Premature Ejaculation Treatment: Take Back Control

What causes premature ejaculation, and is there a treatment? Ways to prolong intercourse using delay sprays, sexual therapy methods, and penile head fillers. A guide to a happy sex life.

Introduction: For Those Who Want to Live the Moment, Not the Duration

The inability to control the ejaculation reflex during sexual intercourse and ejaculation occurring much sooner than desired… This sentence may be a medical definition, but its meaning is much deeper for those who experience it: loss of self-confidence, fear of not satisfying one’s partner, relationship stress, and avoiding intimacy.

Premature ejaculation is not just a problem of ‘extending the duration’; it is a serious relationship issue that disrupts harmony between partners. However, the good news is that premature ejaculation is the most successfully treatable sexual dysfunction.

In this comprehensive guide, you will find out how to understand whether the problem is ‘all in your head’ or a physical hypersensitivity, techniques you can apply at home, and the permanent solutions offered by modern medicine.

What is Premature Ejaculation? (Duration Criterion)

In medical literature, the diagnosis of Premature Ejaculation is not based solely on duration; three fundamental criteria are sought:

Duration: Ejaculation occurring before or immediately after vaginal intercourse (usually less than 1 minute).
Loss of Control: The man’s inability to delay or control his ejaculation reflex.
Negative Impact: This condition causing stress, distress and avoidance of sex in the man or his partner.

Important Note: The duration of ‘normal’ sexual intercourse varies from person to person. However, scientific studies indicate that the average duration of vaginal intercourse is around 5-6 minutes. Durations of less than 1-2 minutes generally require treatment.

Types of Premature Ejaculation: Which One Is Your Problem?

To determine the course of treatment, it is first necessary to understand the nature of the problem.

A. Lifelong (Primary) Premature Ejaculation

It is a condition that has existed since adolescence and the first sexual experience. The person has experienced premature ejaculation for as long as they can remember. Genetic factors or sensitivity of the penis head are usually the main causes.

B. Secondary Premature Ejaculation

Premature ejaculation is when a person’s sexual life was previously normal but they subsequently begin to experience premature ejaculation (following an illness, stress or trauma). It is often associated with prostatitis, thyroid disorders or erectile dysfunction.

Reasons: Psychological or Physical?

There is a widespread belief among the public that the problem is entirely ‘psychological’. This is partly true, but it is not the whole story.

Psychological Reasons

Performance Anxiety: The stress of wondering, ‘Will it end too soon again?’ stimulates the sympathetic nervous system, accelerating ejaculation.
Early Experiences: Masturbation performed quickly during adolescence due to fear of being caught can condition the brain to ‘ejaculate quickly.’
Relationship problems and stress.

Biological (Physical) Causes

Penile Glans Hypersensitivity: In some men, the nerve endings in the glans are much more sensitive than in others.
Serotonin Levels: The serotonin hormone in the brain delays ejaculation. Low serotonin levels can lead to premature ejaculation.
Prostate Diseases: Chronic prostatitis can disrupt the ejaculation mechanism.
Erectile Dysfunction: Fear of losing an erection may cause the individual to unconsciously attempt to hasten the process.

Diagnostic Methods

IELT Duration: The ‘Intravaginal Ejaculation Latency Time’ is assessed.
PEDT Test: An early ejaculation diagnostic test (questionnaire) is administered.
Physical Examination: This includes a prostate examination and assessment of penile glans sensitivity.

Treatment Options: Step-by-Step Solution

Treatment is personalised. Sometimes a single method is required, sometimes a combination (medication + therapy) is needed.

A. Behavioural Therapies and Exercises

These are methods that enable a person to understand their own body without medication.

1. Stop-Start Technique

This is the most well-known method. During masturbation or intercourse, one stops just before the sensation of ejaculation (the point of no return) occurs. Once the excitement subsides, one starts again. After repeating this cycle 3-4 times, ejaculation is allowed. In this way, the brain learns to delay the ejaculation reflex.

2. Squeeze Technique

When the urge to ejaculate arises, the area just below the head of the penis (the frenulum region) is squeezed for 10-15 seconds to suppress the urge to ejaculate.

B. Local Anaesthetic Creams and Sprays

Products containing a mild anaesthetic (lidocaine/prilocaine) that are applied to the penis 15-20 minutes before intercourse.

Advantage: It is a quick and simple solution.
Disadvantage: It may cause numbness in the penis and reduce pleasure. If not washed off before intercourse, it may also numb the partner’s vagina.

C. Oral Medications (Pill Treatment)

It has been noted that SSRIs, a group of drugs commonly used to treat depression, have the side effect of delaying ejaculation. Urologists prescribe these drugs at low doses to treat premature ejaculation. Special tablets (Dapoxetine) taken only before intercourse are also available.

D. Sex Therapy

If the problem stems from performance anxiety or relationship issues, couples therapy with a sex therapist is the most lasting solution. The process is extended by correcting misconceptions about sex and assigning homework specific to the couple (sensory focus).

The Latest Treatment: Penis Head Filler (Glans Filler)

It is a non-surgical method that has grown in popularity in recent years. It is particularly preferred in patients with excessive penile sensitivity.

What is it? It involves injecting hyaluronic acid fillers, used in facial aesthetics, under the skin of the glans penis.
How does it work? The filler acts as a ‘cushion’ between the skin and nerve endings. This reduces nerve stimulation and prolongs the time to ejaculation.
Advantages:
The procedure takes 15 minutes.
It is performed under local anaesthesia and is painless.
It also thickens the glans penis, providing an aesthetic fullness.
Duration of Effect: Depending on the filler used, it lasts for 1-2 years.

Surgical Treatment (Nerve Cutting) – Is it still performed?

Dorsal nerve resection (neurotomy) was a method used in the past. However, due to the risk of permanent loss of sensation and erectile dysfunction, it is not recommended in modern urology today. Instead of this irreversible procedure, fillers or drug treatments are preferred.

Lifestyle Changes and Nutrition

Pelvic Floor Exercises (Kegel): Squeezing and releasing the muscles as if holding urine strengthens the muscles that control ejaculation.
Magnesium and Zinc: Taking supplements of these minerals may be beneficial due to their positive effect on testosterone and neurotransmitters.
Alcohol and Smoking: These should be avoided as they affect the nervous system, making control more difficult.

Frequently Asked Questions (FAQ)

Question: Does premature ejaculation improve with age? Answer: It does not usually improve on its own. In fact, if left untreated, it can trigger erectile dysfunction due to ‘fear of failure,’ making it more complex.

Question: Does foreskin cause premature ejaculation? Answer: The effect of circumcision on premature ejaculation is debatable. While some studies argue that the glans of the penis becomes calloused and numb over time in circumcised men, prolonging the duration, there is no definitive scientific evidence.

Question: Are delay sprays harmful? Answer: High-quality, medically approved products are not harmful. However, using them unconsciously and in very high doses can completely desensitise the penis and cause loss of erection (erectile dysfunction).

Question: I feel embarrassed in front of my partner. What should I do? Answer: This is a common problem for couples. Open communication reduces pressure. Telling your partner that this is a medical condition and that you are seeking treatment can alleviate the ‘performance pressure’ on you and may even help the duration to increase naturally.

Result: Put an End to Quick Starts

Premature ejaculation is not an unsolvable problem, but simply a reflex that needs to be managed. Whether it’s a simple spray, sexual therapy, or a 15-minute filler procedure, there is definitely a solution that is right for you.

Correcting this timing issue in your sex life will not only extend the duration but also strengthen the emotional bond with your partner.

Do not delay consulting a urology specialist to turn time in your favour.