Premature ejaculation (Premature Ejaculation, or PE) is one of the health problems of men that is met often, and is a state that is usually understood incompletely. Many are told that it is a matter of "the mind" or of "confidence".
In medicine, premature ejaculation has a physiological mechanism connected with the peripheral nervous system and the muscles of the pelvic floor, which can be examined, assessed, and have an approach to care designed systematically.
This article explains premature ejaculation from the medical point of view, from the underlying mechanisms, the symptoms that should be noticed, and the approach to assessment, through to the choices of restoration that do not have to rely on local anaesthetic alone.
What is premature ejaculation in medical terms?
Ejaculation is a complex process of response of the nervous system and the muscles (Neuromuscular Reflex), controlled from the central brain and the peripheral nervous system, which send the signal to the group of muscles of the pelvic floor, particularly the bulbospongiosus and ischiocavernosus muscles, whose duty is to contract in order to expel the semen.
Premature ejaculation arises from a loss of balance of this mechanism, making the length of time from insertion to ejaculation (Intravaginal Ejaculatory Latency Time, or IELT) very much shorter than normal, or making it impossible to control the timing of the ejaculation as desired.
The 2 main mechanisms of premature ejaculation
Hypersensitivity of the sensory nerves (Penile / Glans Hypersensitivity)
In some groups of men, the nerves in the area of the head and the shaft of the penis may be more sensitive to sensation than the average. When touch or stimulation is received, the brain therefore receives a signal stronger than normal, and gives the order for ejaculation to occur sooner than it should. Men in this group usually feel that they are strongly stimulated from the first moment of touching the genital organ, which is a physiological factor that can be examined and assessed, and not merely a matter of controlling the mind.
Hyperactivity of the muscles of the pelvic floor (Pelvic Floor Hyperactivity)
Muscles of the pelvic floor that have high tightness, contract in spasm easily, and control their release poorly may respond too sensitively to only slight stimulation. When the muscles twitch and contract too quickly, it therefore becomes impossible to delay the timing of the ejaculation. This state is usually met together with chronic pelvic pain syndrome (CPPS) or hidden inflammation of the prostate gland.
The symptoms that indicate premature ejaculation
The characteristics of the symptoms that should be brought for medical assessment are
- A very short time to ejaculation, for example within 1–3 minutes after insertion, or occurring before insertion
- Being unable to hold back or control the timing of the ejaculation
- A feeling of abnormally high sensitivity to touch
- Twitching of the muscles in the area of the perineum or the base of the organ during sexual intercourse
- Anxiety before having sexual intercourse, which may stimulate the mechanism of ejaculation to occur even sooner
The role of anxiety and accompanying states
Stress and anxiety before having sexual intercourse (Performance Anxiety) can stimulate the sympathetic nervous system to work more, and hasten the process of the body's response.
However, clinically, anxiety is usually not the only cause of premature ejaculation, but is a factor overlying the physiological mechanisms, such as the sensitivity of the nerves, or the hyperactivity of the muscles of the pelvic floor.
Besides this, premature ejaculation may also be met together with erectile dysfunction (ED) or hidden inflammation in the pelvic floor, all of which should be considered in an assessment complete in every dimension.
The approach to assessing the cause of premature ejaculation
Diagnosing premature ejaculation precisely requires an assessment covering many dimensions. The assessment at PYONG MEN may consist of
- Examination of the level of sensitivity of the peripheral nerves in the area of the genital organ (Neurological Sensitivity Assessment)
- Examination by palpation in order to assess the tightness and the hidden points of pain (Trigger Points) of the muscles of the pelvic floor
- Examination of the prostate gland by palpation, in order to distinguish inflammation that may be hidden
Assessment complete in every dimension helps the doctor be able to design a plan of care corresponding to the cause in each individual, instead of care according to the symptoms alone.
The choices of restoration in clinical terms
Care for premature ejaculation at PYONG MEN is directed at adjusting the balance of the nervous system and training the control of the muscles anew (Neuromuscular Re-education), in order to reduce continuous reliance on local anaesthetic.
