EARLY Ejaculation (Pre-mature ejaculation)
Premature ejaculation is when semen comes just before or as soon as the penis enters the vagina, that is, ejaculation occurs earlier than desired. Another definition is that ejaculation occurs before the female partner is satisfied in at least 50% of sexual intercourse. It occurs in about 40% of men under the age of 40. However, it does not have a precise definition. Some men may describe relationships that last 5-10 minutes as premature ejaculation. The generally accepted time (IVLT) is that ejaculation less than 2 minutes after the penis enters the vagina is premature ejaculation. At the same time, premature ejaculation can be defined as ejaculation before the spouses are more satisfied.
It is an important problem because it causes infertility because semen cannot be thrown into the vagina and negatively affects the sexual life of couples. In fact, the problem of not having a child can be solved to a large extent by transferring the sperm of the man to the woman with the intrauterine insemination (IUI) method. But in order for sexual intercourse to be more satisfying, the natural delay of ejaculation should be treated with other methods.
First of all, it should be well differentiated whether the reason for not having sexual intercourse is premature ejaculation or insufficient erection of the penis. Sometimes ejaculation occurs before the penis becomes hard and sexual intercourse cannot take place. Here, it should be well investigated whether there is an erection defect in the penis. For this, tests such as NPT test, penile Doppler and VSS may be requested.
If it is decided that there is no erection defect, real premature ejaculation is diagnosed and treatment is started.
Premature ejaculation is common in first relationships. It depends on anxiety. If this stress situation lasts longer, premature ejaculation may continue for a while. Over time, this problem disappears by itself, as the man begins to control himself. Fears about masturbation are also important factors due to insufficient sexual education and lack of knowledge. Some cases are based on an organic cause. In other words, sensitivity increased in the neural stimulation of the penis. As a result, semen is discharged with a few more movements. For example, in inflammatory conditions such as urethritis.
In the treatment of premature ejaculation, if there are reasons such as infection or irregular sexual life, these are treated first. Some recommendations are given and delay medications are given with it. Depending on the nature of the event, psychiatric counseling may also be requested.
First of all, it is recommended for the man to control himself during sexual intercourse (Masters and Johnson method). The man’s self-control means that he learns to take a break from the relationship by feeling this just before ejaculation. When he feels that he will ejaculate, he should try to stop ejaculation by withdrawing himself or distracting himself. It would be appropriate to start these exercises by trying them first during masturbation. During masturbation, a break is expected just before ejaculation, the erection is expected to decrease, and then it is resumed. In fact, contraction of the muscles, such as holding urine, is also useful in controlling ejaculation. This application is done 2-3 times. Exercise should be repeated 1-3 times a week.
Then, the same exercises are performed during sexual intercourse. Initially, efforts are made to prevent ejaculation before intercourse. Before full ejaculation, the partner is told to take a break from the intercourse and wait until the erection disappears a little, then it is resumed. Once you are confident in this, the practice of delaying ejaculation while the penis is in the vagina is started. At this time, the most suitable position is sexual intercourse in the woman-on-top position, with the man lying on his back. Only in this way can the male best control his ejaculation. In the same way, right before the ejaculation, the spouse is signaled and the relationship is interrupted, and after waiting for a while, it is resumed.
All these applications take time. It could take weeks. It is necessary to be patient and believe that the treatment can take a long time. If unsuccessful, a doctor should be consulted for sex therapy.
Another method of treatment is the technique of squeezing the penis. Here, the penis is squeezed in the palm of the hand to prevent the ejaculation reflex and to reduce the reaction by draining the blood. Care should be taken not to create too much trauma at this time.
It has also been reported that sometimes ejaculation can be delayed during intercourse by masturbating before intercourse. The use of thick or double condoms has also been experienced to delay ejaculation by reducing penile stimulation.
During the treatment period of premature ejaculation, the help of the spouse is absolutely necessary. Because in some cases, the woman’s orgasm may be delayed. For example, there are women who cannot orgasm despite sexual intercourse that lasts for minutes. It may not be possible for a man to continue sexual intercourse without ejaculation for such a long time. The problem here is not that the man ejaculates prematurely, but that the woman starts orgasm late. Treatment should also be directed towards this.
Delay drugs are of two types. 1) oral pills, 2) creams applied to the penis. Oral pills are antidepressant drugs and are generally used in psychiatric disorders. But at the same time, they are widely used in the treatment of premature ejaculation because they delay ejaculation by increasing the stimulation threshold in the penis. It should be noted that the use of these antidepressant drugs in premature ejaculation has not yet been approved by the Ministry of Health. Since they may have side effects or adverse effects, they should be taken under the control of a doctor. Drugs such as clomipramine and fluoxetine are some of them. These drugs should be used for at least 15 days. If there is no response, there is no need to use it much, either the drug is changed or sex therapy is started.
Delaying creams are actually local anesthetics (drugs). They are sold very frequently and randomly in the market. But it has important drawbacks. First of all, they can prevent women from enjoying it by anesthetizing the vagina. It can also impair the stimulation of the penis, making it difficult to get an erection. Sometimes it can also cause irritation on the skin.
As a result, it is very important for the man to control himself in the treatment of premature ejaculation. Learning to start ejaculation late, even for a few seconds during each intercourse, can provide a satisfactory period after a while. The spouse should also show understanding and contribute therapeutically to the event. The use of medication alone may not always be sufficient, so it is essential for the person to use their own will. Sex therapy can be used when necessary.