The initial therapeutic dose is 30 mg and can be increased to 60 mg if necessary, with appropriate caution, that with a higher dose and side effects may be slightly more pronounced.
At this time, it is not recommended to take dapoxetine and PDE5 inhibitors (Viagra, Levitra, Cialis, etc.) at the same time.
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