In our days, premature ejaculation, namely uncontrolled ejaculation, can be treated easily. An exciting sexual intercourse ended with a premature ejaculation is frustrating. Although the problem seems to be premature ejaculation of man, sometimes the factors related to the woman also may play a role on it. For this reason, analyzing couples is very important for the course of the treatment. Controlling the ejaculation and once again making the sexual relations exciting is a work that must be carried out by the mutual effort of the couples.
It is very important that the couple, especially the person who has premature ejaculation problem, wants to receive a treatment for this frequent problem and believe on it. Because our society attributes so much signification to the manhood and penis, generally the men having this problem deny the treatment for they have fear to face the situation.

Premature ejaculation must not be thought as a real disease. In this sense, the harmony between sexual partners is very important. Some men consider an ejaculation realized in 20 minutes as a premature one and complaint about it. But in this situation the problem is due to the other partner who wants the man to continue the intercourse for more time without ejaculating while in fact is she who can’t reach the orgasm. (The couples that contact with us generally represent this pattern) Sometimes, the reverse also is possible. For example; if the woman reaches the orgasm in 5 minutes, ejaculating in first one or two minutes will not cause any problem. So the premature ejaculation is related to the satisfaction degree of the partners. If they are satisfied, there is no problem. But otherwise there will be a problem because of which will arise the need to consult a doctor with the idea of premature ejaculation.

If the premature ejaculation problem persists for six months and is repeated in each sexual intercourse and even the sexual partner is not satisfied for this reason, so the treatment is a must. Once the reason and type of the premature ejaculation is specified, appropriate treatment options can be selected or different treatment options can be combined.
The first thing to do for the treatment of premature ejaculation is to consult an Urology specialist for an urologic analysis. During this analysis, medical examination will be carried out and some tests will be requested to find out whether the problem is a physical one or not. The problem is generally psychologic.

The men having premature ejaculation also may have erection (impotence) ve low libido problems . Curvature and/or pain (Peyronie) during the erection of the penis also may cause premature ejaculation or other sexual problems.

TREATMENT METHODS:

SEXUAL THERAPY
The therapy consists of helping to the couples to understand the meaning and consequences of the problem and giving them information about the sexuality. The basis of the therapy is to teach the technics for controlling and delaying the ejaculation. Where appropriate, the performance anxiety must be reduced and the couples must rely on their sexual performance. Increasing self-esteem, relaxing, reducing stress and anxiety and the motivation are integral parts of the therapy. The exercises recommended to the man or the couple should be made regularly and resolutely. If the exercises prescribed for the ejaculation control are performed regularly and step by step, the problem is resolved generally in 5 or 6 sessions.

SELF-CONTROL OF THE MAN
There are two important approaches. The first one is the man’s position. The position in which the man is below and immobile is the one that delays the ejaculation much more time than others. In this position the man lies back, relaxes his muscles completely while the woman, being above, continue the intercourse moving very slowly, without contracting too much or doing exciting movements.
The second one is to strengthen the will. Turning the attention away can be useful. Especially he should avoid to touch the points that will arouse sexual desires in the woman. Also he should abstain from the movements that arouse sexual desires. For example some men said that they become very excited when they touch or look at some specific points of the women. In these cases it is very important to abstain from exciting movements and to prefer less exciting positions.
Some men say that during this time they think about some details of their work life while the others think about the details of their daily life. But this kind of distraction may reduce the satisfaction to get from the sexual intercourse. So the focusing on the respiration is a more suitable technic. Respiring deeply, holding the breath during 2-5 seconds and then releasing it are very useful. Half closing eyes and focusing on a specific point also are effective.

