Treatment of premature ejaculation with drugs and surgery

Premature ejaculation is one of the most common sexual disorders. This phenomenon is recognized as a pathology if ejaculation occurs before sexual intercourse or with the first frictions .

Some men consider ejaculation to be too fast, occurring 3-5 minutes after the start of sexual intercourse, but doctors have a different opinion: this problem is predominantly psychological and arises from the inability to satisfy the partner.

The rate of ejaculation can be successfully controlled using various methods.

The problem of premature ejaculation

Premature ejaculation from overstimulation (more about the consequences of overstimulation) is a normal phenomenon that often occurs in boys at the age of 16-17 (at the beginning of sexual activity).

High testosterone and lack of experience make it impossible to control the ejaculation reflex. This can happen to a man at the age of 30-40, but it is quite rare. The regular nature of premature ejaculation is a reason to suspect physiological pathology.

Psychological problems may also arise due to rapid ejaculation

• Development of an inferiority complex, decreased libido, subconscious rejection of sex due to the consolidation of the “quick-shooting” status;
• Quarrels with a partner, discord in relationships;
• Inability to enjoy normal sexual intercourse due to rapid orgasm.

The psychological problem of early ejaculation will soon lead to neuroses and depression, symptoms of decreased immunity, the development of cardiovascular and other pathologies gradually appear.

Causes of premature ejaculation

According to the time of development, early ejaculation is divided into 2 types:

1. Primary – a man suffers from his youth from his inability to cope with early ejaculation. A problem arises due to a short frenulum of the penis or increased sensitivity of its head, lack of serotonin in the brain. These causes are congenital.
2. Secondary – develops under the influence of various factors already during normal sexual life.

Secondary premature ejaculation can be caused by a number of reasons:

• Urological pathologies: prostatitis, balanoposthitis, endothelial erectile dysfunction. Varicocele, contrary to popular belief, does not cause early ejaculation;
• Endocrine disorders caused by excess cortisol, leptin, insulin, prolactin;
• Metabolic failures caused by diabetes, obesity;
• Genetic predisposition;
• Taking certain medications.

Urologist-andrologist Draznin Anton Vladimirovich on the causes of premature ejaculation

Secondary premature ejaculation is often situational - it occurs only under certain factors. These may include alcohol consumption, sexual abstinence, excessive arousal, and frequent masturbation.

A separate group of factors for accelerated ejaculation are psychological . This may be a reflex developed and strengthened from childhood to quickly ejaculate during masturbation due to the fear of being taken by surprise, a desire to quickly complete the process due to a subconscious hostility towards a woman, or neuroses.

From the point of view of psychosomatics, premature ejaculation in the vast majority of cases takes on a mixed character - it is a product of psychogenic and organic disorders.

Treatment

In case of premature ejaculation, consult a urologist or andrologist .

At the initial consultation, the doctor asks questions about when and under what circumstances premature ejaculation first occurred, how often it recurs, and how long sexual intercourse lasts.

Special questionnaires help determine the severity of the problem and its impact on the psychophysical state of a man.

Take our test to identify PE according to the criteria of N.D. Akhvlediani, 2011. It is designed to assess your sexual function over the last 4 weeks and will help the doctor identify possible disorders. Please indicate one answer that best matches your condition.

Treatment tactics depend on the reasons that provoked premature ejaculation. In most cases, pharmacotherapy is sufficient, but sometimes surgery is also used. If the problem is psychological in nature, then it is advisable to contact a psychologist or sexologist .

Urologist Kamaletdinov R.E. talks in detail about the causes, diagnosis and treatment of PE

Increased sensitivity of the head

High sensitivity of the head of the penis can be either congenital or acquired due to diseases. You can check the degree of influence of this factor on ejaculation using a lidocaine test , available at home. To do this, buy Emla ointment or a 10% lidocaine solution at the pharmacy.

One of the remedies is to first treat the frenulum of the penis, and then have sexual intercourse (with a condom) . If the result is insignificant, the product is applied to the entire head. If the duration of sexual intercourse has increased, then the problem of premature ejaculation is really hypersensitivity.

You can get rid of it yourself (but temporarily) in several ways:

1. Anesthetic ointments (the same “Emla” will do), sprays and lubricants. The drugs are applied 10-15 minutes before sex (to begin with, only on the frenulum), then they need to be washed off the penis or a condom put on it, since anesthetics can cause allergies and loss of sensitivity in the partner’s genitals.
2. Cock rings are special devices from intimate stores. Placed over the base of the erect penis. By gently squeezing the blood vessels and urethra, they help prevent premature ejaculation.
3. Condoms with a prolonged effect - with thick walls and an anesthetic inside. You can start with thick-walled ones without lubrication, as some men lose erections due to the unusual sensations from anesthetics. Some people just use two regular condoms.

