WHAT TO DO WITH A PREMATURE SEVERAGE: MODERN APPROACHES TO TREATMEN.
Relatively recently, experts came to the conclusion that the psychogenic genesis of premature ejaculation is not its only cause, and neurobiological mechanisms are also important.
There is still no consensus on how long sexual intercourse should normally last, this makes it difficult to diagnose and treat this pathology.
There are 4 aspects characteristic of premature ejaculation:
- lack of control over ejaculation;
- the duration of sexual intercourse is a short period of time;
- lack of sexual satisfaction;
- couple disharmony related to sexual relationships.
According to the International Society of Sexual Medicine, the normal duration of sexual intercourse should be more than 1 minute from the moment the penis is inserted into the vagina.
Premature ejaculation is a pre-existing or acquired sexual disorder that is permanently or temporarily manifested by a lack of control over ejaculation, accompanied by a violation of interpersonal relationships with a partner and premature ejaculation.
Primary and secondary forms are distinguished. Often, early ejaculation is accompanied by erectile dysfunction, two pathological processes may appear at different times. Rather, erectile dysfunction is psychogenic in nature.
A man experiences psychological discomfort from the inability during an intercourse to bring to a partner an orgasm, uncertainty, an inferiority complex. Sometimes a violation of erectile function provokes early ejaculation, since with a weak erection a man consciously tries to complete a sexual act faster, which over time becomes a habit.
The combination of erectile dysfunction and early ejaculation generates a vicious circle.
METHODS FOR TREATING A PREMATURE SEVERAGE
The main aspects in the treatment of this disorder are as follows:
- drug treatment;
- surgical intervention;
- local use of drugs.
Psychotherapy in the treatment of early ejaculation has only recently been a priority way, but practitioners believe that in this case, conversations with a psychologist are not enough as the only component of treatment. The negative side of psychotherapeutic sessions includes a significant period of time and compulsory work with a partner, which is not suitable for every man.
CREAMS, SPRAYS AND OINTMENTS FOR RELAXING THE ERECTION
The use of local anesthetizing (reducing sensitivity) drugs for some patients is one way to solve the problem, but local anesthetics are not suitable for everyone.
In addition, creams, gels or sprays from early ejaculation not only delay the ejection of the seed, but also significantly impoverish the sexual sensations not only in the man, but also in his partner, as vaginal sensitivity decreases during transvaginal absorption (absorption). Such changes lead to a weakening of an erection in a man, in a woman – to the inability to achieve orgasm (anorgasmia).
Studies have confirmed the effectiveness of these drugs to prolong sexual intercourse. At the same time, you have patients.
Moreover, in drugs from this group, in addition to reducing potency and libido, there is an impressive number of side effects: a decrease in the quality of sexual orgasms;
decreased ability to experience orgasm; decreased sex drive; arrhythmia; anorexia; hyponatremia; cramps muscle twitching, trembling, or tremor; nausea; hallucinations and psychoses; depression; effect on the blood coagulation system; loss of appetite; excessive sweating; labored breathing; fever; fainting violation of the stool; urinary retention; vomiting with blood; high blood pressure; visual impairment; irritability; anxiety and panic attacks; dizziness; apathy; hyperactivity loss of concentration; insomnia; allergic reactions; flu-like symptoms; withdrawal syndrome (withdrawal effect).
For the treatment of early ejaculation, drugs from the group of type 5 phosphodiesterase inhibitors (PDE-5) are also used. Their action is carried out by improving the blood supply to the corpora cavernosa, compression of the nerve endings, which reduces sensitivity and allows prolonging sexual intercourse.
In addition, a full-fledged persistent erection gives the patient confidence in male viability, and indirectly, control over ejaculation appears. The positive aspects of taking Viagra, Levitra, Cialis, include the fact that there is the possibility of repeated sexual intercourse.
Note that not all patients can take these drugs, and not everyone has a positive effect on the background of treatment. If psychotherapy, conservative treatment and the use of local anesthetics did not bring the desired result, surgery may be performed.
Surgery for premature ejaculation
Before surgery for denervation of the glans penis, a special test must be performed: an anesthetic is applied to the frenum of the penis 30 minutes before proximity; stand 10 minutes and wash off.
