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For men, premature ejaculation (ejaculatio praecox) is often a disaster. Not only that male pride often suffers greatly from this sexual dysfunction, it also ends intercourse much too early, which deprives both partners of the sensual experience of intimacy. In the long term, ejaculatio praecox can lead to an unfulfilled sex life in the partnership and the associated tensions. For the man concerned, premature ejaculation is also associated with great psychological suffering, which can severely impair self-esteem. According to studies, between 20 and 40 percent of all men are affected by this functional disorder, although mostly out of false shame, not all patients seek the way to a urologist. But how does premature ejaculation occur and how can you counter it? Our contribution to the topic provides information.
Male ejaculation usually takes place at the peak of sexual arousal, which normally builds up slowly during sexual intercourse. In this context, ejaculation occurs in a healthy man an average of 5.4 minutes after the penis penetrates the vagina. However, in patients suffering from ejaculatio praecox, ejaculation occurs much earlier. According to the current medical guidelines, this is referred to as premature ejaculation if the following criteria are met:
- Ejaculation always or almost always takes place within one minute after the male member has been inserted into the vagina.
- The patient is always or almost always unable to delay ejaculation after vaginal penetration.
- In the context of the dysfunction, serious problems arise in the sexual life of the person concerned, for example due to psychological suffering or sexual frustration.
A basic distinction must also be made between different forms of the symptoms, which depend on the duration and the path of origin of the malfunction. In this context, primary ejaculation praecox describes a lifelong dysfunction that exists from the beginning of sexual activity in adolescence or adulthood and that cannot be controlled even during masturbation. A secondary ejaculatio praecox, on the other hand, describes an acquired premature ejaculation, for example due to diseases of the male genital organs or psychological aspects. This form can come to an end through the treatment of the basic complaints and is therefore often limited in time.
How does premature ejaculation develop?
The ejaculation is controlled by the so-called sexual center of the central nervous system. However, as has long been assumed, this is not a specific, independent brain center, but rather different areas of the brain and spinal cord that jointly control sexual function. A highly complex process that works as follows:
Through the stimulation of sympathetic nerve cells in the lumbar region of the spinal cord, the brain and spinal cord areas combined as a sexual center send muscle contractions to the epididymis, vas deferens and the accessory sex glands of the man. This happens via certain nerve fibers, which send contraction signals to the smooth muscles around the testicle area. In addition to the nerve fibers in the lower abdominal network (inferior hypogastric plexus), a sympathetic nerve network that serves to feed the intestines and the pelvis, the lower abdomen nerve (nerve hypogastricus) that arises from the above-mentioned network is also involved in the formation of contractions. It normally inhibits urinary bladder emptying and thus prevents urinary incontinence. In the case of male ejaculation, on the other hand, it takes on rhythmic contraction functions that support the sperm flow.
The contractions in the lumbar region gradually move the sperm out of the testicles towards the urethra. There the sperm is initially enriched with glandular secretions. During this process, the male limb is permanently stiffened, which facilitates the sperm flow. The sciatic or buttock muscle (ischiocavernosus muscle) is largely responsible for strengthening the erection (during the emission). In the tense state, it exerts a compression on the base of the male erectile tissue, which increases the blood pressure in the penis and thus enables an erection. The pubic nerve (pudendal nerve), which runs in the pelvic cavity towards the pelvic floor, is responsible for the contraction of the muscle.
The intermittent expulsion of the sperm is caused by further, reflective muscle contractions of two muscle sections. These are the urethral and erectile tissue muscles. While the urethral muscle (urethral muscle) usually serves as the sphincter of the urethra and thus the retention of the urine, the erectile tissue muscle (bulbospongiosus muscle) in the urethra is specifically responsible for the rhythmic contractions during orgasm. The interaction of both muscles leads to three to ten arbitrary contraction impulses, which cause the sperm to be released in batches. The urethral muscle and bulbospongiosus muscle are again supplied by the pubic nerve.
The highly differentiated interplay of muscles and nerves in the run-up to ejaculation does not make it difficult to guess that ejaculation disorders and thus premature ejaculation can easily occur with nervous impairments. As previously assumed, this need not necessarily be based on psychological causes, even though the psyche of the man certainly plays a role in many cases. Physical causes, for example in the form of nerve damage or other impairments of nerve function, are also conceivable as triggers. Below is a brief overview.