The price of condoms for 3 pieces is from 189 rubles.

You can eliminate excessive sensitivity for a long time using the folk method - always open the head (you can lightly fix the foreskin with something). Gradually, due to friction with underwear and exposure to air, the skin will become rougher (like after circumcision). It is important not to damage the skin or cause infection. To do this, it is recommended to periodically use Levomekol ointment.

You can combat premature ejaculation caused by hypersensitivity using herbs:

• Before sex, lubricate the head with mint juice;
• Drink tincture of cornflower or oak bark;
• Regularly add raspberry and currant leaves to tea. The substances they contain help reduce the sensitivity of the penis receptors.

Experimenting with the sensitivity of the head during premature ejaculation is permissible only if you are completely sure that there is no inflammation (balanitis). There should be no redness, swelling, or rash. Otherwise, suppressing symptoms will transfer the disease to the chronic stage.

Surgical methods

It is possible to radically correct the increased sensitivity of the head and get rid of premature ejaculation through surgical techniques:

1. Denervation of the glans - dissection of the nerves of the penis. There are 2 options for the operation: with subsequent stitching of the fibers and without it. In the first case, sensitivity will be restored after some time, but premature ejaculation usually does not return due to the development of a new ejaculatory reflex.
2. Augmentation of the head - the introduction of hyaluronic acid between the skin and nerve endings. In this case, there is a slight increase in its size. Every six months the procedure is repeated as the acid dissolves, however, as in the case of temporary nerve severing, a new reflex may be developed.
3. Circumcision is the removal of the foreskin.

Why is surgery needed to circumcise the foreskin of the penis, says urologist, andrologist, plastic surgeon R. Yu. Petrovich

Surgical methods are used mainly for primary premature ejaculation caused by congenital hypersensitivity of the head.

Medicines

You can prolong sexual intercourse with the help of PDE-5 inhibitors (Viagra) . The mechanism of operation in this case is the same as that of an erection ring - due to increased blood flow, the sensitivity of the head is somewhat reduced.

There is one more aspect: premature ejaculation often occurs against the background of weak potency (flaccid erection), and PDE-5 inhibitors cause maximum erection, in which the corpora cavernosa fully expand and compress the nervous structures, reducing their sensitivity.

The drugs also help to cope with some psychological causes of early ejaculation.

One of the most commonly prescribed medications for premature ejaculation are SSRI antidepressants (selective serotonin reuptake inhibitors).

These include the drugs “Fluoxetine”, “Sertraline”, “Paroxetine”. The substance dapoxetine, known under the brand name “Priligy,” has been developed specifically for the treatment of early ejaculation.

Antidepressants can be taken occasionally, but the greatest effect is achieved with course therapy.

In some cases, antispasmodics are used in the treatment of premature ejaculation: antispasmodic, papaverine. These substances slow down the transmission of nerve impulses. Relatively harmless medications have the same, but less pronounced effect: tincture of motherwort or valerian.

For premature ejaculation, accompanied by excessive anxiety or neuroses, anxiolytics (Afobazol) are prescribed. Doctors also recommend the antidepressant Trittico .

The product is well tolerated and helps improve the quality of sex and its duration.

Therapy for early ejaculation can be supplemented with the homeopathic drug Impaza , the course of treatment of which lasts about 3 months.

Orgasm Control Methods

You can avoid premature ejaculation with the help of your partner.

Feeling the approaching climax, the man gives the woman a signal, after which she presses her finger on the point between the scrotum and anus.

This is a small depression located closer to the anus. Squeezing the duct helps stop the flow of sperm at the beginning of its journey without the risk of reflux into the bladder.

You can learn to control ejaculation by training your pubococcygeus muscle. There are two methods for this: the Kegel system (squeeze-relax 200 times in 2-3 approaches per day) and interrupting the flow of urine for 10 seconds (2-3 times per urination). These exercises are also useful for prostatitis.

During sexual intercourse, when orgasm approaches, the muscle should be squeezed for a few seconds, while the stomach should be pulled in and your breath held. Subsequent deep abdominal breathing will help relieve arousal. Then the friction continues.

You can also delay ejaculation by retracting the testicles , thus returning the sperm to their original positions. To do this, carefully grasp the scrotum above the testicles with a ring formed by the thumb and forefinger and pull down with little force.

What a man can do on his own to slow down ejaculation and curb the increase in arousal:

• Press your thumb on the base of the frenulum, while your middle and index fingers press on the other side;
• Squeeze the penis with your whole hand, press your thumb on the urethral opening;
• Squeeze the root of the penis on both sides (at the pubis and under the scrotum).