The approaches that may be considered are
Focused Shockwave Therapy (f-ESWT): Firing focused shock waves of low energy onto the line of the nerves and the tissue of the penis, in order to adjust and reduce the sensitivity of the peripheral nerves (Neuromodulation), in a case where the cause is connected with hypersensitivity of the sensory nerves.
PMS Biofeedback (Pelvic Magnetic Stimulation + Ejaculatory Control Biofeedback): Electromagnetic technology that stimulates the contraction of the muscles of the pelvic floor at the highest level, together with a Biofeedback system that helps the person receiving care see and understand the working of their own muscles, in order to train the nerve circuit and the command of the brain to be able to delay the timing of the contraction of the muscles more precisely.
Doctor's Selection (Dry Needling + High Power Laser): A procedure using medical needles in order to release the knots of muscle held in spasm (Trigger Points) in the area of the base of the organ and the pelvic floor, together with a high-power laser in order to reduce the inflammation.
Superdose Activated Purified Growth Factor and Transrectal QMR: In a case where chronic inflammation or hidden CPPS is found on examination, these procedures may be considered in order to support the repair of the nerves and reduce the inflammation in the deep tissue.
In general, the length of time in care and in training control is about 2–3 months, so that the nervous system and the muscles have time to adjust their balance. That said, the approach to care and the frequency of the procedures will depend on the result of the assessment specific to the individual.
The approach to care at PYONG MEN
The plan of care for premature ejaculation at PYONG MEN is designed according to the character of the cause assessed in each individual, and may cover everything from adjusting the balance of the peripheral nerves and training the control of the muscles of the pelvic floor through to caring for inflammation that may be hidden.
This approach helps direct the care straight at the cause, and supports the person receiving care in returning to controlling their own timing more naturally.
In brief
- Premature ejaculation is connected with 2 main mechanisms, namely hypersensitivity of the sensory nerves and hyperactivity of the muscles of the pelvic floor
- Anxiety, inflammation in the pelvic floor, and erectile dysfunction may be accompanying factors that make the condition more complex
- Assessment complete in every dimension consists of examining the sensitivity of the nerves, the muscles of the pelvic floor, and the prostate gland
- The choices of restoration in clinical terms cover Focused Shockwave, PMS Biofeedback, Dry Needling + Laser, and in some people may include Growth Factor and Transrectal QMR
- The length of time of care in general is about 2–3 months, and depends on the cause in each individual
Frequently asked questions (FAQ)
1. Is premature ejaculation a matter of the mind alone? No. In medicine, premature ejaculation has clear physiological mechanisms, connected with the peripheral nerves and the muscles of the pelvic floor. Anxiety may be an accompanying factor, but is not always the only cause.
2. What length of time to ejaculation is considered abnormal? In medicine, if the length of time from insertion to ejaculation is very short, for example within 1–3 minutes, or the timing of the ejaculation cannot be controlled continuously, that is considered a criterion that should receive assessment.
3. Can premature ejaculation be cared for without relying on local anaesthetic? Yes. There are choices of care directed at adjusting the balance of the nervous system and the muscles of the pelvic floor, such as Focused Shockwave and PMS Biofeedback. The suitability of each approach depends on the cause that the doctor assesses.
4. How are premature ejaculation and erectile dysfunction (ED) connected? Both states can be met together. A comprehensive assessment should therefore consider both premature ejaculation and erectile dysfunction, so that the plan of care corresponds to the true cause.
5. What examination must one begin with? In general, the assessment may consist of examining the sensitivity of the peripheral nerves, examining the muscles of the pelvic floor by palpation, and examining the prostate gland by palpation, in order to distinguish inflammation that may be hidden.
6. How long is the length of time of care in general? The plan of care in general is about 2–3 months, so that the nervous system and the muscles have time to adjust their balance and to train the control of the timing anew, systematically.