Premature ejaculation – in everyday language “coming too quickly” – is the most common sexual complaint in men: roughly one man in four or five has experienced it at some point, although under strict medical criteria the proportion is considerably smaller.
It is a medical condition with clear criteria and proven treatments, not a question of willpower. Sometimes it is the first sign of another problem – prostatitis, weaker erections or a thyroid disorder. Dr Penev sees men with this complaint at his practice in Plovdiv and in Karlovo – discreetly and with a realistic plan tailored to the cause.
What premature ejaculation is
According to the European Association of Urology (EAU), premature ejaculation is present when ejaculation always or nearly always happens before penetration or within about one minute of it, the man cannot delay it, and this leads to distress or avoiding intimacy.
The primary (lifelong) form has been present since the first sexual experiences. The secondary, or acquired, form appears after a period of normal sex life – usually against the background of another condition – and in this form the time to ejaculation often shortens to about three minutes.
Symptoms
- ejaculation before penetration or within about a minute of it during almost every act of intercourse;
- a feeling of having no control over the moment of ejaculation;
- distress, embarrassment or avoiding intimacy because of the problem;
- in the acquired form – a clear change compared with your previous sex life.
The condition is not dangerous, but accompanying symptoms – pain on ejaculation, blood in the semen, burning or difficulty passing urine – point to inflammation and should be examined.
Causes and risk factors
In the primary form, inherited and neurochemical factors play the main role – a faster ejaculation reflex. Psychological factors are rarely the only cause, but they almost always make the problem worse.
In the acquired form, the most common causes are:
- erectile dysfunction – the man unconsciously hurries so as not to lose his erection;
- chronic prostatitis and inflammation of the urethra;
- an overactive thyroid gland;
- performance anxiety, stress, a new partner or conflict in the relationship;
- infrequent sex;
- a short frenulum (frenulum breve), which causes pain on penetration.
Diagnosis
The diagnosis is made mainly through conversation. Dr Penev will ask when the problem started, whether it happens every time, how long it takes until ejaculation, how much control you feel you have and how it affects you and your relationship.
This is followed by a urological examination of the external genitals, and if there are prostate or urinary symptoms – a prostate examination, a urine test and an ultrasound scan. Blood tests, for example of thyroid hormones, are arranged only when there are relevant signs.
Treatment
Treatment starts with the cause: getting prostatitis, erectile dysfunction or a hormonal disorder under control often restores control without any other measures. In the primary form the goal is realistic – a longer time and a sense of control, rather than a one-off “cure”.
Behavioural methods. The “stop-start” technique and squeezing the head of the penis as ejaculation approaches train you to recognise the point of no return; pelvic floor exercises also help. On their own their effect is more modest; combined with medicines it is longer-lasting.
Topical products. Creams and sprays containing a mild anaesthetic, applied as directed, usually ten to thirty minutes before intercourse, reduce sensitivity; a condom protects your partner from numbness.
Medicines. The only oral medicine developed specifically for this condition is a short-acting medicine that acts on serotonin, taken as needed one to three hours before intercourse. If the effect is not enough, daily use of related medicines is discussed, and if there is also erectile dysfunction – erection medicines. All of them are prescribed and chosen individually by a doctor.
Partner approach and procedures. Talking openly as a couple and, if needed, psychosexual counselling reduce the anxiety that keeps the problem going. When the cause is a short frenulum, a short outpatient frenulotomy – conventional or laser, as the doctor judges best – removes the pain that keeps the problem going. Operations to reduce the sensitivity of the head of the penis are not recommended.
When to see a urologist
Book a consultation if the problem has lasted more than a few months and worries you, if it started suddenly after years of normal sex life, if it comes with weaker erections, pain, burning or urinary symptoms, or if you have tried products from the internet without success.
Prevention
The lifelong form cannot be prevented, but the acquired form often can – with prompt treatment of prostatitis and urinary infections, looking after your erections through exercise and stopping smoking, a regular sex life and an honest conversation with your partner. Avoid products of unclear composition advertised online.
Premature ejaculation is a problem that can be solved when it is approached openly and with an accurate diagnosis. Book an appointment with Dr Penev for a discreet consultation and a personal plan.
Frequently asked questions
Is it normal for intercourse to last only a few minutes?
Yes. The average time from penetration to ejaculation is about five minutes, and it varies widely between men and from one time to the next. It is considered a problem when ejaculation happens uncontrollably very early and this worries you or your partner.
Can premature ejaculation go away on its own?
The acquired form often settles once the cause is removed – for example anxiety in a new relationship or untreated prostatitis. The form that has been present since the first sexual experiences rarely changes without treatment, but it responds well to combined methods.
Do erection medicines help with premature ejaculation?
Mainly when erections are also weaker. In men with normal erections their effect is limited and they are not the first-choice treatment. The choice of medicine depends on the cause and is made by a doctor.
Should my partner come to the appointment?
It is not essential, but it is helpful. The problem affects the couple, and some of the techniques are practised together. Dr Penev conducts the conversation discreetly and without judgement.
Is premature ejaculation linked to infertility?
Not directly – the semen is normal and conception is possible. Only when ejaculation happens even before penetration and cannot be controlled can it make conception difficult, which is an additional reason for treatment.
The information on this website is for general education and does not replace an examination and consultation with a doctor. If you have urgent symptoms, seek medical help immediately or call 112.