These techniques for curbing premature ejaculation can be used when training using the “stop-start” , based on masturbating the penis first “dry”, then using a lubricant. The purpose of the exercises is to learn to correctly recognize the threshold of orgasm and take timely measures to reduce arousal.

Eastern practices can help in learning to effectively control ejaculation . In popular language, ancient Chinese Taoist techniques are described in the book by Manteca Chia. Some men were able to cope with premature ejaculation with the help of yoga and qigong gymnastics. Regular exercise helps stabilize the nervous system.

Prevention

To prevent the development of a secondary form of premature ejaculation, doctors recommend the following:

1. Stop smoking , minimize the amount of alcohol , since toxins disrupt the functioning of nerve endings.
2. timely measures at the first signs of inflammatory urological diseases .
3. Do not overuse masturbation . After massaging the penis frequently, overstimulation of the genital centers of the spinal cord is possible.
4. Avoid injuries to the lumbar spine , which is responsible for the ejaculatory reflex.
5. Maintain a normal weight and physical activity to avoid metabolic disorders.

Stress and depression can also be controlled with medications or natural remedies.

Conclusion

If ejaculation occurs quickly, this does not mean the presence of pathology. For many men, a modest duration of sexual intercourse is the norm, a physiological feature (typical for small penis sizes). Correction is required only in cases where premature ejaculation causes psychological and physical discomfort.

Source: https://muzhchina.info/potencia/prezhdevremennaya-eyakulyaciya

Treatment of premature ejaculation: surgery, circumcision

Premature ejaculation is the rapid onset of ejaculation (orgasm) during or before sexual intercourse. Treatment of premature ejaculation is carried out in several stages. Below is detailed information.

Hello, Alexander Burusov is here, an expert at the Viva Man men’s club. Today we continue to talk about the topic of rapid ejaculation. In this article we will focus on surgical methods for solving pathology. I suggest starting with the diagnostic process. Many men wonder: why do you cum quickly and what to do? Today I will try to answer this question.

Diagnosis of early ejaculation

Diagnosis of this sexual dysfunction is as follows:

1. Discussion of the individual's sex life with the attending physician. It may be necessary to negotiate with the patient’s sexual partner, since several main reasons may stem from personal problems and discomfort.
2. Carrying out physical methods of medical diagnostics - a set of special measures to establish an accurate diagnosis and subsequent treatment of premature ejaculation.
3. Submission of necessary tests.

After diagnosis, the causes of this disorder . There may be several of them:

1) Problems in psychological terms.

2) Impaired functioning of the body, disease of the genital organs. Various equally important factors are also taken into account: the age of the person and his sexual partner, the duration of the period of arousal and how often intimacy occurs.

In the process of studying this sexual disorder, experts developed a test (of two types - complete and selective) for a complete and correct medical diagnosis. It helps determine what type of surgery the patient needs.

The test is based on the use of lidocaine (10% solution). It is commonly used for anesthesia (pain relief). In this case, the product is used to reduce the sensitivity of the head of the penis.

• Selective test - before sexual intercourse, the frenulum of the penis and the base of the glans are lubricated with lidocaine until there is complete loss of sensitivity. You should have sex using a contraceptive. If the erection was complete and the orgasm was completely satisfying, then surgery to remove the foreskin is prescribed.
• Full test – carried out if the result of the first test is unsatisfactory. In this case, the glans penis is completely treated with the drug. If the result is positive, then surgical intervention is planned to significantly reduce sensitivity by suturing the nerve trunks.

In any case, if such a problem occurs, you must immediately go to the hospital in order to avoid negative consequences.

Treatment methods

Treatment for premature ejaculation may not be necessary, since this problem can gradually resolve without outside intervention if the cause of the dysfunction is: alcohol abuse, smoking, or the use of certain drugs. If these options are excluded, then they resort to special treatment methods :

1. Surgical intervention - carrying out operations after the “lidocaine test”.
2. Psychotherapy – conversations with the attending physician who tries to make the patient feel positive about sexual intercourse in order to get rid of worries and worries.
3. Training – the doctor may recommend performing Kegel exercises, “butterfly” (stretching the leg muscles), as they help enhance pleasant sensations and control your own arousal.

Methods of surgical treatment

If training and psychotherapy do not help, a decision is made to perform an operation to denervate (block the nerve endings) of the head of the penis.

The first type of operation is as follows: the skin is cut near the groove of the glans penis and moved to the base of the genital organ. In this case, access to all nerve endings is open, they are stitched together using medical instruments.

 Four months after the operation, the sensitivity of the head noticeably decreases, sexual intercourse lasts longer. Gradually, you need to train to control the duration of sex and the moment of ejaculation.

