Premature Ejaculation
EARLY EJACULATION (PREMATURE EJACULATION)
WHAT IS IT? WHAT CAUSES IT? A COMPREHENSIVE OVERVIEW OF SYMPTOMS, CAUSES, TYPES, DIAGNOSIS, AND MODERN TREATMENTS
Introduction: What Is Premature Ejaculation?
Premature ejaculation is one of the most common sexual dysfunctions in men and affects millions of men worldwide. Because it leads to both physical and psychological consequences, it is not merely a sexual problem but also a significant health issue that affects quality of life.
According to medical diagnostic criteria, premature ejaculation is defined as:
• Ejaculation occurring within 1 minute of vaginal penetration,
• Significant difficulty controlling ejaculation,
• A condition that has persisted for at least 6 months,
• A problem that causes significant distress to the man or his partner,
.
However, according to the modern approach, evaluating premature ejaculation based solely on duration is insufficient. This is because premature ejaculation occurs when there is a dysfunction in at least one of the following three fundamental mechanisms:
Penile nerve sensitivity (hypersensitivity)
Central Nervous System – Serotonin Balance
Psychological and behavioral factors
For this reason, premature ejaculation is a multifactorial problem, and its treatment varies from person to person.
HOW COMMON IS PREMATURE EJACULATION?
According to scientific data:
• The lifetime prevalence of premature ejaculation among men is 30–40%
• The prevalence of chronic premature ejaculation is 20–25%
• Primary (congenital) premature ejaculation accounts for 3–5%
• Secondary (acquired) premature ejaculation accounts for 20% or more
These figures show just how significant a role premature ejaculation plays in men's sexual health.
SYMPTOMS OF PREMATURE EJACULATION
Common symptoms of premature ejaculation:
• Ejaculation within 1 minute of penetration
• Inability to control the urge to ejaculate
• Anxiety due to the fear of premature ejaculation
• Sexual dissatisfaction
• Problems with intimacy with a partner
• Loss of sexual confidence
• Unintentionally reaching orgasm too early
• The duration of intercourse being consistently short in every sexual encounter
• Uncontrolled ejaculation even during masturbation
• Causing sexual anxiety in daily life
These symptoms may be persistent or temporary.
TYPES OF PREMATURE EJACULATION
Primary (Congenital) Premature Ejaculation
• It has been present since the beginning of the man’s sexual life.
• It occurs in almost every sexual encounter.
• The duration is always very short (it can be as short as 5–15 seconds).
• It is usually related to penile hypersensitivity.
• This is the group that responds best to treatment.
Secondary (Acquired) Premature Ejaculation
• It develops later in a man who previously had normal function.
• The causes are varied:
o Prostatitis
o Erectile dysfunction
o Thyroid disorders
o Stress, depression
o Diabetes
o Relationship conflicts
• The underlying cause must be identified before treatment can begin.
Secondary premature ejaculation is often completely treatable.
CAUSES OF PREMATURE EJACULATION
To understand the causes of premature ejaculation, it is necessary to evaluate these three systems together.
A) Physiological Causes
1) Penile hypersensitivity (Hypersensitivity)
This is the strongest biological cause of premature ejaculation.
• The nerve endings in the glans are very sensitive.
• The dorsal nerve transmits the stimulus very quickly.
• The brain sends the ejaculation signal too early.
Symptoms:
• Sudden increase in pleasure upon touch
• Burning sensation in the glans area
• Temporary relief from creams
• Premature ejaculation even with controlled stimulation
This mechanism forms the basis for glans augmentation and nerve cryotherapy treatments.
2) Serotonin Deficiency
Serotonin is a neurotransmitter that delays ejaculation.
Low serotonin levels weaken ejaculatory control.
3) Prostate Disorders
• Chronic prostatitis
• Acute infection
• Pelvic muscle spasm
4) Erectile Dysfunction
Fear of losing an erection → Rushing → Reflex ejaculation
5) Hormonal Disorders
• High thyroid hormone levels
• Low testosterone levels
• High prolactin levels
6) Urethral sensitivity
B) Psychological Causes
• Performance anxiety
• Pressure from a partner’s expectations
• Lack of sexual experience
• Depression
• Traumatic experiences
• Loss of self-confidence
C) Behavioral Causes
• Habit of having sex too quickly
• Rushed masturbation
• Porn addiction
• Incorrect arousal pattern
HOW IS PREMATURE EJACULATION DIAGNOSED?
