EVERYTHİNG YOU SHOULD KNOW ABOUT PREMATURE EJACULATİON •••

 Premature Ejaculation •••

  

Premature ejaculation is defined as the desire to speak of words with sexual stimulation before or just after the penis enters the vagina, and this event causes a significant distress in the person.  Premature ejaculation is a common condition among men.  Although there are differences between the estimates, it is thought that approximately one in three men will encounter this problem during his lifetime.  It is not a situation that does not occur frequently.  Although a full definition of premature ejaculation cannot be made, if the person has exemplary features, premature ejaculation can be diagnosed:

  Ejaculation that occurs about 1 minute after vaginal penetration all the time or in most relationships

  Failure to delay 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 can play a role in premature ejaculation.  Although the problem of premature ejaculation is a subject that men feel ashamed and avoid talking about, it is a frequently encountered and treated health problem.  In men with premature ejaculation, the problem is mild at first and may get worse over time.  In some cases, men try not to make their partners feel their premature ejaculation problems.  This situation can lead to communication problems between the couple and related sexual problems.  In heterosexual couples, there may be arousal disorders in women as a result of sexual reluctance, inability to have orgasm, and the man not sparing enough time for foreplay.  Unification cannot occur in heavy forms.  If couples do not approach the problem in a constructive way, they may experience serious problems in their relationships.

 Types of premature ejaculation

 Before moving on to the causes of premature ejaculation, it is necessary to know that there are types of premature ejaculation.  Premature ejaculation is divided into 4 classes.

 Premature ejaculation that continues throughout life: 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.  China and studies in Turkey report that observed between 2.3 to 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 in the general population between 3.9% and 4.2%.

 Variable premature ejaculation  It is the most common type of premature ejaculation problem.  It is seen in the general population with a rate of 8.5-11.4%.  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 premature ejaculation problem, but thinks that he has premature ejaculation due to cultural and psychological reasons.  The rate of observation in the general population is in the range of 5.1-6.4%.

 Causes of premature ejaculation

 Premature ejaculation causes are divided into psychological and biological.

 Psychological causes of premature ejaculation;

 Sexual inexperience

 Negative perception of one's own body image

 Relationship innovation

 Extreme excitement and arousal

 Relationship stress

 Anxiety

 Self-blame and a feeling of inadequacy

 Depression

 It can be listed as psychological problems related to control and intimacy.

 These psychological factors are common causes, especially in men who have experienced normal ejaculation before and then faced premature ejaculation.

 In contrast, a life-long problem of premature ejaculation is experienced due to earlier trauma.  As an example to these;

 Being sexually abused

 Strict sexual education and upbringing

 Traumatic sexual intercourse experience

 Situations such as psychological conditioning (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, a study published in Translational Andrology and Urology in 2016 showed that a significant majority of diabetic patients with erectile dysfunction also have premature ejaculation problems.  The biological mechanism by which diabetes causes premature ejaculation is not fully known.

 Hormone disorders: Testosterone 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: Studies show a correlation between prostate gland infections and premature ejaculation.

 Other reasons: Recent studies show the role of hypersensitivity of the penis and increased excitability of the ejaculatory center neurophysiologically in premature ejaculation.

Can premature ejaculation be prevented 

 Men with premature ejaculation problems may develop inappropriate strategies while attempting to solve this problem on their own.  Since the increase in the stimulation of the penis during foreplay will shorten the duration of sexual pleasure, men who have this problem can avoid foreplay.  This situation 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 behave painfully to themselves (pinching, biting lip) during intercourse.  The purpose of this approach is to try to increase the duration by reducing sexual pleasure.  Even if the period is partially longer, the quality of the sexual act will deteriorate.  The sexual environment may become anxious in men who aim for the second and third ejaculation by masturbation before.

 Providing sexual satisfaction of the partner by prolonging foreplay is the best strategy that an 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.  Long consultation with the doctor and physical examination are essential in the diagnosis of premature ejaculation.  If erectile dysfunction (erectile dysfunction) is experienced along with the problem of premature ejaculation, the doctor may request some tests to look at the hormone levels.  During this interview, the patient's medical history is conveyed in as much detail as possible, and the treatment strategy is determined correctly.  In the medical history, past and present diseases, accidents, traumas, medications used will be asked, and the patient's sexual life will be rested.

 What is the treatment for premature ejaculation?

Today, the treatment of premature ejaculation is promising.  Once the underlying cause of the disease is determined, one or more of the following treatments can be used together, depending on the patient's condition.

Medication: Oral medications are one of the most preferred treatment methods for premature ejaculation.  When the drugs called SSRI (Selective Seratonin Reuptake Inhibitor) are taken daily as a tablet, the effect begins to be observed after 5-10 days.  However, the need to use these drugs every day and the emergence of side effects such as fatigue, nausea, sweating, and yawning cause a low rate of patients to continue treatment.  The drug with dapoxetine active ingredient, a new form of the same type of drugs, is successful when used 1-3 hours before intercourse.  Since it does not require daily use, patient satisfaction is very high in this treatment.

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 around the clock.  During sexual intercourse, when the person feels that he will ejaculate, he will contract the muscles in this area and will also contract the muscle structure of the bladder neck 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 beneficial in preventing premature ejaculation.

 Creams and gels: Another method used in the treatment of premature ejaculation is the use of creams containing local anesthetics.  Creams / gels / sprays applied to the penis before intercourse cause loss of sensation in the penis and delay ejaculation.  Since these treatments are local, there are no systemic side effects observed in pills.  However, creams and gels can prevent orgasm sensation in men and women depending on the amount of use.  In particular, the bad odor of the gels used can create an unpleasant environment during intercourse.

 Condoms: Condoms, such as creams and gels, are one of the treatment methods used to prevent premature ejaculation as they reduce the sense of sensation during intercourse.

 Sex therapies: One of the effective methods of treating premature ejaculation is sex therapies.  Keeping the foreplay period as long as possible;  The application of the taught maneuvers brings success in treatment.  These maneuvers are "stop-start" and "squeeze" techniques.  The stop-start technique is a gradual technique and each stage takes an average of 2 weeks, and it is necessary to perform the recommended maneuvers at least three times each week.  These maneuvers aim to reduce the stimulation of the penis and thus delay ejaculation.  The tightening technique, on the other hand, is to stop the relationship when ejaculation is felt during intercourse, and tighten the tip of the penis until the feeling of ejaculation passes and thus delay ejaculation.

 Surgical treatments: This method is an irreversible method and is rarely applied.  The logic 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 to the penis in various ways.

 The most appropriate treatment strategy for premature ejaculation is personally programmed treatments with the specialist physician.  If you think you have premature ejaculation problem, consult your nearest health facility.