If there is no intimacy for a long time, the problem will reappear and a repeat operation will be necessary.

Operations should be carried out only after tests using the drug lidocaine. You can do without this and begin treating premature ejaculation with the consent of the patient. This option is usually chosen by actors starring in pornographic films.

Additional treatments

There are several other options to reduce sensitivity:

1. The use of a silicone retractor in the form of a ring , which is put on the penis and secured at the base of the glans. Thus, the underwear constantly rubs against the head of the penis, which leads to irritation. At first the sensations are unpleasant, but then they disappear.
2. Circumcision is the removal of the foreskin. As a result, the head is exposed and sensitivity decreases.

Doctors may decide that a patient will require frenuloplasty . Before this operation, various tests are not required, but it is performed to achieve the same goal.

It is prohibited to immediately begin to have an active sex life. It is necessary to wait a week after treatment.

If the client simultaneously has a problem - penile curvature - then the attending physicians perform surgery to correct it.

The above methods for treating premature ejaculation are used if the cause is dysfunction of physiological processes and other diseases. If the problem is psychological, then other methods are used.

Source: http://viva-man.ru/prezhdevremennaya-eyakulyatsiya/operativnoe-lechenie-prezhdevremennoy-eyakulyatsii/

Premature ejaculation

“Only my wife knows about my experiences. I finished sexual intercourse in a maximum of twenty seconds, I specifically timed it. And if after the first contact I immediately succeeded in the second, then it lasted at most half a minute. And only twice, when I was very drunk, did I manage to hold out for more than a minute.” /Patient with premature ejaculation./

Premature ejaculation is a sexual dysfunction that involves the inability to control ejaculation sufficiently to ensure that both partners enjoy sexual intercourse.

It should be noted that premature ejaculation is not only a medical, but also a social problem, since its presence causes a decrease in self-esteem and quality of life in men, has an adverse effect on the partner and worsens sexual relationships, and sometimes leads to family breakdown.

Sex therapists believe that the main cause of premature ejaculation is sexual intercourse in adolescence, carried out in a hurry in a state of nervous tension due to the fear of being caught by someone.

The most common factors are also: dissatisfaction with family life, failure to resolve interpersonal conflicts, lack of trust in a partner, fear of intimate and romantic relationships, sexual role conflicts.

Typically, such men have very high sensitivity of the glans penis. It becomes less sensitive by cutting some of the nerve fibers going to it.

After this, the nerves are sutured using microsurgical instruments.

Then, over the course of several months, sensitivity is restored depending on the growth rate of any of the nerve trunks (“mosaic” sensitivity).

Treatment for premature ejaculation A new method - microsurgical prolonged denervation from RUB 55,800.  1. The most effective method of treatment for early ejaculation 2. Hospital stay 1 day 3. Extensive experience in andrological operations  4. Operations are performed at the Clinical Center for Microsurgery, Reconstructive and Reproductive Andrology at the LRC of the Ministry of Health and Social Development Sign up for a consultation and operation - 8 (495) 66-44-888

Gradually, as sensitivity is restored, the patient gets used to the new sensations, but he has already formed a normal ejaculatory reflex, and in the future the patient can already control the duration of sexual intercourse. The attitude towards prolonged sexual intercourse is already fixed in the subconscious. After 6-8 months, the sensitivity of the glans and skin of the penis is usually completely restored.

[to contents]

EARLY EJACULATION SYNDROME. MICROSURGICAL DENERVATION OF THE PENIS.

Introduction

Premature ejaculation (PE) is a sexual dysfunction that is not caused by organic disorders or diseases and consists of the inability to control ejaculation to an extent sufficient for both partners to receive satisfaction from sexual intercourse (ICD 10).

It should be noted that premature ejaculation is not only a medical, but also a social problem, since its presence causes a decrease in self-esteem and quality of life in men, has an adverse effect on the partner and worsens sexual relationships, and sometimes leads to family breakdown.

There is no clear definition of PE in the scientific literature. This is due to the lack of uniform ideas about the normal duration of the frictional stage of the copulatory cycle.

Kinsey wrote in 1948: “In about three-quarters of all men, orgasm is achieved within two minutes after the onset of intercourse, and in a large proportion of men, release can occur before the end of a minute or even within 10-20 seconds after introjection.

At times, a man may be so excited mentally or physically by caresses that ejaculation occurs before the genitals touch.”

It should be taken into account that the duration of the frictional stage depends not only on the state of health and physical characteristics of men, but also on the use and mastery of the technique of prolonging sexual intercourse, which is achieved by regulating the frequency and amplitude of copulatory frictions.

