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Premature ejaculation is considered to be the onset of ejaculation before the immission of the penis. In most cases, ejaculation occurs immediately before the immission - when the genitalia of the male contacts the female genitalia. But also cases of premature ejaculation and during preliminaries even in those cases when they are not connected with direct contact with male genitalia are not uncommon. Ejaculation can occur at moments of undressing, kissing. In this case, there is a partial erection, or even a complete absence of it.

"Too early ejaculation" is a medical term for those cases in which ejaculation occurs after the immission of the penis, but after too short a period of time, insufficient for the onset of orgasm in a woman. Ejaculation can occur almost immediately after the introduction of the penis, several frictions, or a brief sexual contact less than one to two minutes. That is, the time period, which is clearly not enough to get sexual satisfaction partner.

The duration of the sexual intercourse of the "average" male is from 7 to 14 minutes. Women consider the normal duration of sexual intercourse before the onset of ejaculation averaging 11 minutes. There are no temporary criteria for the onset of ejaculation. In some cases, sexual intercourse can last for less than 1 minute and bring satisfaction to both partners. So, if the sexual partners are satisfied with the duration of the sexual act, it is not accepted to talk about premature ejaculation, and therefore it is not necessary to treat it. There is no standard definition of premature ejaculation. According to the definition of the World Health Organization, ejaculation, which occurred less than 1 minute after the beginning of the act, may be called premature. The extreme manifestation of premature ejaculation is ejaculation, occurring before the introduction of the penis into the vagina. Relative premature ejaculation occurs from 1 to 3 minutes after the beginning of the act. According to the literature, the average duration of the frictional period should be from 2 to 10 minutes. There are several concepts of "premature ejaculation" (premature ejaculation, early ejaculation, early ejaculation, rapid ejaculation, rapid ejaculation, accelerated ejaculation, accelerated ejaculation). dapoxetine ssri

By force, the effect on the quality of life of male MS is not inferior to (impotence) erectile dysfunction. Among problems in the field of intimate relations premature ejaculation takes far from last place. The feeling of hopelessness of the situation and the inability to receive satisfaction from sexual relations often lead to family conflicts, the severance of relationships and, often, male depression. The predominant problems in people suffering from MS are low self-esteem, a syndrome of expectation of failure and uncertainty in the future.

Men suffering from rapid ejaculation sometimes experience great difficulties in family relationships. Some men try to solve the problem of too early ejaculation by training and trying to control themselves during the act. This method helps only those who have premature ejaculation is psychogenic and, more often than not, is caused by inexperience. In most cases, concentration solely on the control of orgasm keeps a man in constant tension, which, as a rule, leads to too early ejaculation.

What is premature ejaculation, and what are its causes?

The PS is divided into primary and secondary (acquired). The primary is called PS, which takes place from the beginning of sexual activity or from the first sexual experience. The rapid onset of ejaculation during masturbation is not considered a medical problem. Secondary is the SS, which came against a background of initially normal sexual life, which can sometimes be associated with the development of other diseases and is their manifestation. Secondary PS can be true, developed as an independent disease, and may be symptomatic or appeared as one of the manifestations of another disease. Distinguish premature ejaculation: psychogenic, organic, combined.

Secondary MS often occurs with urological diseases (urethritis, colliculitis, prostatitis, vesiculitis, enuresis, prostate adenoma). Colliculitis - inflammatory, hypertrophic and other changes in the seed hillock. In the process of sexual intercourse, the blood circulation increases in the seminal mound, ascending pulses increase, irritating the zones of the central nervous system responsible for orgasm. With a pathological increase (hypertrophy) and inflammation, such impulse increases, orgasm occurs earlier, usually with the loss of quality of the orgasm itself. Prostatitis and vesiculitis - inflammatory diseases of the accessory genital glands have a close connection with the seed hillock. Therefore, if they become inflamed, a pathological reaction may involve the latter.

Hypersensitivity of the glans penis has an increased number of nerve endings in the penis head and their greater than normal sensitivity to the effects is the most common cause of early ejaculation. The nerve endings located in the glans penis are the main receptors in the nerve arc closing in the spinal cord. Among other reasons: alcoholism, drug addiction, Parkinson's disease, chronic depression, diabetes mellitus, renal failure, some hormonal disorders, erectile dysfunction, pronounced ejaculatory reflex , Genetic predisposition, surgical, pharmacological.

