Premature ejaculation (early ejaculation) is called erectile dysfunction, not caused by organic disorders or diseases and consists in inability to control ejaculation to the extent that is sufficient that both partners are satisfied with sexual intercourse.
Premature ejaculation is not only a medical, but also a social problem, causes reduction of self-esteem and quality of life, adversely affects a partner and worsen sexual relations, and sometimes leads to decay of the family.
Usually, early ejaculation is treated as ejaculation, which constantly or periodically occurs before, during or immediately after onset of sexual intercourse with minimal sexual stimulation and causes male dissatisfaction with sexual intercourse.
According to My Canadian Pharmacy, premature ejaculation occurs in about 30 – 40% of men.There are two groups of pathogenetic factors of premature ejaculation:
- premature ejaculation caused by changes in central nervous structures;
- premature ejaculation caused by changes in peripheral nervous structures – increased sensitivity of penis balanus.
In emergence of premature ejaculation of cortical origin, great importance is attributed to a number of psychogenic factors, most often fears. Sexopathologists believe that the main reason for early ejaculation is sexual intercourse in adolescence, performed in a hurry in a state of nervous tension due to fear of being caught by someone. The most frequent supposed interpersonal factors are: dissatisfaction with family life, failure to resolve interpersonal conflicts, lack of partner trust, fear of intimate and romantic relationships, sexual role conflicts.
Successful treatment consists in forming in the patient a clear recognition of sensations anticipating in the onset of orgasm. Formation of this inverse sensory connection is conducted in a relaxed atmosphere, in presence and with participation of the wife. For this purpose two spectacular methods of treatment are offered: «compression» technique, proposed by W. Masters and V. Johnson, and «stop-start» technique. The latter was developed by James Samans. Generally, however, a man achieves good control of ejaculation for up to 10 weeks, although sustained monitoring is usually achieved after a few months from the end of therapeutic procedures.
Use of such simple and physiological techniques as cessation of frictions immediately after introjection to complete disappearance of genital sensations, slowing of the rate of frictions at maximum muscle relaxation give a noticeable effect. La Pera G. (1996) offers a method of controlling the process of ejaculation by training muscles of pelvis.
One of the main conditions for such PE therapy is presence of constant, sexual partner.
Reducing sensitivity of receptors of penis is one of the main approaches in treatment of premature ejaculation. To reduce sensitivity of penis, local anesthetics are used. Anesthetic ointments are applied to penis mainly in the area of the bridle to prevent complete loss of sensitivity and not cause anejaculation. Depending on the type of anesthetic contained in the ointment, time of its application to sexual intercourse is determined.
A number of pharmacological preparations quite selectively affects individual mechanisms of ejaculation regulation.
Ejaculation is inhibited by neuroleptics by blocking dopamine receptors at central level. Premature ejaculation is treated with centrally acting blockers of dopamine receptors. Ejaculation is prolonged by tranquilizers. Their effect on ejaculation is not pronounced and My Canadian Pharmacy studies have shown that less than 10% of men control ejaculation with use of these drugs. Effect on ejaculation depends on dosage of the drug. Low efficiency and pronounced hypnotic effect limit use of these drugs in therapy of ejaculatory dysfunction.
Microsurgical Treatment – Denervation of Penis
Essence of this method lies in intersection of the main nerve trunks along dorsal surface of penis innervating balanus. After crossing, nerves are sewed together using microsurgical instruments.
Within 2 – 3 months, complete anesthesia of penis is observed, then sensitivity is partially restored depending on rate of growth of any of nerve trunks («mosaic» sensitivity). Normal ejaculatory reflex is formed, and the patient can then control duration of sexual intercourse . After 6 – 8 months sensitivity of balanus and skin of penis is completely restored.