The situation, so-called premature ejaculation among the people, is ‘uncontrolled ejaculation’ of a person during sexual intercourse. It is a frequently seen sexual dysfunction in men of all ages.
Premature ejaculation causes loss of confidence, loss of concentration, decreased motivation, depression and partner relation problems. It can decrease the quality of life if not treated.
Premature means ‘earlier than ideal time’, ejaculation means ‘expel of semen’. According to the World Health Organization's definition of premature ejaculation, penis should stay in vagina at least 1 minute without ejaculation during coitus (sex). If it doesn’t happen, it’s called as ‘uncontrolled ejaculation’ or ‘premature ejaculation’. The problem must continue for at least 6 months and cause problems with man’s himself and with his partner.
However, since a man knows how to control his urine, he can also learn how to control ejaculation and postpone it like 30-60 minutes.
Sympathetic hyperactivity leads to premature ejaculation as a result of laziness of the muscle tissue in the anatomical structure of the penis, uncontrolled contraction or excessive excitability.
Premature ejaculation may occur due to psychological and organic (physical) reasons.
Psychological reasons include loss of performance, performance anxiety, lack of knowledge and experience about sexuality, depression, the presence of simultaneous erection problems, vaginismus or dyspareunia (painful sexual intercourse) problems in female partner and marriage problems.
Organic (physical) reasons usually include cardiac and circulatory problems, nerve damage caused by prostate and bladder surgeries, vascular diseases, thyroid diseases, some drugs, prostate infections (prostatitis) and painful ejaculation.
The autonomic nerve system that manages our entire body is divided into two part as ‘sympathetic system’ and ‘parasympathetic system’. Both systems operate in a balanced and harmonious manner.
In men, the parasympathetic system allows the penis to be filled with blood, ie erection of the penis, and sympathetic system allows ejaculation. After parasympathetic activity reaches a certain level, it leaves domination to the sympathetic system and ejaculation happens.
In cases of extreme anxiety (tension),excessive excitement or fear, the sympathetic system dominance increase rapidly with increased adrenaline-type hormones and ejaculation occurs earlier and uncontrolled.
Vaginismus is a sexual problem which is characterized with the inability of having sexual intercourse or providing sexual penetration difficulty depending on the involuntary contraction of women during sexual intercourse. Couples who have this problem are ashamed to share their problems with anyone. Thus, there are some marriages that last for months or even years without any sexual intercourse. Vaginismus problem in women can lead to premature ejaculation, erectile problems and sexual desire loss problems in men over time. Since most of these conditions are secondarily related to vaginismus problem, such sexual problems will be eliminated after vaginismus problem is solved.
Primary premature ejaculation: It is lifelong premature ejaculation type which is seen since from the beginning of active sexual life. Namely, the problem has been going on from the beginning. Ejaculation occurs during the foreplay before sexual penetration, right after the sexual penetration or within the first few minutes of sexual intercourse.
Secondary premature ejaculation: It is the situation where normally progressing pleasure and ejaculation period since from the beginning of active sexual life cannot be controlled after a certain time. In other words, premature ejaculation problem is acquired after a certain time and continues for more than 6 months.
Social changes, the absence of regular sex life, the death of a close person, financial difficulties, work stress, problems in the relationship, marital problems and adultery may cause secondary premature ejaculation.
Conditional premature ejaculation: Conditional or situational premature ejaculation occurs in some cases. It is not considered as pathological because it does not have continuity. Variable stress dynamics of daily life can be effective on this problem besides the partner’s attitude and partner relationship.
The treatment of premature ejaculation varies according to the type of disorder and treatment is possible. In primary type, combination with psychotherapy, sexual therapy and medical therapy can provide a very high success rate.
In secondary type of premature ejaculation, if there is no underlying physical problem (thyroid, heart and circulatory disorders, diabetes, etc.),it can be easily overcome with psychotherapy and sexual therapy. Medical drugs, like dapoxetine and some of the antidepressant drugs can also be used for the treatment.
In the case of conditional premature ejaculation, the problem can be easily eliminated with short-term psychotherapy. In the course of the therapy, the reason of early ejaculation is determined and reason-oriented treatment is initiated after a detailed medical and sexual history (anamnesis) is taken. However, it should be supported by behavioral therapies with some homework.
Premature ejaculation is a very common sexual dysfunction, but it is possible to be treated with the help of psychotherapy and sexual therapy under physician’s supervision. Ejaculation function can be extended, such as controlling urination. So, it can be extended up to half an hour, even up to one hour with the treatment.
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