Premature ejaculation is one of the most difficult to define male sexual disorders; to simplify, we can talk about premature ejaculation when there is a stable and persistent difficulty in the voluntary control of ejaculation, so that this comes after a minimum stimulation and before the subject desires, often before the partner has reached the orgasm.
It is difficult, and all in all not very useful, to define in minutes what is the “normal” duration of the relationship from penetration to ejaculation, because it is extremely variable from couple to couple; for numbers lovers, a recent study has shown that there are couples where this time is just over a minute (without it being experienced as a problem) and others in which you get to go beyond 30 minutes, while the median time was around 5-6 minutes.
Apart from the extreme cases in which ejaculation takes place even before penetration (premature ejaculation “ante-portam”) or a few seconds later, it is fundamental in the framing of the problem to establish whether the ejaculation times in that particular pair decrease the quality of the sexual intercourse and the satisfaction of one or both partners.
A certain ejaculatory precocity can be a characteristic of early relationships in younger males, and this disorder usually tends to regress with experience
Other times, especially if the problem is not correctly addressed with the help of an andrologist, the situation can stabilize and last for years or even for life (in this case premature ejaculation is defined, with English term,” life -long “). In other subjects premature ejaculation may appear later in time, after many years of completely normal and satisfying ejaculatory times; in these cases (so-called “secondary” premature ejaculation) the origin of the problem is often to be found in the loss of confidence, at a conscious or unconscious level, in one’s ability to maintain an erection for the duration of the sexual relationship. More rarely, premature ejaculation is caused by anatomical abnormalities such as the shortness of the frenulum of the penis or inflammatory pathologies of the prostate; also in these situations the role of the andrologist is fundamental, as a correct diagnosis allows to solve the problem brilliantly with a simple drug therapy or a small intervention.
The treatment of premature ejaculation is usually based on different strategies, variously combined depending on the characteristics of the individual patient.
First of all, the so-called “counseling”, an English term that is difficult to translate into Italian, which indicates all that support activity carried out by the speCialist to develop in the patient himself those potentialities useful to bring the relationship back to the normal context. It is essential to keep in mind that premature ejaculation is first and foremost a problem of the couple, so it is very useful that both partners are involved in defining the therapeutic path.
Often a “behavioral therapy” is taught to the couple, which consists of a series of progressive exercises to be performed to improve ejaculation control
In the most resistant cases it may also be useful to resort to psycho-sexual support, and it is important that the andrologist knows how to play in a team with the other professional figures that may be involved.
In the past, extensive use has been made of so-called “retardant” creams and condoms, based on anesthetic substances that reduce the intensity of sensations at glans level;
The major limitation of these therapies is that it is difficult to correctly dose the anesthetic activity, and often the lengthening of the ejaculatory times is paid in terms of loss of pleasure or even decrease in the validity of the erection.
Until a few years ago there were no “dedicated” oral medications for premature ejaculation
Drugs designed for other pathologies were used which could, if taken continuously in the long term, lead to a certain lengthening of the ejaculation times, sometimes at the cost of some annoying side effects.
Today, however, a dedicated drug is available that can be taken as needed before sexual intercourse, without the need to perform continuous therapies; this drug has proven to be a safe and effective remedy in preclinical tests and in the experience of the first years of large-scale use, especially for the most serious cases of premature ejaculation. The main problem with drug therapy is that the effectiveness is limited to the hours following the tablet intake, and therefore this therapy alone cannot resolve the problem definitively.
In conclusion, there is no single therapy for all patients:
In order to “heal” it is really necessary to adopt various combined solutions in a strategy that must be thought of as a suit tailored to each individual patient. Relying on an experienced andrologist is therefore of fundamental importance to solve a problem that, if not adequately addressed, can lead over time to a progressive loss of quality of the sexual relationship, to a decrease in safety and self-esteem, up to the deterioration of the relationship of couple already in place or the difficulty of starting a new one.