The list of possible psychological causes for premature ejaculation is very long. Ejaculatio praecox is often preceded by an enormous stress load, such as that caused by
- Performance thinking,
- sexual childhood trauma,
- Disorders in early childhood sex education,
- unrealistic sex ideas
- or fear of failure.
All of these psychological aspects put pressure on those affected, which can then manifest physically in an excessive ejaculation reaction. A good example of this is teenagers' fear of being caught masturbating. If this fear persists for a certain period of time, an trained ejaculatio praecox can develop from it.
The longer the functional disorder persists due to psychological influences, the more some of the factors mentioned (e.g. fear of failure or pressure to perform) can be increased. In this way, a mental vicious circle arises from mental stress during sex and the resulting premature ejaculation. The partner's behavior can also have a strong impact on this. For example, if the partner reacts with frustration or anger at the ejaculatio praecox, this increases the psychological stress enormously.
Diseases of the male genital organs
With regard to the physical causes of premature ejaculation, inflammatory genital diseases should first be mentioned. The inflammation associated with such an infection is a permanent irritation of the sensitive nerves and muscles in the urethra of the man, which can contribute to excessive muscle contractions as part of the sexual act. Typical inflammatory diseases that repeatedly lead to a secondary ejaculatio praecox
- Inflammation of the glans (balanitis),
- Inflammation of the urethra (urethritis),
- Inflammation of the prostate (prostatitis).
Erectile dysfunction is also conceivable as the cause. This leads to a reduced erection ability of the penis, which can sometimes lead to premature termination or ejaculation. Likewise, hypersensitivity of the penile skin, for example due to a shortened penis band (frenelum breve), can trigger increased contractility in the urethra and thus trigger ejaculatio praecox.
Diseases of the nerves
A disturbed signal line of the nerves, which triggers premature ejaculation in the course of sexual intercourse, can of course also be caused by neurological diseases. For example, a nervous disorder such as multiple sclerosis comes into question. The disease leads to chronic inflammatory processes on the medullary sheaths of the central nervous system, which sooner or later causes neurological dysfunctions that do not stop at the urethral and penile nerves. Spasticity is also conceivable, i.e. muscle spasms that transport the sperm into the urethra too quickly through voluntary muscle contractions and thus shorten the ejaculation time.
The body's own hormone activity during premature ejaculation is often underestimated. An increased serotonin level in particular can enormously favor ejaculatio praecox. The hormone is heavily involved in the development of ejaculative muscle processes. If there is too much serotonin in the body, this can speed up the processes.
Diseases such as diabetes mellitus and certain medications that influence sympathetic activity (e.g. opiates and sympathomimetics) cannot be ruled out as causes. In addition, some doctors now suspect genetic factors in cases of primary forms of premature ejaculation. As a result, the dysfunction could be a relic of prehistoric days in which rapid ejaculation was necessary for those males who had no alpha role and could therefore only reproduce within the "herd" through a rapid, unnoticed sexual act. In this context, it is also discussed whether premature ejaculation is not a lack of evolutionary adaptation rather than a functional disorder.
The cardinal symptom is of course the premature ejaculation itself, which occurs one to a maximum of two minutes after the male member has penetrated the female vagina. Depending on the underlying cause, ejaculation may also be accompanied by pain, cramps or even bleeding (e.g. in the case of urethritis or spasms). Mention should also be made of the accompanying psychological complaints in the event of a persistent dysfunction. A special sense of suffering that endangers self-esteem and harmony in partnership is common for patients with ejaculatio praecox. In addition, there are potential barriers to social interaction with the female gender and associated difficulties in finding a partner. Overall, the following symptoms can be expected with premature ejaculation:
- premature ejaculation,
- Pain or cramps while ejaculating,
- Blood in the sperm,
- low self esteem,
- Fear of failure,
- tensions and conflicts based on partnership,
- unfulfilled sex life,
- social barriers,
- mental stress to depression.