The duration of sexual intercourse is noted. Test assessment: with an increase in coitus duration by 2 times, the test is considered positive.
If this does not happen, it is necessary to clarify the reason; surgical treatment may be ineffective. Using a condom during sex will keep your vagina sensitive to stimulation. During the operation, the dorsal nerve bundle crosses and then stitches together (non-selective denervation – renervation) or individual nerve fibers intersect (selective denervation).
Side effects include a prolonged loss of sensitivity, the development of relapses. The rehabilitation period is about 3-4 weeks. The denervation can be open and closed. In the second case, the effect on the nerves occurs under the influence of an electric current, but the effectiveness of the intervention is less.
Microsurgical open surgery with dissection of nerve fibers and their stitching with special material is preferable, the result is 95%. Over the course of 6-12 months, the man gradually gets used to new sensations, some have a sip of a scar and there is a feeling of numbness. In the first time after the operation, positive dynamics can be traced, but for maximum it takes some time.
Circumcisio – circumcision of the foreskin, in some patients, after the intervention, sexual intercourse is lengthened, since the frenum, which has many nerve endings, is excised. But in many patients, surgery does not radically solve the problem. Improvement occurs in 25% of cases.
INTRACAVERNOUS INJECTION INTRODUCTION
In the treatment of early ejaculation, some experts recommend the introduction of intracavernous injections.
It is believed that after administration, the sensitivity of the nerve structures decreases due to their compression by the increased cavernous bodies. Method of application: intracavernous, from 5 to 20 mcg, the selection of therapeutic dosage for each patient is individual. The desired result is maintaining a stable erection for 60 minutes. Injections can be performed by the patient after training on their own.
The main contraindications:
- Ischemic heart disease;
- cardiovascular failure;
- pronounced concomitant pathology.
HYALURONIC ACID INJECTION
The introduction of hyaluronic acid (a polysaccharide of animal origin) during early ejaculation can be considered as a minimally invasive method in which a filler drug is injected under the skin of the penis.
The gel forms a layer between the nerve fibers and the ends, which dulls the sensitivity. After some time, the hyaluronic acid gel dissolves, which does not lead to any deformation encountered after the introduction of polymer-containing fillers.
The result develops after 30 days, the duration of the effect is from 8 to 12 months (in some men longer), after which a second injection is possible.
- oncological processes;
- urogenital herpes;
- inflammatory diseases of the skin of the penis;
- systemic diseases.
Complications are rare, with non-compliance with sexual rest, secondary infection may join. With a large volume of hyaluronic gel, cosmetic defects may appear.
COMBINED THERAPY FOR PREMATURE FAMILY EXCLUSION
There is no single treatment regimen with clinical recommendations for managing patients with premature ejaculation, which means that it is difficult to choose an effective therapy.
Scientists conducted studies aimed at establishing which algorithm of actions is most effective for treating patients with early ejaculation.
In the first group, patients received SSRIs (Paroxetine 20 mg / day), in the second – Tadalafil 20 mg 3 p. / Week, in the third – a combination of Paroxetine and Tadalafil, in the same dosages, but lasting 12 weeks.
The best results were noted when using a combination of Paroxetine and Tadalafil with a 3-month course of taking medications, although positive dynamics were recorded in all three groups of patients.
It was concluded that Paroxetine is effective in the primary form of early ejaculation associated with dysfunction of serotonergic regulation, and Tadalafil is reasonably prescribed for the treatment of patients with concomitant erectile dysfunction.
There were more side effects in patients receiving combination treatment, but they were slightly expressed and resolved on their own.
- The combination of Paroxetine and Tadalafil is the optimal regimen for men with premature ejaculation and impaired erectile function.
- For patients with normal erectile function and primary premature ejaculation, only Paroxetine is sufficient, since there was no significant improvement in the quality of the erection.
- In men with secondary early ejaculation without erectile dysfunction, the effect was observed only during treatment, etiological therapy.
- In case of secondary premature ejaculation complicated by impaired erectile function, a positive result was obtained both with combination therapy and with the use of Tadalafil as the only drug. Considering that after a month the secondary premature ejaculation was recorded again, only Tadalafil is justified.