How to last longer: everything about premature ejaculation

*bulbospongiosus muscles

Other ejaculation problems

Premature ejaculation (PE) is the most common sexual problem, but there are also other types of ejaculatory disorders that can cause sexual dissatisfaction. It is important to identify these problems in order to find a solution that meets your unique needs. 

Retrograde ejaculation

Retrograde ejaculation occurs when sperm enters the bladder instead of emerging through the penis during orgasm. It is also called ‘dry orgasm’. The retrograde-ejaculated sperm is excreted with the next urination. 

• Possible causes: Damage to the bladder neck sphincter during bladder or prostate surgery, various medications (such as antidepressants), or disorders such as diabetes and multiple sclerosis. 
• Treatment options: For men with retrograde ejaculation who wish to father children, sperm can be retrieved from the urine after ejaculation. If the retrograde ejaculation is caused by a medication, medication adjustments under the supervision of a doctor can be considered.  

Delayed ejaculation

Delayed ejaculation, also called delayed orgasm, is when a man cannot ejaculate easily or at all. 

• Possible causes: Various medications (such as antidepressants), psychological factors such as stress or decreased arousal, or hormonal imbalances such as low serotonin. 
• Treatment options: Medication adjustment. Sex therapy and counselling can be helpful to look at the underlying cause or triggers. 

Anejaculation

Anejaculation is defined as complete absence of ejaculation during sexual activity, even during orgasm. Anejaculation can have psychological and physiological causes. 

• Possible causes: Although rare, neurological disorders, damage to the nervous system or psychological factors, such as anxiety, may play a role. 
• Treatment options: There are several methods to induce ejaculation, such as vibratory stimulation and electrostimulation. Psychotherapy or sex therapy can be helpful in people with anejaculation caused by anxiety or stress. 

Ways to naturally increase serotonin levels

Simple lifestyle changes can help stimulate serotonin levels: 

• Healthy diet: Eat foods that contain a substance known as tryptophan, such as turkey, bananas and nuts. To increase serotonin production, it is important consume carbohydrates (whole wheat bread or pasta) alongside these foods. Tryptophan needs carbohydrates to be able to reach the brain and create serotonin. 
• Regular exercise: Physical activity, especially cardio, triggers the release of serotonin. 
• Get plenty of sleep: Good sleep increases serotonin and helps reduce stress.  

Medications for PE

There are various medical therapies available for PE besides SSRIs (e.g., Priligy). These include: 

• Phosphodiesterase-5 (PDE5) inhibitors: Medications such as Sildenafil (indicated for the treatment of erectile dysfunction) may also be effective in treating premature ejaculation. They help reduce stress and performance anxiety, which in turn can give more control over ejaculation. However, these medications should not be considered a cure for PE, but they can provide relief in some situations.  

Are you considering medication? Discuss the options and side effects with a doctor to see what medication best suits your needs. 

New and emerging treatment options for PE

The PE treatment market continues to evolve, offering new opportunities for treatment, including: 

• Neuromodulation: Transcranial magnetic stimulation (TMS) is a treatment technique that uses magnetic pulses to stimulate nerves in the brain. This method is currently being investigated as a possible treatment for premature ejaculation. 
• Hyaluronic acid injections: Hyaluronic acid injection into the glans penis is a non-surgical procedure intended to reduce glans hypersensitivity to delay ejaculation. 
• Botulinum toxin injection: Botulinum toxin injection into specific muscles in the penis could reduce their activity, improving control over ejaculation.  

However, these treatments are being researched and not yet available on the market. 

Combination therapy for PE

Studies have shown that combination therapy can be more effective than treating PE with a single medication. For instance, the use of an SSRI with a PDE-5 inhibitor may increase ejaculation delay as well as sexual satisfaction, especially in men with both PE and erection problems. Even though this approach may increase the severity of some side effects, such as headache and facial flushing, it still offers a more complete solution. 

Note: the use of combination therapies must take place under medical supervision to ensure their safety and effectiveness. 

Types of premature ejaculation

PE can be classified into four major types: 

• Primary PE: Primary premature ejaculation is lifelong and begins as soon as the patient becomes sexually active. It is defined as ejaculating within a minute of sexual intercourse. 
• Secondary PE: Secondary premature ejaculation is the sudden inability to delay ejaculation after experiencing normal ejaculation during sexual experiences. This type is often triggered by physiological or psychological factors. 
• Natural variable PE: Men with natural variable PE occasionally experience an early ejaculation. It should not be regarded as a disorder and usually resolves on its own over time. 
• Subjective PE: Subjective PE is when a man feels like he ejaculates too quickly, even if his time to ejaculate is normal.  

Treatment is varied and depends on the type of PE. Therefore, the first step to finding the right treatment is to determine what type of PE you have. This must be done by a healthcare professional. 

Diagnostic tools and questionnaires

Various screening questionnaires, such as the Premature Ejaculation Diagnostic Tool (PEDT), can be used to calculate the severity of premature ejaculation. The PEDT can be used to diagnose PE and consists of multiple-choice questions about ejaculatory control and frequency. This tool can be extremely helpful in diagnosing PE and deciding on a treatment plan with a doctor. 

Conclusion

Ejaculation problems are complex and can be caused by a number of things. Thankfully, there are a variety of treatment options available, from medications to psychological support and self-help approaches. If you have ejaculation issues, it's important to be open to help. A doctor or specialist can help determine the best course of treatment for your specific problem. 

Remember, you are not the only person with PE. There are treatment options out there.  

Doctoronline can help you find a treatment that meets your specific needs.