Men who suffer from premature ejaculation are strongly advised to seek the help of a urologist. In many cases, the malfunction can be treated with suitable measures as soon as the cause has been found. For the examination, the attending doctor first carries out a detailed medical history. As part of the patient consultation, the points of criticism are asked here, which must be fulfilled in order to speak of ejaculatio praecox. It is asked about the time period between the penetration and the ejaculation, as well as your own control ability to delay the ejaculation and the suffering that is connected with the sexual inability. In addition, possible psychological factors are asked, such as incisive sexual experiences in childhood and adolescence of the patient or stress factors such as pressure to perform and fear of failure.
It is very important that affected men answer honestly here and give the doctor the best possible insight into their attitude and any sexual trauma, no matter how banal at first glance. Because often subconscious aspects act here, the original triggers of which the patient may have long suppressed. It may also be necessary to interview the partner to find out how much premature ejaculation affects the private life of the person concerned and their partner. All in all, the patient and possibly his partner should prepare themselves for answering the following questions:
- How long does it take for ejaculation after penile penetration?
- Can ejaculation be controlled or not?
- Does premature ejaculation trigger psychological stress?
- When did premature ejaculation occur for the first time?
- Did you have sexual experiences before the ejaculatio praecox?
- Is premature ejaculation stressful for the partner?
- Does premature ejaculation create conflict within the relationship?
- Does sex avoid?
To determine possible physical causes, the responsible urologist also inquires about accompanying symptoms such as pain or swelling and existing medical conditions. Depending on the suspicion, physical examinations and imaging procedures can then be used to find the cause. In the case of inflammation of the urethra, prostate or glans, a smear may be taken, for example. Blood tests are carried out for diabetes mellitus and reflex tests for nervous disorders.
There are various treatment approaches for treating premature ejaculation. Sex therapy measures and behavioral training as well as home remedies, initiative and medication are conceivable. In principle, the procedure depends heavily on the underlying causes. Overall, patients have the following options:
If there are psychological causes, the responsible physicians will order sexual or couple therapy. In the context of a conversation therapy, psychological stress can be reduced, sexual trauma can be processed and positive dealing with the problem in partnership can be promoted. It is important to deal with the complaint on both sides. The partner should not put additional pressure on the patient unless success is achieved immediately. Encouragement and good persuasion, as well as the partner's backing that there are no expectations or benefits, are incredibly important.
In addition to talk therapy, targeted behavioral training can also take place, which gives the man concerned more control over his ejaculation. The stop-start method and the squeeze technique according to Masters and Johnson are known here, for example.
The gynecologist William Howell Masters and the psychologist Virginia Eshelman Johnson are considered pioneers who first comprehensively studied human sexual behavior in the 1950s and 1960s. They also discovered that prior to ejaculation there is a kind of plateau phase in which the excitation is kept constant before it reaches the so-called "point of no return" at which the ejaculation can no longer be stopped.
In the context of premature ejaculations, Masters and Johnson invented a technique based on these observations that men should learn to use breathing exercises (deep inhalation and exhalation to improve nerve relaxation), position and movement changes during sexual intercourse to reduce the stimulation so that the The plateau phase lasts longer and the point of no return occurs later. The goal is to ejaculate after about 15 to 20 minutes. This should be practiced several times a week, because frequency and routine can also have an influence on the time of ejaculation.
It should be mentioned that this measure mostly only helps with secondary forms of premature ejaculation. Primary and thus chronic forms generally do not react to this stop-start technique, if at all. Certain nerve and muscle disorders also respond to such techniques only to a limited extent. Often, medication or other treatment measures have to be used here.
This technique was also developed by William Masters and Virginia Johnson. The word squeeze comes from the English and means “press” or “squeeze”. Accordingly, the muscular contractions located there should be soothed by targeted pressing or pressing of certain penis areas (e.g. shaft or glans) that the ejaculation reflex is delayed or even completely interrupted. Again a technique that is unfortunately often only helpful for secondary ejaculation praecox, but is definitely worth trying here.
Training the pelvic muscles through targeted pelvic floor exercises can also be helpful in ejaculatio praecox. Strengthening the pelvic muscles also increases the ability to control precisely those muscle sections, which allows improved control of the ejaculation process. A recent study also suggests that physical activity can generally lower the risk of premature ejaculation. Researchers came to the conclusion that on average, fewer men who exercise were significantly more likely to suffer from ejaculatio praecox than physically active men. Again, the reason for this is the increased ability to control the muscle areas responsible for ejaculation through targeted muscle training.
