Premature Ejaculation: What It Is, Causes, Symptoms, and Treatment

Sexual Dysfunction Is One of the Most Common Health Issues Today.

Sexual dysfunction is one of the most common health issues today. Thanks to medical studies conducted in recent years, clearer data on the causes of these disorders has begun to be obtained, and significant progress has been made in treatment. One of the issues that seriously negatively affects couples' sexual lives is the problem of premature ejaculation.

What is Premature Ejaculation?

Ejaculation is the process by which semen containing sperm exits the penis during orgasm, which is the peak of sexual pleasure in men. Premature ejaculation, or premature ejaculation, refers to the condition where a man reaches orgasm and ejaculates during sexual intercourse sooner than desired. This is considered a significant health issue that prevents couples from achieving the desired level of satisfaction during sexual intercourse and can lead to a disinterest in sexual activity.

Premature ejaculation is a problem that is quite common in society. According to research, one in three men between the ages of 18 and 59 experiences premature ejaculation at some point in their lives.

Although premature ejaculation is classified as a sexual dysfunction, it differs from other sexual function problems, such as erectile dysfunction, contrary to popular belief. Erectile dysfunction refers to the inability to maintain or achieve penile firmness during sexual intercourse. However, erectile dysfunction and premature ejaculation can coexist or trigger one another.

The issue of premature ejaculation is subjective and can vary from patient to patient. Accordingly, the definition of premature ejaculation may vary based on couples' expectations and satisfaction levels during sexual relations. Since premature ejaculation is defined as the person ejaculating sooner than desired, the perception of premature ejaculation can change based on the individual's self-defined ideal duration of sexual intercourse.

However, in clinical practice, objective criteria have been established to define the problem of premature ejaculation. In a clinical setting, premature ejaculation is assessed based on the following criteria:

• Ejaculation occurs before or within one minute of penetration.
• Delaying ejaculation is not possible in nearly every sexual intercourse.
• There are negative psychological symptoms such as avoidance of sexual intercourse, intense stress, and depression.

What Causes Premature Ejaculation?

The onset of premature ejaculation can be studied in two main sections based on the initial phase of the problem. In individuals who have consistently experienced premature ejaculation since their first sexual experience, it is referred to as primary premature ejaculation. In contrast, in individuals with normal sexual experiences who later develop premature ejaculation, it is classified as secondary premature ejaculation.

The primary form of the issue may persist throughout life, and underlying organic causes can be identified. In the secondary form, since there is a history of normal sexual experiences, it can be inferred that the issue is more likely to stem from psychological reasons.

Premature ejaculation is a condition that can develop at specific times in healthy men; it does not pose a significant problem unless it is long-lasting or recurrent. As a man gains more sexual experience and learns to control the feeling of ejaculation, the problem of premature ejaculation usually resolves.

However, the problem of long-term or recurrent premature ejaculation may arise in the presence of the following conditions and health issues:

• Intense stress, anxiety, or depression: Premature ejaculation is more common among individuals experiencing intense psychological stress, significant anxiety about their relationship or sexual experiences, or mood disorders.
• Negative self-perception: Premature ejaculation can occur in situations where a person has negative thoughts about their body, dislikes themselves, or judges themselves harshly.
• Problems with the partner: Relationship issues with a sexual partner can psychologically affect the patient and trigger premature ejaculation.
• History of sexual abuse: Having previously experienced sexual abuse is a serious risk factor for sexual dysfunctions such as premature ejaculation.
• Sexual dysfunctions such as erectile dysfunction: Conditions like an inability to maintain an erection can accompany premature ejaculation.
• Hormonal imbalances: Changes in the blood levels of sex hormones such as testosterone, androgen, or estrogen can result in premature ejaculation.
• Inflammatory diseases like prostatitis or urethritis: Inflammation of the tissues and organs of the reproductive system may trigger premature ejaculation.
• Advanced age: As men age, it becomes more difficult to delay and control ejaculation, leading to a higher prevalence of sexual dysfunctions like premature ejaculation.
• Chronic diseases: Individuals with chronic illnesses such as hypertension, diabetes, or heart disease are more likely to experience sexual dysfunctions.

What Are the Symptoms of Premature Ejaculation?

Patients with premature ejaculation may exhibit various clinical symptoms. The following signs are frequently observed in men experiencing premature ejaculation:

• Reaching orgasm and ejaculation immediately at the beginning of sexual intercourse or within 1 minute of its initiation.
• Inability to control ejaculation during sexual intercourse.
• Experiencing intense stress, anxiety, guilt, or depression before or after premature ejaculation.
• Having relationship problems with a sexual partner.
• Decrease in sexual desire (libido).
• Experiencing erectile problems or inability to maintain an erection during intercourse.

How Is Premature Ejaculation Diagnosed?

Establishing the presence of premature ejaculation requires effective communication between the patient and the evaluating physician. Patients may express their concerns regarding premature ejaculation in the context of their expectations from sexual intercourse. However, clinically significant premature ejaculation is diagnosed based on the presence of the following criteria:

• Ejaculation occurs at the beginning of intercourse or within 1 minute afterward.
• Inability to control ejaculation during this time frame.
• The presence of psychological or organic factors that predispose to premature ejaculation.
• A detailed medical history taken by the physician and thorough physical examination, with additional imaging and laboratory tests if deemed necessary. Since premature ejaculation often arises from functional issues, the focus may shift from investigating organic causes to exploring the factors contributing to this problem.

How Is Premature Ejaculation Treated?

In cases where a specific organic cause is identified during the diagnosis phase, targeted treatment for the underlying issue is conducted. However, since premature ejaculation frequently arises from psychological or functional reasons, various lifestyle changes, methods, and psychotherapeutic approaches are recommended or applied to patients.

The following methods are commonly used to address premature ejaculation:

• Masturbation up to one hour before intercourse can help in controlling ejaculation during the act.
• Engaging in foreplay before transitioning to sexual intercourse helps prepare for the act and may alleviate premature ejaculation.
• The “stop-start” technique can be employed for controlling ejaculation. In this method, the sexual partner provides stimulation until the person feels close to ejaculation. The stimulation is then ceased, allowing the feeling of ejaculation to dissipate. This “stop-start” application is repeated two more times, permitting ejaculation on the fourth stimulation. Applying this method three times a week is highly beneficial for controlling ejaculation.
• Another technique used for ejaculation control is the “squeeze” method. In this method, after providing sexual stimulation to bring the person close to ejaculation, the tip of the penis is squeezed until the feeling of ejaculation subsides, delaying the ejaculation. This method also aids in learning ejaculation control and can alleviate premature ejaculation.
• A method known as Kegel exercises aims to strengthen the pelvic muscles in the penile area through repeated contractions throughout the day. This allows the sensation of ejaculation to be delayed with the help of the pelvic muscles. Kegel exercises are typically performed in a repetitive manner by contracting the muscles for about three seconds and then relaxing for another three seconds.
• Utilizing methods to reduce the amount of sexual stimulation to the penis before intercourse can be beneficial. In this context, delay sprays, condoms, and anesthetic agents may be used.
• Psychotherapy can be beneficial in treating sexual disorders with the participation of both the individual and their partner. It is particularly effective in addressing psychological problems stemming from issues in the partnership or relationship.
• As part of medication therapy, antidepressants and medications like sildenafil and tadalafil, which are used for erectile dysfunction, can be beneficial for some patients.