Premature Ejaculation

Causes – Diagnosis – Effective Treatment.


One of the most important and more frequent (particularly in young ages) problem which men face, is the problem of premature ejaculation. As premature ejaculation is defined the ejaculation at a time of less than 60 seconds after penetration in more than 50% of the total number of penetrations.

The problem caused by the disorder in the patient’s sex life, as well as its implications in the smooth relationship of the couple are self-evident. In fact, many times, besides feeling disappointed, the person often starts to avoid sexual activity.

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When does it Appear?

Premature ejaculation may appear at the beginning of the man’s sex life (primary). This means that the man experiences the problem continuously after his first sexual experience. In this case, ejaculation happens very fast, in some cases even before vaginal penetration.

It can however appear at a point in time without previous history (acquired). In this case it appears gradually or suddenly. Before this happens, the man usually ejaculated in adequate time. He could enjoy the sexual intercourse.


Although earlier the causes for the occurrence were attributed to purely psychogenic factors, now both the psychological factor and the biological one, are recognized as causes for the occurrence, as a dysfunction of the central serotonin receptors is observed.

Regarding primary premature ejaculation, stress, some hypersensitivity of the glans or a serotonin disorder in its receptors in the brain are presented as causes.

In secondary ejaculation, erectile dysfunction, hypothyroidism, chronic prostate inflammation, neurological disorders, drug side-effects are mentioned as causes.

Together we can find a complete and individualized response to the problem of premature ejaculation, with responsibility and understanding.

Treatment – Therapy

For the treatment of the disease it is of great importance to take a complete history from the patient, who must be detailed in the information he will provide to the doctor. Specifically, the doctor must learn:

  • Whether the patient is diabetic or has a kidney disease or suffers from angina
  • Any neural diseases or lesions and injuries in the spine and in the genitals
  • Whether the patient has had inflammations in the urinary system or the prostata
  • Any endocrinological (e.g. hyperthyroidism) or psychiatric illnesses of the patient
  • Any operations the patient has had
  • Drugs (e.g. psychotropic) the patient may take

Taking the patient’s history is also highly important, as the doctor needs to have an “objective” image of the ejaculation time. Also, he must know whether premature ejaculation is accompanied by other dysfunctions, like  erectile dysfunction.

The right cooperation between patient – doctor in taking the sexual history will help the doctor find out whether the problem of premature ejaculation is related to:

  • Premature or traumatic sexual experience
  • Traumatic experience due to punishment for masturbating
  • Sexual violence or mistreatment
  • Increased stress related to sexual performance etc.

At the next stage the doctor must investigate the patient’s social behavior (any social isolation, low self-esteem, problems at work, any support he receives from his partner in facing the problem etc.) and then he proceeds to:

  • Laboratory testing (general blood and urine test, urine culture and semen culture, hormonal tests, PSA)
  • Clinical examination of the genitals
  • Ultrasound of the urinary system

Η θεραπεία της νόσου είναι κατά βάση φαρμακευτική μπορεί να χρειαστεί όμως και συνεργασία με ψυχολόγο στις περιπτώσεις που ψυχολογικά προβλήματα εμπλέκονται στην αιτιολογία.

Υπάρχει φαρμακευτική θεραπεία που έχει πλέον εγκριθεί για την πρόωρη εκσπερμάτιση αλλά και αρκετά φάρμακα που παρότι δεν έχουν επίσημη ένδειξη για αυτήν, φαίνεται από πολλές μελέτες ότι βοηθούν στο πρόβλημα.

Η σωστή αιτιολογική διάγνωση είναι πολύ σημαντική γιατί θα βοηθήσει σημαντικά στην επιλογή του καλύτερου φαρμάκου  για κάθε ασθενή.

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Vasilis Protogerou

Dimitrios Mporousas

Konstantinos Makarounis