What is premature ejaculation?
Premature ejaculation (ejaculatio praecox) means that the climax, including ejaculation, can no longer be held back even after brief sexual stimulation. Young men with little sexual experience and those who have been sexually abstinent for a long period of time are particularly familiar with this phenomenon.
Normally, the issue resolves itself: With increasing experience and regular sexual activity, a man learns to better perceive and control his own level of arousal.
The situation is different if someone repeatedly ejaculates too early – regardless of the situation and sexual partner. However, this fact alone is not sufficient for a medical diagnosis of “premature ejaculation”. Doctors only speak of ejaculatio praecox requiring treatment if:
- the premature ejaculation is chronic and the affected man has no control over his ejaculation, i.e. cannot delay it voluntarily
- the affected man suffers from it subjectively, for example the dysfunction has a negative impact on his self-esteem, leads to stress, anxiety and avoidance behavior and/or impairs his sexual relationships
What does “premature” mean?
Scientific studies show that the so-called intravaginal latency period (= time span between the start of penetration and ejaculation) is around five minutes on average. Accordingly, doctors diagnose premature ejaculation if this period is regularly significantly shorter, i.e. ejaculation occurs before insertion or one to two minutes afterwards.
Primary and secondary ejaculatio praecox
When it comes to premature ejaculation, doctors differentiate between primary ejaculatio praecox and secondary ejaculatio praecox.
- Primary ejaculatio praecox: In this case, premature ejaculation occurs during the first sexual experience and the symptoms persist for life.
- Secondary ejaculatio praecox: This is the acquired form. Premature ejaculation occurs suddenly in men who previously had no problems with ejaculation. Secondary ejaculatio praecox often occurs in connection with illnesses such as thyroid dysfunction or prostate disease.
How can premature ejaculation be prevented or treated?
Ejaculatio praecox therapy depends on the underlying cause. The scientifically based and recommended treatment methods include medication and psychotherapeutic approaches – they are often combined with each other.
Before starting treatment, possible illnesses that could be the cause of premature ejaculation should be ruled out. These include prostatitis, thyroid disease and diabetes mellitus.
Premature ejaculation: treatment with medication
Treatment with medication can be internal (systemic) or external (topical).
Systemic (internal) drug treatment
A deficiency of the neurotransmitter serotonin appears to play a role in primary ejaculatio praecox in particular. For this reason, systemic (internal) drug therapy is carried out with a so-called serotonin reuptake inhibitor (SSRI). This allows the sertonin level in the body to be increased.
The active ingredient dapoxetine is usually used. In many countries, it is the only approved medication for premature ejaculation.
Dapoxetine is a short-acting serotonin reuptake inhibitor that slightly prolongs the intravaginal latency period. This means that men with ejaculatio praecox do not have to take the medication permanently, but only when needed – i.e. a few hours before the planned sexual intercourse.
Due to the possible side effects and interactions, the use of dapoxetine should be carefully considered by a doctor.
Sometimes a doctor prescribes common antidepressants as a remedy for premature ejaculation. These active ingredients are used here in so-called off-label use. This means that they are not actually approved for the treatment of premature ejaculation, but experience has shown that they can often help.
Antidepressants are particularly useful if there are psychological causes behind the premature ejaculation, such as depression or anxiety disorder, which respond to treatment with these active ingredients.
Antidepressants used “off-label” to treat premature ejaculation include, for example
- citalopram
- fluoxetine
- fluvoxamine
- paroxetine
- sertraline
Antidepressants only develop their full effect after about two weeks of use. They must therefore be taken regularly and are therefore not suitable for the treatment of premature ejaculation on demand (in contrast to dapoxetine).
Antidepressants may only be used for premature ejaculation if prescribed by a doctor. The drugs interfere with brain metabolism and can have various side effects. The decision to treat premature ejaculation with antidepressants must therefore be weighed up very carefully.
Topical (external) drug treatment
In these cases, premature ejaculation can be helped with an ointment or spray containing local anaesthetic ingredients such as lidocaine. The products are applied to the penis before sexual intercourse to make it less sensitive to touch. Studies have shown that ejaculatio praecox can be prevented with a spray or ointment containing a local anesthetic.
