Masturbation can lead to premature ejaculation and ED
Ejaculatio praecox: Coming too early is taboo
Premature ejaculation is a taboo subject, although it is the most common sexual dysfunction. In surveys, between three and 30 percent of men stated that they “come” too early and that they lack control over the time of their sexual climax.
"We assume that about every seventh man suffers from it - either from a lifelong or an acquired form," says Markus Margreiter, urologist at the Med-Uni Vienna. Acquired, for example, through a change of partner or relationship problems. The distribution is likely to be roughly the same across all age groups, even if most of those seeking help are between 25 and 35 years old.
Variable point in time
According to the definition, a clinical disorder is when less than a minute passes between penetration into the vagina and ejaculation (DSM-V). The current DSM-V diagnostic criteria also state that premature ejaculation must be present for at least six months and in more than 75 percent of the sex acts.
To some extent, the variable timing of orgasm is quite natural. However, as soon as the pressure of suffering and the resulting problems arise in the partnership, you should seek help. "Many of those affected avoid sexual contact and closeness and lose all sexual self-confidence. That frustrates both sides," says Margreiter. It's a vicious circle because it only makes the problem worse.
Not a disease, rather a symptom
However, there is now a tendency to see potency problems no longer as a disease, but as a symptom. The causes are usually elsewhere. The problem is often associated with a disturbed serotonin balance: If you give those affected an antidepressant from the group of serotonin reuptake inhibitors (SSRIs), the disorder often disappears.
"The assumption that premature ejaculation is a purely psychological problem is becoming more and more obsolete," says Margreiter, because there are often clear organic causes. For example diseases of the prostate, thyroid or cardiovascular system - which often first appear in sexual function.
It can also occur as a side effect of medication taken (such as reboxetine and citalopram). But psychological causes such as problems in the partnership or stress can also be behind it. Pubertal imprint, inexperience, fear of failure and drastic earlier experiences are also considered to be the cause. Due to the large number of possible reasons, a comprehensive anamnesis interview is essential.
Although the level of suffering can be enormous, less than ten percent of those affected go to the doctor. "Most get their information from the Internet. There is an enormous inhibition threshold to get help," says urologist Margreiter.
Because potency problems are still afflicted with shame and stigma, many resort to their own "solutions": alcohol, illegal drugs, special creams or certain positions during sexual intercourse.
There are several proven effective therapies. By taking the fast-acting antidepressant dapoxetine (trade name Priligy) - the only on-demand treatment approved for ejaculatio praecox - the time it takes to ejaculate can be increased by up to four times, as studies have shown. Control over the timing of orgasm can also be improved.
But also "off-label use" drugs, which are not explicitly approved for this treatment, have proven themselves: For example a number of antidepressants (tricyclic or SSRI) and some painkillers (such as tramadol). Local anesthetics (such as lidocaine or prilocaine) that are applied directly to the penis and reduce its irritability are also effective. The problem here, however, is that these also affect the vagina.
Last but not least, many also benefit from behavioral or sex therapy, ideally together with their partner, who should be included as early as possible. That alone can lead to permanent improvement. The prerequisite is: being able to talk about it, no matter how uncomfortable that may be. (Florian Bayer, May 3, 2015)
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