1. Typically, PE is interpreted as ejaculation, which constantly or periodically occurs before, during or immediately after introjection with minimal sexual stimulation and causes dissatisfaction with sexual intercourse.
2. According to various authors, PE is considered a fairly common copulative dysfunction and occurs in approximately 30-40% of men.
3. From a practical point of view, it seems appropriate to distinguish two groups of pathogenetic factors of this phenomenon: PE caused by changes in the central and peripheral nervous structures associated with the regulation of copulatory function.

In the occurrence of PE of cortical origin, great importance is attached to a number of psychogenic factors, most often fear.

Sexopathologists believe that the main cause of PE is sexual intercourse in adolescence, carried out in a hurry in a state of nervous tension due to the fear of being caught by someone.

As literature data indicate, in the vast majority of cases, PE is the result of a functional disorder of nervous regulation at its various levels. The share of PE caused by functional disorders of the subcortical nerve centers in the total mass of sexual disorders is insignificant.

The connection between the occurrence of PE and prostatitis and colliculitis has not been proven.

Most experts believe that treatment of premature ejaculation should be predominantly pathogenetic. According to sex therapists and sex therapists, PE occurs quite often, is very disturbing for patients, and in most cases is amenable to psychotherapy (sex therapy).

However, they note that this disorder is difficult to correct using other methods. Successful treatment consists of developing in the patient a clear recognition of the sensations that precede the onset of orgasm. The formation of this sensory feedback is carried out in a calm environment, in the presence and participation of the wife.

For this purpose, two effective treatment methods are proposed - the “compression” technique proposed by W. Masters and V. Johnson, and the “stop-start” technique. The latter was designed by James Samans.

As a rule, a man achieves good control over ejaculation over a period of 2 to 10 weeks, although stable control is usually achieved after several months from the time of cessation of therapeutic procedures. However, negative reactions of spouses (fatigue, disappointment, resistance, etc.) can be an obstacle to the progress of treatment.

The use of such simple and physiological techniques as stopping friction immediately after introjection until vollustic genital sensations completely disappear, slowing down the rate of friction with maximum muscle relaxation give a noticeable effect. La Pera G. (1996) offers a method of controlling the ejaculation process by training the pelvic floor muscles.

• However, in all cases, it is necessary to identify and eliminate the corresponding phobias and provide a therapeutic perspective - the patient must be prepared for the fact that treatment will require time, effort, patience and perseverance, but will certainly be successful.
• One of the main conditions for such therapy for PE is the presence of a permanent, supportive sexual partner.
• Despite the integrity and interconnection of various parts of the nervous system, disorders of cortical, spinal or genital receptor origin require a different approach when constructing a treatment plan.

One of the approaches to correcting premature ejaculation is to reduce the sensitivity of the receptor structures of the penis.

Currently, to reduce the increased sensitivity of the glans penis, local anesthetics (ethylaminobenzoate, anesthetic and lidocaine ointments, SS cream) are usually used with the simultaneous use of a condom.

Anesthetic ointments are applied to the head of the penis, mainly in the area of ​​the frenulum, to prevent complete loss of sensitivity and not to cause anejaculation.

For the treatment of premature ejaculation, magnesium sulfate, novocaine, ergot preparations and other drugs, as well as chlorethyl blockade, have traditionally been and are now being used less and less often. Magnesium sulfate reduces the excitability of the central nervous system.

Novocaine has an inhibitory effect on the transmission of excitation to the central synapses of the reflex arcs of the spinal cord. Ergot preparations increase smooth muscle tone, block sympathetic nerve impulses and help reduce the excitability of the ejaculatory center.

Spasmolitin, typhen, papaverine, diprofen are used for PE, as they interrupt the transmission of nerve impulses in the ganglia of the parasympathetic nerves. Minor tranquilizers (meprotane, andexin, meprobamate, elenium, trioxazine) are used to reduce feelings of fear and uncertainty.

Sedatives are recommended, such as sodium bromide, potassium bromide, valerian tincture, motherwort tincture, etc. It should be noted that in general, the effectiveness of the listed drugs for the treatment of PE is clearly insufficient and it has not been subjected to special statistical processing.

In recent years, studies have appeared on the effectiveness of using intracavernosal injections (ICI) of vasoactive drugs for the correction of PE.

Perhaps one of the mechanisms for increasing the duration of the frictional stage during intracavernosal therapy is a decrease in the sensitivity of the nervous structures of the penis due to their compression by the cavernous bodies acquiring adequate rigidity.

Perhaps the man’s sense of confidence in successful coitus after intracavernosal injection also plays a role. However, the decisive factor is that with a pharmacological erection, it persists even after ejaculation, which allows the patient to prolong sexual intercourse. The latest experimental and clinical studies have demonstrated the ability of a number of pharmacological drugs to have a rather selective effect on individual mechanisms regulating ejaculation.