Condoms have a similar effect – they also make the penis slightly less sensitive.
Premature ejaculation: psychotherapeutic approaches
If anxiety, excessive demands or sexual trauma are behind premature ejaculation, psychotherapeutic treatment can help.
Some experts also see a connection between social phobia and premature ejaculation: those affected react to sexual closeness with avoidance by unconsciously shortening the duration of the encounter through early ejaculation.
Psychotherapeutic treatment can take the form of individual or couples therapy.
- Individual therapy: In individual therapy, for example, traumas and fears are uncovered and analyzed as part of talk therapy in order to better process them. In behavioral therapy, those affected learn how to solve their sexual problems by practicing new ways of thinking and behaving.
Behavioral techniques
Sometimes premature ejaculation can be managed with a manual solution (stop-start method, squeeze technique). The aim here is for the person affected to increase control over their own arousal and ejaculation. Manual techniques are quite successful in the short term, but their long-term effect has not been sufficiently scientifically investigated.
Other techniques that some sufferers use to try to last longer during sex are masturbation before sex and mental distraction during intercourse (cognitive technique). Here are more details on the individual methods:
Stop-start method:
This involves stimulating the penis until just before the so-called “point of no return”. This is the point at which orgasm and therefore ejaculation inevitably occur. Shortly before this point is reached, stimulation is stopped and you wait until the level of arousal has decreased significantly. Then the stimulation is continued.
The whole process is repeated several times. In this way, the person concerned gets to know and control their own arousal behavior better.
Squeeze technique:
Masturbation before sexual intercourse:
Masturbation before sex is said to make the penis less sensitive to touch and thus reduce arousal. This may prevent premature ejaculation during sexual intercourse and help you last longer.
Cognitive technique:
If you consciously think about something sober and factual during intercourse, such as your tax return or the list for your next shopping trip, you can also effectively reduce the level of arousal. However, many sufferers find this technique less satisfying, as it has a negative effect on the erotic experience and emotional closeness to the partner.
Premature ejaculation: home remedies
Many men try various home remedies for premature ejaculation. Magnesium and zinc are among the favorites. Some sufferers also rely on pelvic floor training. However, the effectiveness of these methods has not been scientifically proven.
Magnesium:
According to one study, men with normal ejaculatory behavior have higher levels of magnesium in their sperm than men who suffer from premature ejaculation. However, no causal relationship between low magnesium levels and premature ejaculation can be derived from this.
Zinc:
According to a study, the trace element can increase testosterone levels in men and thus stimulate sexual desire (libido). However, there is no evidence that it specifically helps against ejaculatio praecox.
Pelvic floor training:
Those who specifically train the muscles of the pelvis can control these same muscles more consciously and thus prevent premature ejaculation – or so the theory goes. However, this has not been scientifically proven.
But there is certainly no harm in having strong pelvic floor muscles. And for some men, muscle training helps them to feel themselves better in this area of the body and thus control ejaculation more effectively.
Premature ejaculation: surgery
Premature ejaculation can also be treated surgically: In a procedure known as selective dorsal neurectomy (SDN), the surgeon cuts some nerve connections in the glans, making it significantly less sensitive.
However, SDN is rarely performed in Europe. In Asian countries such as South Korea, however, it is one of the standard methods of ejaculatio praecox therapy.
What can cause premature ejaculation?
Why some men suffer from premature ejaculation is ultimately unclear. However, a connection with biological and/or psychological abnormalities is suspected.
Premature ejaculation: biological causes
- a hypersensitive penis
- erectile dysfunction (impotence): Studies often also show ejaculatio praecox in affected men.
- inflammation of the prostate (prostatitis)
- Hormonal disorders, such as thyroid disease
Premature ejaculation: psychological causes
Premature ejaculation can also be caused by psychological factors. For example, the following factors can play a role:
- Anxiety, especially fear of failure, which can be triggered by high subjective pressure to perform
- stress
- traumatic sexual experiences
- emotional disorders (e.g. experts are discussing whether premature ejaculation and social phobia could be linked)