1) Detailed History
• Time to ejaculation
• Sense of control
• Duration of masturbation
• Partner compatibility
• Onset of the problem
• Level of sensitivity
2) Physical Examination
The glans, frenulum, urethra, and prostate are examined.
3) Additional Tests, if Necessary
• Penile sensometer
• Thyroid tests
• Hormones
• Prostate exam
• Infection tests
In most cases, the diagnosis is based solely on the patient's history.
THE RELATIONSHIP BETWEEN PENILE SENSITIVITY AND PREMATURE EJACULATION
Dorsal nerve sensitivity → Premature ejaculation
If sensitivity increases:
• Ejaculation time shortens
• Sense of control is lost
• Stimulation threshold decreases
Modern treatments target this mechanism:
• Nerve freezing
• Glans penis filler
• Topical anesthetics
• Serotonin-regulating medications
TREATMENTS FOR PREMATURE EJACULATION (MODERN APPROACH)
1) Behavioral Therapies
• Stop–start
• Squeeze technique
• Sensate focus
• Delayed response therapy
2) Topical Anesthetics
• Lidocaine
• Prilocaine
• EMLA derivatives
3) SSRI Medications
• Sertraline
• Paroxetine
• Fluoxetine
4) Dapoxetine
Should be taken 1–3 hours before intercourse.
5) Hormone Therapies
Treatments for thyroid, testosterone, or prolactin disorders.
6) Prostate Treatments
Premature ejaculation caused by prostatitis is common.
7) Sensitivity Measurement with a Penile Sensometer
Enables the development of personalized treatment plans.
8) Nerve Freezing (Cryoablation)
• Dorsal nerve endings are frozen at temperatures between -60°C and -80°C.
• Reduces sensitivity.
• Effects may last 6–36 months.
9) Penile Head Augmentation (Glans Augmentation)
• Sensitivity is reduced with hyaluronic acid filler.
• Effective for 12–24 months.
10) PRP – Exosomes – Stem Cells
: Promotes tissue healing and nerve regulation.
11) Erectile Dysfunction Treatment
PDE5 inhibitors are effective in treating premature ejaculation caused by erectile dysfunction.
12) Sex Therapy
Provides lasting relief from psychologically based premature ejaculation.
SUCCESS RATES OF PREMATURE EJACULATION TREATMENTS
| Treatment Method | Success Rate | Duration of Effect |
|---|---|---|
| SSRI Medications | 50–70% | As long as the medication is being taken |
| Dapoxetine | 65–75% | Hourly |
| Topical Creams | 30–60% | Short |
| Nerve Freezing | 70–85% | 6–36 months |
| Penile Head Augmentation | 60–75% | 12–24 months |
| Sex Therapy | 40–70% | Permanent |
| PRP / Exosomes | Variable | 6–12 months |
HOW IS THE BEST TREATMENT FOR YOU DETERMINED?
1) Penile sensitivity is measured
2) The ejaculation reflex is assessed
3) Erectile function is examined
4) Hormone and thyroid levels are checked
5) Behavioral factors are examined
FREQUENTLY ASKED QUESTIONS
Can premature ejaculation be completely cured?
Yes, it can be largely resolved with appropriate treatment.
Is nerve freezing dangerous?
No, it does not cause permanent loss of sensation.
Is penile head augmentation safe?
It is very safe when performed by the right specialist.
Are creams harmful?
Not when used correctly.
CONCLUSION
Premature ejaculation is a complex sexual health issue influenced by multifaceted mechanisms such as sensitivity, nerve transmission, psychological state, and hormones.
Today, there are highly advanced methods available for diagnosis and treatment:
• Penile sensometry
• Nerve freezing
• Glans penile augmentation
• Dapoxetine
• Behavioral therapies
• Prostate treatments
• Hormone therapy
Premature ejaculation is a condition that modern medicine can now manage and that is fully treatable.
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