8 December 2020 Author : Nuno Tomada Marques This control inability to delay ejaculation in all or almost all vaginal penetrations results in negative effects , both personal and for the couple, such as: Anxiety; Difficulty in interpersonal relationships; Annoyance; Frustration; Avoiding sexual intimacy. Premature ejaculation is the most common sexual dysfunction in men, though it is also the one that is less diagnosed and treated. The shame and ignorance surrounding this topic, as well as the lack of medical guidance certainly contributes this. It can affect 20% to 30% of men (one in five). Even so, only around 9% of patients suffering with premature ejaculation seek help. Primary premature ejaculation is not associated with age or factors like social status or marital status. What types of premature ejaculation are there? There are 4 types of premature ejaculation: Primary premature ejaculation, which is ejaculatory dysfunction that has persisted since the man’s first sexual experience; Acquired premature ejaculation, when ejaculatory dysfunction begins gradually or suddenly after a period of normal ejaculatory experiences; Situational premature ejaculation, which is a variation in normal sexual performance that may be related to a new partner, an unusual situation or infrequent sexual activity; Subjective premature ejaculation , a subjective perception of rapid ejaculation but with an intravaginal ejaculation latency time that is the same or longer than normal, is not considered pathological. Are there risk factors for premature ejaculation? Despite being related to reduced levels of some substances in our central nervous system and genetic predisposition, there are psychological factors to consider. The following psychological profile is at added risk of premature ejaculation: Anxiety or vulnerability to performance anxiety; Emotional instability and feelings of guilt; Depression; Daily stress and pressure; Previous negative sexual experiences. The following are also known risk factors for ejaculatory dysfunction premature acquired: Hormonal changes in testosterone and prolactin levels; Hyperthyroidism; Obesity; Diabetes; Inflammation of the prostate (prostatitis); Alcoholism; Opiate or antipsychotics withdrawal syndrome. What are the symptoms of premature ejaculation? The symptoms related with premature ejaculation include: Reduced self-confidence; Anxiety and negative feelings, such as shame and distress; Irritability; Depression. The following factors are usually associated with these symptoms: Lower overall satisfaction with sexual intercourse; Difficulty relaxing during intercourse; Less frequent sexual intercourse; Partner dissatisfaction; Deterioration in marital relations. How is premature ejaculation diagnosed? Diagnosis of ejaculatory dysfunction is based on: A detailed medical history and physical examination; Special diagnostic tools such as IELT (intravaginal ejaculation latency time) and questionnaires like the PEDT (premature ejaculation diagnostic tool). Is premature ejaculation treatable? Treatment of premature ejaculation may involve: Behavioural measures; Psychotherapy; Treatment with medication. Treatment should begin with the correction of risk factors , when applicable, such as: Weight loss; Physical exercise; Treatment of hyperthyroidism and/or other hormonal disorders; Control of diabetes; Treatment of prostatitis; Abstinence from drugs. When accompanied by a urologist or psychiatrist, psychotherapy also helps reduce anxiety levels, ameliorate sexual performance and optimise the couple relationship. What measures can a person with premature ejaculation take every day? Behavioral measure can be relaxation techniques (such as yoga) and distraction with unstimulating, non-sexual thoughts. Stopping and restarting sexual contact or squeezing the glans just before reaching orgasm can also delay ejaculation. Pre-coital masturbation (one to two hours before) can prolong intravaginal ejaculation latency, especially if premature ejaculation is acquired. There are many brands of desensitizing condoms on the market to prolong pleasure and delay ejaculation. Is there any specific medication for premature ejaculation? There are medications to be taken daily or on demand. The last ones are taken only when necessary, about one to three hours before sexual intercourse. The drugs used to treat erectile dysfunction seem to have a positive effect on patients with premature ejaculation and concomitant erection problems. There are topical creams that reduce the sensitivity of the penis and prolong sexual intercourse. More recently, these patients have available a spray with topical anesthetic drugs that are applied and absorbed only on the glans, and that do not require the concomitant use of condoms to avoid partner anesthesia. This application has a high rate of effectiveness with little or no adverse effects. In selected cases, cutting the penis braje and/or circumcision are associated with better ejaculatory control. Meet the urology team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