The current level of development of pharmacology makes it possible to treat premature ejaculation more effectively.

Ejaculation is inhibited by antipsychotics by blocking dopamine receptors at the central level. This group of medications is also known as antipsychotic drugs. PE is prevented by centrally acting dopamine receptor blockers. Antipsychotics are not widely used in the treatment of premature ejaculation.

Ejaculation is minimally inhibited by tranquilizers - benzodiazepine derivatives, drugs that increase the concentration of gamma-aminobenzoanoic acid (GABA) and activate its action in the brain. Their effect on ejaculation is most likely dose dependent. These include diazepam (Sibazon), lorazepam and alprazolam.

Low efficiency and pronounced hypnotic effects limit the use of these drugs in the treatment of ejaculatory dysfunction.

Ejaculation is inhibited to a certain extent by alpha-adrenergic blockers (for example, phenoxybenzamine) through an inhibitory effect on the sympathetic part of the ejaculatory reflex. This mechanism may be due to the blockade of alpha-1 adrenergic receptors.

Phenoxybenzamine inhibits the entry of sperm into the posterior urethra and delays ejaculation, although orgasm is usually maintained. The drug has not found widespread use in clinical practice for the treatment of PE due to a frequent adverse reaction - retrograde ejaculation.

Various studies have shown the ability of phenoxybenzamine to inhibit ejaculation to the point of its absence in 4.5-100% of cases when taking phenoxybenzamine at a dose of 5-70 mg per day.

Ejaculation is also inhibited by tricyclic antidepressants, which have anticholinergic and alpha-adrenergic properties and increase levels of monoamines, including serotonin, by blocking their reuptake. This effect is dose-dependent.

This group of drugs includes clomipramine (Anafranil) and amitriptyline. They have a rapid, apparent and dose-dependent effect and are often used, especially clomipramine, for the treatment of premature ejaculation.

However, tricyclic agents are less “pure” and less selective in their effects on specific serotonergic synapses. They also have more side effects. Antidepressants and monoamine oxidase inhibitors (MAOIs), for example, phenelzine, cause inhibition of ejaculation in 10-50% of patients.

A number of antidepressants increase serotonin levels by selectively blocking its reuptake. The newest drugs in this group are paroxetine, fluoxetine (Prozac), sertraline (Zoloft). It has been established that all of them are effective, have a dose-dependent effect, and a small number of adverse reactions.

Drugs in this group are considered the most promising for the treatment of PE. Currently, work is underway to comprehensively evaluate these drugs in the treatment of this sexual dysfunction.

Modern therapeutic tactics for inflammatory lesions of the accessory sex glands, prostatic urethra and seminal tubercle are described in detail in many publications.

In recent years, there have been reports of the use of denervating (neurotomy) surgical interventions on the penis to increase the duration of coitus.

The attitude towards these operations, taking into account their disadvantages (irreversible loss of sensitivity of the glans and skin of the penis, the possibility of the formation of neuromas based on the ends of the crossed nerves) and insufficient selectivity of influence, has not been fully formed.

Circumcision and frenulotomy are considered as more accessible surgical options.

We set ourselves the goal of developing an effective method of surgical treatment of premature ejaculation that does not have the obvious disadvantages of behavioral therapy, drug treatment and surgical correction methods described in the literature.

Advantages of our method

The main advantage of our original method of surgical treatment of premature ejaculation is the rapid achievement of the desired result, the absence of side effects characteristic of drug therapy, and the inconvenience associated with behavioral therapy (long-term treatment with the obligatory presence of an adequate partner). At the same time, when using our method, denervation of the glans is temporary, and after a certain period of time, sufficient for the formation of a normal ejaculatory reflex, the sensitivity of the glans and skin of the penis is restored.

Thus, thanks to our treatment method, a high quality of life for patients is restored and maintained.

Description of the technique

All patients are asked to perform a lidocaine test and have several sexual acts using a condom before surgery. This test reflects the essence of the operation, which allows us to confidently judge the preservation of erection and ejaculation in patients in the postoperative period until sensitivity is restored.

Skeletonization of the penis is performed using pericoronal access. At a distance of 2-3 cm from the edge of the incision, the main nerve trunks (4-5) are identified along the dorsal surface of the penis, innervating the glans. The nerves are then crossed.

The nerves are then repaired using microsurgical instruments by placing an intrafascicular suture with 10-0 prolene suture end to end.

Subsequently, within 2-3 months, complete anesthesia of the glans penis is observed, then sensitivity is partially restored depending on the growth rate of any of the nerve trunks (“mosaic” sensitivity).

