Premature ejaculation (PE) is the most frequent sexual dysfunction in men, estimated to affect up to 20% to 30% of men at some stage of their active life. It is characterized by ejaculation that always, or nearly always, occurs before vaginal penetration or within about one minute of it, associated with the inability to delay or control the ejaculatory reflex and a marked feeling of frustration, personal anxiety, or interpersonal relationship difficulties.
Clinically, premature ejaculation can be classified as:
PE results from a combination of factors:
The diagnosis is fundamentally based on the detailed clinical history provided by the patient in a consultation setting.
The urologist assesses the approximate intravaginal ejaculatory latency time, the degree of control perceived by the patient, and the emotional impact.
The modern approach to premature ejaculation is based on personalization and, frequently, on the combination of several therapeutic aspects to restore sexual self-confidence:
The use of drugs that temporarily increase serotonin levels in the central nervous system is highly effective. Dapoxetine is the only medication specifically approved and developed for the treatment of premature ejaculation on-demand (taken 1 to 3 hours before sexual activity), managing to triple or quadruple the ejaculatory latency time. In selected cases, other daily antidepressants may be used.
The application of desensitizing sprays or creams based on lidocaine/prilocaine to the glans of the penis a few minutes before intercourse helps to reduce local hypersensitivity, delaying the ejaculatory reflex.
If rapid ejaculation is secondary to prostatitis or erectile failure, prioritizing the treatment of the infection with antibiotics or the prescription of PDE5 inhibitors (tadalafil/sildenafil) resolves the ejaculatory control problem indirectly in most cases.
Specific exercises performed during sexual activity—such as the “start-stop” technique or the squeeze technique—help the man recognize the sensations that precede the point of ejaculatory inevitability, training the brain to tolerate higher levels of arousal. Support from sexual therapy helps to reduce associated anxiety.
Book your urology appointment with Dr Frederico Furriel, a urologist with consultations in Leiria, Caldas da Rainha and Porto de Mós. Select your preferred location and submit your appointment request.