There are several different definitions of premature ejaculation. One looks at the time from vaginal penetration with an erect penis to ejaculation, and defines ejaculation within 2–3 minutes as premature. Another defines it as ejaculation occurring before the partner is satisfied in at least 50% of sexual encounters. The definition most widely used today is ejaculation that occurs with minimal sexual stimulation, before or shortly after penetration, and earlier than desired.
Premature ejaculation affects around 35% of men and is the most common form of male sexual dysfunction.
When assessing a patient with premature ejaculation, factors such as depression and anxiety, lesions that overstimulate the skin of the penis, prostate inflammation, urinary tract infection and conditions that put pressure on the spine (such as a herniated disc) should also be investigated.
Premature ejaculation can stem from a habit of reaching orgasm and satisfaction quickly. Frequent masturbation without a partner, and regularly ejaculating while watching pornography even when partnered sex is possible, have become important causes of premature ejaculation today.
We enrol our patients with premature ejaculation in a 3-month treatment programme. We see the patient once a month to review the treatment and its results.
Alongside 3 months of medication, we teach psychological and behavioural techniques, have the patient practise them and evaluate the results. We help the patient develop a sense of control over satisfaction and ejaculation, and work to make this lasting.
We recommend that patients starting treatment for premature ejaculation attend the sessions after the first visit together with their spouse or partner. The partner’s support plays an important role in treatment. Psychological and behavioural methods aim to achieve control over ejaculation, sustained intercourse and satisfying sex.
More recently, reducing the sensitivity of the penis with a “penile filler injection” has also become an important treatment option. In this method, filler is applied all the way around the area where the head of the penis ends, which can reduce sensitivity over a long period.
Penile filler injections use a substance called “hyaluronic acid”, which is also frequently used in orthopaedics and physical therapy. Hyaluronic acid can reduce the excessive sensitivity and stimulation in the treated area that cause premature ejaculation. Around 10 cc of hyaluronic acid is injected all the way around the area where the head of the penis ends. The procedure is performed under local anaesthesia and is neither painful nor complicated.
Repeating the penile filler injection twice over a 3-month period gives very good results in the treatment of premature ejaculation.
In short, power without control is not power: premature ejaculation is a treatable sexual dysfunction.