Gradually, as sensitivity is restored, the patient gets used to the new sensations, but he has already formed a normal ejaculatory reflex, and in the future the patient can already control the duration of sexual intercourse. After 6-8 months, the sensitivity of the glans and skin of the penis is usually completely restored.

As a result of surgical treatment in all patients, the duration of sexual intercourse increases to normal values ​​(2-15 minutes), and the sensitivity of the skin and glans penis is completely restored after 5-8 months.

Application for treatment (High surgical technologies)

Source: http://www.rusmedserv.com/intimsurgery/andro05.html

Premature ejaculation, treatment of premature ejaculation | Men's Health | Urologist, andrologist Fateev D. M

Premature ejaculation is a condition when a man is unable to control the duration of sexual intercourse to an extent that would be sufficient for both partners to receive sexual satisfaction (ICD 10).

As can be seen from the definition, WHO does not currently provide any quantitative criteria for the normal duration of sexual intercourse. Thus, a rather serious problem arises in diagnosing premature ejaculation, since a man, as a rule, experiences orgasm and receives sexual satisfaction even with relatively short sexual intercourse.

On the other hand, a woman may suffer from anorgasmia and not receive satisfaction from sexual intercourse, regardless of its quality and duration.

According to WHO statistics, 40% of men of all ages worldwide suffer from premature ejaculation. Most sexologists believe that premature ejaculation is ejaculation that occurs two to three minutes after the start of sexual intercourse or even earlier.

Causes of premature ejaculation

1. prolonged abstinence from sex or low frequency of sexual intercourse, resulting in increased sexual arousal
2. inflammatory diseases of the prostate gland (chron.

   prostatitis) and urethra

3. discomfort during sexual intercourse associated with anxiety due to the expectation of rapid ejaculation and possible sexual dissatisfaction of the partner
4. psychological tendency towards early ejaculation, usually formed at a young age during the first sexual intercourse and caused by the fear of being caught by strangers
5. individual constitutional features of the innervation of the penis, which determine increased sexual sensitivity
6. features of the central part of the ejaculatory reflex, leading to the formation of a low threshold of the ejaculatory reflex

Treatment for premature ejaculation

Currently, there are 4 main approaches to the treatment of premature ejaculation:

• Local treatment
• Sex therapy
• Pharmacotherapy
• Surgery

It should be noted that local treatment and pharmacotherapy are only a temporary solution to this problem and require constant use of medications.

Sex therapy , although the safest method, still has a number of disadvantages. The main ones include a long-term lack of effect and the mandatory participation of a sexual partner in treatment.

Surgical intervention allows you to get the desired result in the shortest possible time, which will not disappear later. A positive point is the opportunity to evaluate the effectiveness of the operation before it is performed.

Local therapy for early ejaculation

The basis of local therapy for premature ejaculation is the use of local anesthetics to block the nerve endings located in the skin of the head and body of the penis, in order to turn off the peripheral part of the ejaculation mechanism.

There are 2 options for local treatment of premature ejaculation:

• using condoms with anesthetics
• applying gels and ointments with local anesthetics to the skin of the penis

Currently, there is a large selection of condoms, the lubricant of which contains a small amount of local anesthetic. When using such condoms, the sensitivity of the head of the penis decreases, which causes a slight increase in the duration of sexual intercourse.

The low concentration of anesthetic in the condom lubricant is due to the fact that lidocaine irritates the mucous membranes, causing a burning sensation.

And if in a man the mucous membrane is represented only by a small area around the opening of the urethra, then in a woman the mucous membrane covers the entrance and the entire internal surface of the vagina, which can lead to quite severe pain when an anesthetic gets on them and the impossibility of sexual intercourse. However, the lower the lidocaine content in the condom lubricant, the weaker the nerve endings are blocked and the earlier ejaculation occurs.

If you do not want to use condoms, local anesthetics are used according to the following method: after treating the penis with lidocaine, you must wait until the drug is absorbed into the skin, then you must thoroughly wash the penis to avoid lidocaine getting into the vagina.

Local therapy, as a rule, allows you to increase the time of sexual intercourse by an average of 1.5-2 times. However, if further treatment is refused, complete regression of premature ejaculation occurs. In this regard, most patients, after treatment using anesthetics, seek surgical treatment to obtain a permanent result.

Sex therapy for early ejaculation

Sex therapy as a method of treating premature ejaculation is based on the use of a set of techniques that allows, to a certain extent, to control the time of ejaculation. This type of therapy is quite effective and allows you to increase the time of sexual intercourse to 5-10 minutes.

The most widely used method is squeezing the glans penis and the “start-stop” technique.

In the first case, the partner applies quite strong compression to the head of the penis at the moment immediately preceding ejaculation. As a result, the ejaculation process is inhibited, which makes it possible for further oral or manual stimulation of the penis.