The diagnosis of premature ejaculation is not complicated - the patient's complaints are fundamental in establishing the diagnosis. The great difficulty is not the establishment of the fact of the presence of premature ejaculation, but the determination of the cause of this disorder. The doctor can plan the examination: external examination, rectal examination, genital ultrasound, in some cases - tests for the detection of infectious and inflammatory diseases, other laboratory diagnostic methods, methods for assessing the blood supply of the penis (to eliminate erectile dysfunction), and a series of tests. It is necessary to take into account the fact that, whatever the initial cause of premature ejaculation, the psychogenic component always joins. Not regular sex life is most often the cause of the development of prostatitis, vesiculitis, colliculitis and accelerated ejaculation, and this leads to a decrease in the quality of sex in both partners.

How is premature ejaculation treated?

Treatment of premature ejaculation does not represent significant difficulties. Must be done necessarily with a sexual partner. Depending on the revealed cause of early ejaculation, a medicinal, physiotherapeutic or microsurgical correction of ejaculation is performed. Primary and true secondary PS are treated almost exclusively by conservative methods. Secondary symptomatic MS is eliminated either during the treatment of the underlying causative disease, or additionally with the treatment of the primary or true secondary PS. Very often after treatment of prostatitis, urethritis lengthens the sexual intercourse. In any case, the course of treatment of PS should be appointed only after a thorough examination of a qualified specialist in the diagnosis and treatment of sexual dysfunction in men.

1. Treatment of inflammatory diseases that caused the disease;

2. Sexual, psychological, behavioral therapy, self-regulation and the method of abstraction, behavioral therapy consists in the formation of a clear recognition of the sensations in the man, anticipating the onset of orgasm and the ability to control this process with the help of various techniques;

3. Conservative treatment of hypersensitivity, carried out with the help of a condom and anesthetic ointments applied to the penis head in the bridle area, ointment should be immediately before sexual intercourse, for 10-15 minutes, and this is not always convenient physically and psychologically;

4. Pharmacotherapy, which includes treatment with antidepressants, serotonin reuptake inhibitors, sometimes used to improve potency, often for the prolongation of sexual intercourse, the lifelong use of certain drugs is necessary;

5. Reflexotherapy, acupuncture, highly effective physiotherapy methods.

6. Surgical treatment - circumcision with plastic frenum and microsurgical denervation of the head of the penis. It should be borne in mind that surgical treatment of PS, in particular, the intersection of nerves that provide sensitivity to the glans penis (the so-called selective neurotomy) can lead to a permanent loss of sensitivity of the penis, and as a result, deterioration of the quality of erections and weakening of orgasm.

7. Modern treatment of premature ejaculation A more modern and unique method of conservative treatment (in 95% of cases there is control over ejaculation) is the introduction of certain hyaluronic acid injections into certain areas of the penile head. Gilauronic acid creates a "pillow" between the skin and nerve endings, thereby reducing the sensitivity of the glans penis. The drug is intended for administration in the dermis exclusively by a specialist doctor who has experience in this field. Since the technique of administration is the main factor of its success in this procedure, the injection of this drug should be performed only by a doctor who has undergone special training in injection techniques into the urogenital zones. This method does not require hospitalization. The procedure is performed on the day of treatment, under local anesthesia with modern anesthetics and takes from 15 to 50 minutes. With combined treatment, the effect develops in the shortest possible time (up to 10 days). After the operation the patient can have sex in a week. According to foreign urologists, an increase in the glans penis by injecting a gel based on hyaluronic acid proved to be very effective in treating premature ejaculation. This procedure can replace a more dangerous dorsal neurotomy. Biological gels based on hyaluronic acid are sometimes used in urology to increase the size of the glans penis.

8. Vacuum massage of the penis (LOD - therapy). As a result of the action, according to rheophallography, the arterial influx increases, the vascular tone is normalized and venous outflow from the cavernous tissue improves.

What recommendations can be given to those suffering premature ejaculation?

1. It is necessary to understand the relativity of the concept of "early ejaculation". So, it is hardly possible to consider insolvent a man who did not satisfy his partner after a 5 to 10-minute coitus, proceeding "according to all the rules." Consequently, much depends on the woman, her physical and emotional state, health.

2. Lead a normal lifestyle: adjust the mode of work and rest, do physical training and sports, eat right.

3. Have a regular sex life. This is important for both partners: prolonged abstinence accelerates the ejaculation of a man, but lengthens the period of orgasm in a woman. Therefore, it is advisable, if a man is able to do this, to repeat the sexual act. At this, his duration is prolonged for a man and accelerated by a woman, since she is still excited by the first intimacy. With age, this dissonance is observed less and less often, as there is mutual adaptation.