Premature Ejaculation and Ejaculatio Praecox: Common Treatments and Treatment Options

Overall, there is no universally accepted definition of premature ejaculation. It generally refers to a situation in which a man no longer has control over the exact timing of ejaculation. 

As a result, the orgasmic reflex is triggered earlier than intended. Most descriptions of premature ejaculation highlight three main aspects:

1. A short duration from the start of vaginal penetration to ejaculation
2. Loss of voluntary control over ejaculation
3. Psychological distress experienced by the affected individual and/or their partner

It is important to note that the estimated time to orgasm is based on subjective perception. Men often overestimate this time. Men who do not suffer from premature ejaculation take an average of about 5.4 minutes to reach climax.

For those affected, this interval—also known as the latency period—is less than one to two minutes. Sometimes, simply thinking about a sexual act can be enough to trigger premature ejaculation.

According to estimates, about four percent of men are affected by premature ejaculation @ megaflopp /AdobeStock

The exact triggers for premature ejaculation have not yet been fully clarified. 

Possible causes include:

• Psychological triggers
• Neurophysiological triggers 

Neurophysiological causes refer to triggers that lie somewhere in the signal transmission between nerve cells.

There are various factors that can contribute to premature ejaculation. For example, erectile dysfunction and premature ejaculation sometimes occur simultaneously. 

The frequency of sexual intercourse can also play a role. For instance, irregular sexual activity and inexperience can contribute to premature ejaculation.

In addition, there are several psychological causes that may be responsible for premature ejaculation:

• Early childhood sexual disturbances
• Restrictive sex education
• Performance anxiety
• Unrealistic expectations about sexuality
• Fear of failure
• Anxiety disorders

Physical causes and the use of certain medications can also be triggers:

• Urinary tract infections
• Diabetes mellitus
• Use of pain relievers
• Sympathomimetics (medications that affect the sympathetic nervous system, a part of the autonomic nervous system)
• Imbalanced serotonin levels

The causes of premature ejaculation are varied @ Wasan /AdobeStock

The appropriate specialist to consult for premature ejaculation is a urologist. The urologist first takes the patient’s medical history and asks specific questions about the man’s sex life. 

These include, for example:

• Sexual development
• Experiences and 
• the course of the sexual response

Often, the answers reveal a great deal about the triggers, as they reflect the patient’s inner mindset. This is particularly important with regard to treatment. A diagnosis of premature ejaculation is made when less than two minutes elapse between penetration and ejaculation.

From a medical perspective, treatment for premature ejaculation is not necessarily required. It is necessary, however, if the affected individual or his partner is suffering as a result. 

Depending on the triggers, treatment may involve the following approaches:

• Physical methods
• Medication-based methods, or 
• Psychotherapeutic methods

For some men, frequent masturbation or reaching orgasm before sexual intercourse can already be helpful. In addition, there are certain methods for better recognizing and controlling the timing of ejaculation. 

These include, for example:

• The stop-start method and 
• The squeeze method
• Psychotherapeutic Approaches

Psychotherapy as part of the treatment for premature ejaculation is based on various approaches:

• Sex therapy
• Behavioral therapy
• Couples therapy
• Family therapy

It can be helpful for the partner to participate in therapy as well. Psychotherapy can help alleviate anxiety and thereby break the vicious cycle of anxiety and premature ejaculation. 

Psychotherapy is also useful for changing entrenched behaviors and thought patterns and for alleviating sexual pressure.

Affected men usually experience significant psychological distress; psychotherapy can help @ Prostock-studio /AdobeStock

• Stop-Start Method

With the stop-start method, the man learns to better control his arousal. The goal is to delay ejaculation. To do this, the man masturbates until he is just about to reach the critical threshold.

Then he waits until his arousal subsides again. Afterward, he resumes masturbation. He repeats this process until he is able to better control his ejaculation.

• Squeeze Method

This method is a further development of the stop-start method and is also intended to delay the moment of ejaculation. In this method, the man interrupts sexual intercourse just before climax. 

This helps him become more aware of the moment of unwanted climax and thus better control it. In addition, he presses his thumb against the penis in the area of the glans. This reduces the blood flow to the penis, interrupting the ejaculatory reflex. This, too, leads to delayed ejaculation.

“Premature ejaculation” is a common sexual dysfunction that affects many men. Premature ejaculation is defined as ejaculation that occurs always or almost always very early, shortening the time to ejaculation and causing men to suffer from premature ejaculation.

Possible causes range from psychological and physical factors to factors that influence the urge to ejaculate and control over ejaculation, which is why both physical and psychological causes may be present. Treatment for premature ejaculation involves various approaches aimed at delaying ejaculation, prolonging it somewhat, and improving control over it. 

What is premature ejaculation?

Premature ejaculation, or ejaculatio praecox, is defined as ejaculation that occurs always or almost always earlier than desired. Many men experience only a very short duration before ejaculation. This sexual dysfunction may be primary, present since a man’s first sexual experiences, or secondary, developing later in life.

What causes premature ejaculation?

The causes of premature ejaculation can be both physical and psychological. Performance anxiety, stress, heightened arousal, or relationship problems often play a role. Physical causes, neurological factors, or increased sensitivity of the glans penis can also influence ejaculation.

How is ejaculatio praecox treated?

Treatment for premature ejaculation includes both medication and psychotherapy. Dapoxetine, numbing sprays, or sex therapy are often used to delay ejaculation. The goal of treating premature ejaculation is to achieve better control over the ejaculatory process.

Can premature ejaculation be prevented?

Many people affected by this condition can delay ejaculation and improve their control over it through training techniques, relaxation exercises, or sex therapy. Special exercises can also help individuals become more aware of the urge to ejaculate. In some cases, premature ejaculation can be significantly reduced through consistent treatment.

When should you seek medical help?

If a man suffers from persistent premature ejaculation and it is affecting his relationship or sex life, he should undergo a urological evaluation. Premature ejaculation is usually diagnosed through a discussion about the time to ejaculation and possible causes. Early treatment options can help alleviate distressing symptoms.