With the “start-stop” technique, the time delay of the moment of ejaculation is achieved by stopping friction at the first urge to ejaculate. After a pause, it is possible to continue sexual intercourse until the next sensation of impending ejaculation appears.

• It should be noted that the first attempts to use the described techniques, as a rule, are unsuccessful due to the inability of a man to adequately control his own sensations during sexual intercourse and predict the onset of ejaculation.
• Another negative side of sex therapy is the lack of immediate immediate improvement (usually it takes about 4-6 months of regular sessions to achieve an acceptable result), which often causes the patient to be unsure about the correct choice of treatment method.
• However, the most serious disadvantage of sex therapy is the mandatory participation in treatment of an adequate sexual partner, which in most cases is impossible.

Drug therapy for early ejaculation

The property of some medications (neuroleptics, benzodiazepine derivatives, alpha-blockers) to delay the onset of ejaculation has been known for quite a long time, but their use for the treatment of premature ejaculation was impossible due to the presence of pronounced side effects due to the main pharmacological action of these substances.

Currently, drug therapy for premature ejaculation has become widespread due to the emergence of new drugs from the group of antidepressants - serotonin reuptake inhibitors, which have the ability to inhibit the ejaculation process. Side effects may develop: the development of anejaculation (lack of ejaculation) and in 14% of cases erectile dysfunction develops.

1. The effectiveness of drug therapy for premature ejaculation with antidepressant drugs is quite high (the average duration of sexual intercourse increases by 4-6 times).
2. The negative side of drug treatment is the need for constant monitoring by a psychotherapist to assess one’s own psycho-emotional state (taking psychoactive drugs can cause depression).
3. Stopping the medication leads to a decrease in the duration of sexual intercourse to the initial level.

Surgical treatment of early ejaculation

The simplest and most affordable way to treat premature ejaculation is surgery to circumcise the foreskin. After circumcision, the head of the penis becomes rougher due to constant contact with underwear, and its sensitivity decreases.

The average duration of sexual intercourse after circumcision increases 2-3 times compared to the initial state. So, if ejaculation occurs after 4 minutes, then after circumcision the time of sexual intercourse will increase to 10 minutes.

Lidocaine test (test with skin anesthetic).

The lidocaine test allows you to evaluate the effectiveness of the operation before it is performed. The patient is asked to treat the skin of the head and body of the penis with lidocaine at home, and then put on a condom and have sex (you can also use condoms with an anesthetic).

Microsurgical denervation of the glans penis

Today, another method of surgical treatment of premature ejaculation has been proposed. The developed method of temporary denervation of the penis by transection followed by surgical restoration of the sensory nerve trunks makes it possible to increase the duration of sexual intercourse by 3-5 times.

After the operation, almost complete anesthesia of the penis occurs, which makes it possible to have prolonged sexual intercourse (up to 30-40 minutes). This anesthesia is temporary and lasts up to six months. At this time, the patient is advised to have frequent and regular sex.

Undoubtedly, with reduced sensitivity of the head, sexual sensations do not have all the fullness and colorfulness that existed before the operation.

However, during the process of reinnervation and restoration of sensitivity of the penis, subject to regular sexual intercourse, the patient develops a clear dominant for long-term sexual intercourse, which persists after complete restoration of sensitivity (after 6 months).

After complete restoration of sensitivity, the duration of sexual intercourse decreases slightly and ultimately ends up at a level 3-5 times higher than the original one.

The effectiveness of this method can also be assessed in advance using a lidocaine test.

The surgical intervention is not traumatic and does not require rehabilitation of the patient. The cosmetic result after the operation is more than acceptable: the incision is made around the head of the penis, after removing the sutures, a thin incision line remains, visible only when the head is exposed.

Injection of hyaluronic acid into the skin of the glans penis.

The essence of the technique is the injection of a gel substance based on hyaluronic acid into the skin of the glans penis. This allows the sensitive receptors to be separated from the surface layer of the skin, which leads to a decrease in the sensitivity of the organ and prolongs sexual intercourse.

Currently, depending on the wishes and concerns of the patient, it is possible to introduce different types of gel, designed for different periods of complete resorption.

In other words, the gel substance will be completely absorbed by the patient’s body for a long time (from 3 to 12 months) without any consequences.

After the hyaluronic acid gel is absorbed, most patients develop a persistent (sometimes lifelong) commitment to long-term sexual intercourse. However, in a number of men, premature ejaculation occurs again and re-introduction of the gel is possible to treat it.

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Source: https://yarurolog.ru/articles/muzhskoe-zdorove/prezhdevremennaya-eyakulyatsiya-lechenie-prezhdevremennoy-eyakulyatsii/