Another home remedy is to masturbate before the actual sexual act. Experience has shown that the repeated excitability of the penis is delayed by the first ejaculation, which enables a longer stamina.
It is also always recommended to consciously think of something completely unotic during sexual intercourse in order to reduce arousal and thus to delay ejaculation. Basically, it is important that those affected do not put any psychological pressure on themselves during sexual intercourse. The resulting tension and nervousness greatly favor premature ejaculation, which is why it makes sense to take conscious relaxation exercises in the form of yoga, sound therapy or meditation.
In the case of premature ejaculation, active ingredients from the area of local anesthetics (local anesthetics) are used as medication. These include, for example, gels, ointments and sprays with ingredients such as benzocaine, dapoxetine, lidocaine or prilocaine. They are applied to the penis approximately 20 to 30 minutes before sexual intercourse and are then intended to delay ejaculation by reducing penile excitability. In the meantime, there are also special condoms that are provided with appropriate active ingredients.
In the case of an elevated serotonin level, so-called serotonin reuptake inhibitors (SSRIs) can also be used. According to the name, they inhibit the release of serotonin and thus slow down the ejaculation process. Classic active ingredients in this regard are citalopram, fluoxetine, paroxetine and sertaline.
Occasionally, other medications are used in drug treatment that list inhibition of ejaculation ability as reported side effects. These include tricyclic antidepressants (e.g. clomipramine), alpha and beta blockers. However, it should be noted that such strong medications are subject to a prescription and may only be used for treatment after express medical prescription. In addition to a reduced ejaculation function, the drugs also harbor the risk of other side effects such as orgasm or erectile dysfunction, complete loss of libido or genital numbness, which could only further impair the patient's sex life.
Depending on the underlying cause of the disease, other medications are conceivable. In the case of inflammation of the glans, urethra or prostate there is, for example, the possibility of treating the inflammatory disease and the associated ejaculation disorder with anti-inflammatory preparations and antibiotics. Diseases such as diabetes mellitus require the use of insulin, although there is no guarantee that premature ejaculation can also be treated. As is well known, diabetes is a lifelong illness that has not yet been completely curable. The same applies to multiple sclerosis and chronic forms of erectile dysfunction.
When it comes to herbs to improve sex life, there is often talk of aphrodisiacs. These stimulate libido and help to improve erection. With premature ejaculation, however, herbs are more needed, which do the exact opposite and curb the arousal. We are talking about so-called anaphrodisiacs. You can find such herbs in abundance. Some of them, such as valerian, are used as sedatives by default. Other anaphrodisiacs, like the chaste tree, did not get their name by chance, since in the Middle Ages the plant was traditionally used by monks and other clergymen to keep their sexual arousal under control while devoted to celibacy. All in all, the following anaphrodisiacs are recommended for Ejaculatio praecox.
- Chaste tree,
- Water lilies.
For example, the herbs can be prepared as a soothing tea or used as an additive for a meditative hip bath.
Surgical interventions for premature ejaculation are still very experimental in this country. In other countries, such as South Korea, so-called selective dorsal neurectomy (SDN), on the other hand, has long been part of the standard repertoire of treatment options. In doing so, nerve strands are cut through in a targeted manner, which lead to excessive excitability and thus remedy the ejaculation praecox in the long term.
Surgery for premature ejaculation may also be necessary if there is a shortened foreskin band. Under local anesthesia, the ribbon can be easily cut with a small incision, which in many cases ends the ejaculative dysfunction. However, it should be ensured that the operation is only carried out by professional surgeons, since errors in treatment can lead to permanent loss of sensation on the glans. (ma)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Miriam Adam, Dr. med. Andreas Schilling
- Kostas Hatzimouratidis et al .: Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation, European urology, (retrieved on June 24, 2019), European urology
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- Ahmed Hamed et al .: Prevalence of premature ejaculation and its impact on the quality of life: Results from a sample of Egyptian patients, Andrologia, (retrieved on June 24, 2019), Wiley
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