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Questions and answers about ejaculation control
One of the most discussed topics in this men's health blog is premature ejaculation, and in fact most of the questions our readers and readers have to do with this topic.
That is why we decided to summarize the information of the different articles we publish about premature ejaculation and present the most frequent questions about it with their corresponding answers.
How could premature ejaculation be defined? Is there any normal time of sexual intercourse or intercourse?
The ad hoc committee of the International Society of Sexual Medicine (ISSM) and international experts in premature ejaculation agreed that it is necessary to consider the time elapsed from vaginal penetration to ejaculation, the inability to delay ejaculation and the resulting negative personal consequences of the problem. Consequently, this committee defined premature ejaculation for life or primary as a male sexual dysfunction characterized by:
-Ejaculation that always or almost always occurs before or within about a minute of vaginal penetration.
-The inability to delay ejaculation in all or almost all vaginal penetrations.
-Negative personal consequences such as anxiety, discomfort, frustration and / or avoidance of sexual intimacy.
Is premature ejaculation frequent?
It is definitely much more frequent than most people believe. However, we have no unified figures, and in fact they vary significantly. The highest prevalence rate that has been documented so far is 31% (in men between 18 and 59 years old) and was found in the National Survey of Health and Social Life of the United States of America. However, it is unlikely that the prevalence is so high considering the relatively low number of men who come to the consultation with this symptom.
Are there different degrees of premature ejaculation?
According to the consensus of the International Academy of Medical Sexology (AISM), three grades are established:
Grade I or Mild. After penetration and few coital movements.
Grade II or Moderate. Immediately after penetration, it is also called before portas.
Grade III or Severe. Before penetration, also recognized as ultra early.
What are the causes of premature ejaculation?
Several causes of premature ejaculation have been established, both from a biological and psychological point of view: generalized anxiety, penile hypersensitivity, performance anxiety, genetic predisposition, general poor health and obesity, prostate inflammation, hormone disorders Thyroid, diabetes, emotional problems and stress, bad masturbation habits, traumatic sexual experiences, chronic prostatitis, among others.
We want to highlight the particular negative influence of fast self-stimulation habits, when man seeks a sexual discharge instead of trying to prolong the pleasure of excitement prior to orgasm. On the other hand, anxiety about sexual performance, understood as the marked (almost obsessive) concern about not ejaculating rapidly, generates a physiological acceleration and lack of awareness of levels of excitement, perpetuating the problem.
Are there sexual positions that favor or complicate ejaculatory control?
In general, the posture that allows better control is that in which the couple sits on top of the man, who is lying on his back. In this case he is bodily relaxed and can better perceive the signs of sexual arousal, a fundamental condition for ejaculatory control.
Lateral postures also facilitate ejaculation control. This is possible because the penetration is not very deep, and the movements in general are not as fast as in other cases.
In general, the missionary type posture, that is, the man on top, is not favorable for the control of ejaculation since the body is tense, the penis enters more just in the vagina and in general the position leads to an unstoppable race towards orgasm . In a few cases, men say they find the best position because they handle the speed and depth of coital movements better.
What are the main compensation mechanisms used by men with problems to control ejaculation?
Folklore methods are many, some really unusual and even counterintuitive. In the sexological consultation we often hear the following: mental distraction - thinking of non-sexual or antierotic images - drinking alcohol, smoking marijuana, prior masturbation practice, causing pain by biting or pinching the skin, among others.
How are treatments for premature ejaculation?
The recommendation of the current protocols is to coordinate medical and psychological treatment (focused on sexual symptoms). According to current scientific evidence, pharmacotherapy is superior to reduce symptoms of premature ejaculation compared to psychological treatment alone. However, the relevant psychological problems and mechanisms should not be overlooked, and it is important to treat, for example, levels of performance anxiety and modify dysfunctional sexual habits for a definitive solution to the problem.
Behavior therapy methods include the stop and start technique and the squeeze technique. Another possible therapy, increasingly recommended by doctors, is pelvic floor rehabilitation exercises. All of these behavioral therapy approaches have the potential to be beneficial when combined with drug treatment.
Topical methods are a simple local treatment modality, with lidocaine-prilocaine cream being the most studied. The results of research on this type of therapy indicated that the duration of vaginal penetration increased 6.3 times.
With regard to oral treatments, serotonergic antidepressants are considered the basis of treatment. It has been found that serotonin exerts an inhibitory function in ejaculation through several descending pathways, and this process is enhanced by selective serotonin reuptake inhibitors (SSRIs). Among the various SSRIs, it has been found that the efficacy of paroxetine in the treatment of premature ejaculation is superior to fluoxetine, clomipramine and sertraline.
Tramadol, an opioid that is used as an analgesic, has proven effective for treatment on demand for premature ejaculation in several placebo-controlled studies.
We definitely have a lot of evidence and therapeutic tools to help our patients with a diagnosis of premature ejaculation. Timely consultation is key to a brief and effective treatment.
Drafted for Boston Medical Group by Ezequiel LГіpez Peralta.
Psychologist. Master in Clinical Sexology and Couples Therapy.

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