Premature ejaculation is that which takes place before the individual wants it to, affecting self-esteem and the sexual response of the partner. Most commonly, this problem presents from the very onset of sexual activity, although it can also take place after having experienced normal control of the ejaculation. The most serious form is the one in which the ejaculation takes place prior to penetration. Ejaculation is considered to be premature when it takes place less than 2 minutes after penetration.
Its causes are still not very well known, although every day there is increasing scientific evidence to indicate disorders of certain elements at brain level. However, on many occasions, premature ejaculation is due to poor initial sexual experiences and certain personality disorders.
The study of this problem begins with a detailed medical history and physical examination. The patient must provide information about the so-called intravaginal ejaculation latency time (time between penetration and ejaculation).
It is of the utmost importance to undertake a psychological evaluation prior to initiating or concomitant to the application of other treatments.
Apart from psychotherapy, treatment with anti-depressant drugs is currently recommended (sertraline, fluoxetine, paroxetine) due to their effects in delaying ejaculation. There is still no drug on the market exclusively for this problem, although there are some that are currently in the clinical trial phase.
Pharmacological treatment may initially be undertaken continually and subsequently, depending on the response, it may be taken only when sexual activity is anticipated.
Other methods which can be tried are manual manoeuvres which consist in compressing the balanopreputial sulcus (border between the glans and the start of the skin of the penis) or the base of the penis when the sensation of imminent ejaculation is felt. This manipulation may be carried out various times in the same act and can be undertaken by the man or by his partner.
There are also certain anaesthetic solutions which can be applied to the penis a short time prior to beginning sexual activity. Before doing so, it is important to carefully clean the penis or to use a condom.
In certain very select cases, when the ejaculation is very premature, and does not respond to any of the treatments mentioned and represents a significant problem for the couple, it is possible to try a treatment called penile neurotomy. It consists in cutting off some of the nerve threads responsible for the sensitivity of the penis.
Treatment for premature ejaculation is more difficult when the individual does not have a partner or regular sexual activity.