Premature Ejaculation

Premature ejaculation is defined as the involuntary ejaculation of the person with limited sexual stimulation before or just after the penis enters the vagina, and this event causes significant distress in the person. Premature ejaculation is a common occurrence among men. Although there are differences between the estimates, it is thought that approximately one out of every three men has encountered this problem during their lifetime.In order to fully define premature ejaculation (uncontrolled ejaculation), we must first define the ejaculation process. A woman is passively living her sexuality whenever she wants it, whether she wants it or not, whether she enjoys it or not. In other words, there is no precondition for a woman to have sexual intercourse. For a man to have sexual intercourse, he must have an erection and maintain this rigidity until the end of the relationship. Some men cannot control ejaculation time. But if this uncontrollable period is after the woman’s orgasm, there is no problem. Because both sides have achieved the pleasure they want and this draw is completed in a profitable way for both sides.If the man cannot control the ejaculation process and this ejaculation process is before his partner, it can be said that there is an ejaculation problem or premature ejaculation problem. The question of why premature ejaculation draws attention, but it is not a cause for concern unless it is experienced frequently. Although a full definition of premature ejaculation cannot be made, it can be diagnosed as premature ejaculation if the following characteristics are observed in the person:• Ejaculation that occurs approximately 1 minute after vaginal penetration at all times or most intercourse• Failure to delay ejaculation, ie ejaculation, for the period after vaginal penetration or until vaginal penetration• Avoiding sexual intercourse due to stress and anxiety

Premature Ejaculation Problem

Both physiological and biological factors may play a role in premature ejaculation. Although premature ejaculation is an issue that men are ashamed of and avoid talking about, it is a common health problem with treatment. In men with premature ejaculation, the problem is mild at first and may worsen over time. In some cases, men try not to make their partners feel their premature ejaculation problems. This can lead to communication problems and related sexual problems between the couple. Heterosexual couples may have arousal disorders as a result of lack of sexual desire in women, inability to have an orgasm, and a man’s inability to spare enough time for foreplay. In its heavy forms, fusion cannot occur. If couples do not approach the problem in a constructive way, they may experience serious problems in their relationships. Sexually transmitted diseases may also underlie the problem of premature ejaculation due to psychological reasons. For example, it can be thought that a person who thinks he has HIV symptoms or has a fear in this direction or has a suspicion after unprotected sexual intercourse may also have premature ejaculation problem. 

Types of Premature Ejaculation

We answered the question of what is premature ejaculation, and before we move on to its causes, it is necessary to know that there are types of premature ejaculation. It is divided into 4 classes.

Lifelong premature ejaculation: This type of premature ejaculation is observed with the first sexual activity and continues throughout life. It is the least common type of premature ejaculation in the general population. Studies conducted in China and Turkey report that it is observed between 2.3 and 3.2% in the general population.Acquired premature ejaculation: It is a more common problem. It can occur as a result of a physiological or psychological change. It is observed between 3.9% and 4.2% of the general population.Variable premature ejaculation: It is the most common type of premature ejaculation. It is seen in 8.5-11.4% of the general population. The person experiences normal ejaculation from time to time and premature ejaculation from time to time.

Sensory (Subjective) premature ejaculation: In this type, the person does not really have a problem with premature ejaculation, but thinks that he has premature ejaculation due to cultural and psychological reasons. The incidence rate in the general population is between 5.1% and 6.4%. 

What are the Causes of Premature Ejaculation?

The causes of premature ejaculation are divided into psychological and biological.

Psychological causes of premature ejaculation;• Sexual inexperience• Negative perception of one’s own body image• Relationship innovation• Excessive excitement and arousal• Relationship stress• Anxiety disorder• Self-blame and feeling of inadequacy• Depression• Psychological problems related to control and intimacy.These psychological factors are the most common causes, especially in men who have experienced normal ejaculation before and then face premature ejaculation. One of the reasons that cause premature ejaculation problems with psychological factors may be obesity. There are many options in the treatment of obesity, so patients may wonder what is a gastric balloon, what is a tube stomach.On the other hand, lifelong premature ejaculation problem is experienced due to earlier traumas. As an example of these;• Being sexually abused• Strict sex education and upbringing• Traumatic sexual intercourse experience• Conditions such as psychological conditioning (the rapid ejaculation of young people by masturbation due to fear of being caught) can be given. 

