Premature ejaculation is a sexual dysfunction seen in most men. The diagnostic criteria for premature ejaculation are: ejaculation occurring in under 7 minutes, inability to control it, its occurrence in most of the intercourse in the last three months, and its causing significant distress to the man and his partner. Although premature ejaculation has various biological and psychological causes, the most common cause is that men masturbate incorrectly from adolescence onwards. When men masturbate very quickly and focus only on ejaculation from adolescence, the muscles responsible for ejaculation gradually get used to ejaculating in a shorter time, and this carries over into the man's adult sex life. When the woman reaches orgasm over a longer time, the man's premature ejaculation also creates a sexual mismatch between the couple. The man's premature ejaculation leads to a decline in the woman's sexual quality of life as well. That is why premature ejaculation is the couple's shared problem.
After a person is diagnosed with premature ejaculation, a medical examination should first be carried out to check whether there is a physical cause underlying the problem. If there is a condition that directly leads to premature ejaculation, such as prostatitis, this should be treated first, because the desired result cannot be obtained from cognitive and behavioural methods without treating physical problems. If the cause of premature ejaculation is not a physical problem, or after any possible physical problem has been treated, the primary treatment to be applied is cognitive behavioural therapy. This treatment method includes providing accurate information about sexuality, recognising and controlling the muscles that govern ejaculation, and turning ejaculation from a reflex into a manageable process. For this, the client is given various exercises: Kegel exercises that enable control of the pelvic muscles governing ejaculation, breathing exercises, relaxation exercises to prevent involuntary body contractions during intercourse, followed by masturbation and intercourse exercises. At this point the client's own effort also becomes important. When the client does the exercises given, it is possible to obtain a lasting result of over 90% from this treatment. In addition, we combine behavioural therapy with ESWT (extracorporeal shockwave therapy), because ESWT both improves erection quality and strengthens the pelvic muscles responsible for ejaculation. Erection quality is related to the time to ejaculation: if a man wants to have quality sex for a long time, a strong penis is required, and ESWT provides this. Moreover, time to ejaculation, erection quality and sexual desire are factors that affect one another. A deterioration in one impairs the others; an improvement in one positively affects the others.
If the client does not do the exercises within behavioural therapy, we recommend medication as the second option. Time to ejaculation can be prolonged as a side effect of certain psychiatric drugs. In the treatment of premature ejaculation we can make use of these drugs by prescribing them at low doses. However, to benefit from them these drugs must be taken continuously; once the medication is stopped, premature ejaculation can reappear within a few months. As a third option we recommend creams or sprays to the client. These creams and sprays are applied locally to the glans and to the circumcision area behind the glans, and intercourse takes place after a short wait. These also prolong the time to ejaculation.
In addition to the solution options described above, a glans filler can also be performed to overcome premature ejaculation. The duration of effect of this method is approximately 6 months.
Özgür Balaban
Psychologist