Leaning forward while deeply respiring will exercise a certain pressure on the bladder and prostate, as a result of which the ejaculation will be delayed by stimulating parasympathetic nerves. The most important technic is respiring deeply and leaning forward while exercising pressure on the bladder and prostate meanwhile pelvic muscles are contracted as if the urine was retained. As it is known, ejaculation is performed by sympathetic nerves while parasympathetic nerves impede it. Some men’s parasympathetic nerve stimulation represent a certain irregularity because of which the ejaculation starts precociously. So we recommend to apply above mentioned technics to strengthen parasympathetic nerves.
Also it is important that the men know and control the genital zone also named as sexual muscle. So we teach how to make Kegel exercises on a daily basis to feel and control the muscles found on the genital zone.
These exercises may be difficult at the beginning. But in time, by getting accustomed and making practices, the ejaculation will be delayed. The most important point to remember is the importance of developing the self-control. Other technics also can be developed to enable the self-control. But these technics should never be applied in a harsh way that may affect the sexual intercourse and erection. A balance must be sought.

MASTERS VE JOHNSON TECHNICS (PENIS SQUEEZING)
This technic is developed by Masters and Johnson. It consists of squeezing penis to delay the ejaculation just before the man gets totally excited. Here the point is not to turn the attention away but, on the contrary, to focus on increasing the sexual desire. The penis must be squeezed once the threshold of excitement is reached in a short time and squeezing the penis just before the ejaculation.
In this way the man learns at which degree of excitement he reaches the threshold of ejaculation. And he finds out how much time he can control himself in a normal sexual relation. But, at the beginning, the penis must be excited by the man before it enters the vagina. This can be made by the partner also. Or the man also can do it by himself through masturbation by squeezing the penis once the threshold of ejaculation is reached.
First the penis must be totally excited during foreplay. This can be made either by the partner or by himself during the masturbation. In the same time, the man imagines the scenes that will lead him to the climax. The objective is to reach the threshold of ejaculation as soon as possible.

When he feels that he will ejaculate, the point where the head and body of the penis converge must be squeezed during 15-20 seconds. Will be felt a certain pain. But the pain must never hurts the penis. During this time the penis may lose erection a little bit.
It must be waited 30 seconds and then the penis must be excited once again. The exercise is repeated 3 times and then the penis is introduced into the vagina.

START-STOP METHOD
Controlling ejaculation reflex and learn the threshold of ejaculation depend on similar technics. Man warns his partner when he feels that he is about to ejaculate and stops the intercourse. After the sensation of ejaculation disappears, the intercourse continues. The ejaculation is realized after trying 3 times.
It will be easier to control the ejaculation after trying a several times. The harmony and coordination between the couples is very important.

MEDICAL TREATMENT
The ejaculation can be delayed 5-10 minutes by using medicines. But searching solutions in medicines is not always the best option. The better is to combine with above mentioned exercises.
As medicines, we recommend low dose antidepressants. The treatment is planned either by using them constantly or taking them some hours before the relation. In some treatments, the medicines are constantly used during one month and then are administered before the sexual relation.
Using antidepressants without control is not recommended for they may cause attacks and low blood pressure in some cases. Even they can cause erectile dysfunctions. For this reason, they must be administered in low doses and for a short period.

There are some researches suggesting that some medicines as sildenafil and vardenafil used in the treatment of erection (impotence) problems also have positive effects on premature ejaculation. These medicines should be used under doctor control for they have some adverse effects.
Anesthesic sprays, creams, pomades also can be used as complementary treatment on the persons having high sensibility of penis and genital zone.

INJECTION TREATMENT (GLANS PENIS)
Especially the glans penis may cause premature ejaculation due to its high contact sensitivity. (High penis sensitivity). In this very easy treatment filling materials are used to cover glans penis to enlarge the penis a little bit. As a consequence of which the contact sensitivity of the penis is reduced. The effect of the filling material lasts between 6 months and 1 year. I got very successful results on the patients having premature ejaculation problem due to the high sensitive penis, in 4-6 sexual therapy sessions.

OTHER SURGICAL PROCEDURES (PLASTIC SURGERY/PROCEDURES)
Most sensitive parts of the genital zone: The area between glans penis (head of the penis) - a protrusion named frenilum below glans penis - and penoscrotal webbing, namely the part found between scrotum (sack covering the testicles) and the base of the penis. In some men these areas may be more sensitive. The men having this type of high sensitivity and premature ejaculation

© 2016 - Op. Dr. Cem ÖZLÜK