Biological causes of premature ejaculation:There are hormones, infections and nervous system diseases that can cause premature ejaculation.Diabetes: Although diabetes is a disease that usually causes erectile dysfunction in men, later studies have shown that a significant majority of diabetic patients with erectile dysfunction also have premature ejaculation problem. The biological mechanism that causes diabetes to cause premature ejaculation is not fully known.

Hormone disorders: Testosterone hormone deficiency, thyroid hormone disorder and pituitary gland diseases cause premature ejaculation.

Multiple Sclerosis: Premature ejaculation is one of the many sexual dysfunctions observed in multiple sclerosis patients.

Prostate gland problems: Research shows a correlation between prostate gland infections and premature ejaculation.

Other causes: Recent studies show the role of penile hypersensitivity and neurophysiologically increased excitability of the ejaculation center in premature ejaculation.

Can Premature Ejaculation Be Prevented?

Men with premature ejaculation may develop inappropriate strategies in an attempt to solve this problem on their own. Men who seek a solution to premature ejaculation may avoid foreplay, as increased stimulation of the penis during foreplay will shorten the duration of sexual pleasure. This reduces sexual satisfaction and communication in their partners and themselves. It can also cause arousal problem in the female partner. Another wrong strategy is to act painfully on themselves during intercourse (pinch, lip bite). The aim of this approach is to try to increase the duration by reducing sexual pleasure. Even if the duration is prolonged, the quality of the sexual act will be impaired. In men, who previously ejaculate with masturbation and aim for the second and third ejaculation, the sexual environment may become anxious.Providing sexual satisfaction of the partner by prolonging the foreplay is the most accurate strategy that the individual can take on his own.

How Is Premature Ejaculation Diagnosed?

In order to be diagnosed with premature ejaculation, the patient must have an active sexual life. A long discussion with the doctor and a physical examination are essential in the diagnosis of premature ejaculation. If erectile dysfunction (erectile dysfunction) is also experienced with premature ejaculation, the doctor may order some tests to look at hormone levels. During this interview, the patient’s medical history as detailed as possible ensures the correct determination of the treatment strategy. In the medical history, past and present diseases, accidents, traumas, medications used will be asked, and the patient’s sexual life will be listened to. 

How is Premature Ejaculation Treated?

Today, the treatment of premature ejaculation is pleasing. After determining the underlying cause of the disease, one or more of the following treatments can be used together, depending on the patient’s condition. Some of the treatments that can be a solution to premature ejaculation are as follows:

Exercise and sports: Kegel exercises, which are also used in children, women and men with urinary incontinence, are also used in the treatment of premature ejaculation. This exercise works the pelvic muscles and can be practiced at any time of the day. During sexual intercourse, when the person feels that he is going to ejaculate, he will contract the muscles in this area, causing the muscle structure in the bladder neck to contract and control the ejaculation. Kegel exercise is one of the effective treatment methods against premature ejaculation. Apart from this, fitness and similar sports that work the pelvic floor muscles are also useful in preventing premature ejaculation.

Penis Head Filling Process: The logic in this treatment is based on the assumption that the penis is hypersensitive in patients, and a filler is injected into the glans part called the glans, under the tissue. The procedure is performed under local anesthesia in our clinic. It takes about 30-60 minutes. It is aimed to reduce this hypersensitivity by filling the area where the nerves going to the penis are. Thanks to the procedure performed, treatment for 1-2 years is provided by reducing hypersensitivity. Thanks to the patients having a healthy sexual life during this period, psychological pressure, feeling of inadequacy etc. along with the process. survivors have also been observed.

Surgical treatments: This method is an irreversible method and is rarely applied. The rationale in this treatment is based on the assumption that the penis is hypersensitive in patients and it is aimed to reduce this hypersensitivity by cutting the nerves going to the penis in various ways.The most accurate treatment strategy for premature ejaculation is personalized programmed treatments with a specialist physician. If you think you have a premature ejaculation problem, contact your nearest health institution.

 Classical Treatment Methods We Do Not Recommend

1. Behavioral and psychological treatments: They are ineffective in lifelong premature ejaculation and do not offer a long-term solution.

2. Local numbing cream applications to the penile skin: It acts by reducing the penile sensation.

3. Treatment with oral drugs:a. Antidepressants and similar drugsI. It has side effects such as fatigue, dizziness, yawning, nausea, vomiting, dry mouth, diarrhea and sweating; these are often mild and gradually improve within 2-3 weeks. Decreased libido, anorgasmia, anejaculation, and erectile dysfunction have also been reported..