Premature Ejaculation

Premature Ejaculation (PE) is one of the most common complaints among male sexual dysfunctions. Its medical diagnosis is based on criteria established by international urology and sexual medicine associations.

• Definition: A persistent or recurrent pattern of ejaculation occurring before or shortly after vaginal penetration, sooner than the individual or partner desires, and in a way that the individual cannot control.
• Clinical Diagnostic Criteria: Generally, an Intravaginal Ejaculatory Latency Time (IELT) of approximately 1 minute or less (for Lifelong PE) or under 3 minutes (for Acquired PE) is taken as a reference point.
• Key Components: Diagnosis is based not only on time but also on the individual's decreased ability to control ejaculation and the resulting significant stress and anxiety.

Causes of premature ejaculation: Physiological and psychological factors

Premature ejaculation occurs as a result of a complex interaction between biological, psychological, and relationship factors.

Physiological and neurobiological causes

• Serotonin levels: Low serotonin (5-HT) levels in the brain are one of the most important biological factors that lower the threshold controlling the ejaculatory reflex.
• Penile sensitivity: Hypersensitivity of the sensory nerves specifically on the glans penis (regional hypersensitivity) is a prominent physiological factor.
• Hormonal levels: Thyroid or other hormonal imbalances can occasionally be associated with PE.

Psychological and environmental causes

• Anxiety and stress: Performance anxiety, in particular, negatively affects a person's control over ejaculation.
• Learned behaviors: Habitual rapid ejaculation developed during adolescence or early sexual experiences.

Treatment methods: Behavioral and pharmacological approaches

Behavioral and sexual therapy

Techniques like Stop-Start and Squeeze aim for the individual to recognize their arousal threshold and learn to delay the ejaculatory reflex.

Pharmacological treatments

Systemic medications (SSRI group) that increase serotonin levels in the central nervous system or local anesthetic creams that reduce surface sensitivity of the glans penis are used.

Minimal invasive and surgical solutions

For cases that do not respond to medication or therapy, the following methods may be considered:

• Glans penis filler: Injecting fillers like hyaluronic acid under the skin of the glans to create a barrier between nerve endings and the surface.
• Dorsal nerve cryoablation: A technique that temporarily suspends nerve function by applying cold energy to the dorsal nerve branches.
• Selective dorsal neurectomy (SDN): A microsurgical operation aimed at permanently reducing sensitivity by surgically cutting selected branches of the penile sensory nerves.

Adana and regional diagnostic/treatment approaches

Adana urology doctors approach patients in the Çukurova region with a comprehensive sexual history and physiological evaluation. The most suitable treatment algorithm for the patient's condition is determined within ethical standards.

What is Premature Ejaculation?

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Glans Penis Filler (Glans Augmentation)

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Selective Dorsal Neurectomy

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Selective Dorsal Nerve Cryoablation

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