Premature Ejaculation: Types, Causes, and Treatment Options

Premature ejaculation (also known as PE) occurs when a man does not have full control over orgasm and ejaculates between 60 seconds and 2 minutes after penetration or even minimal stimulation, earlier than desired.

It is a dysfunction that affects approximately 25% of the male population across the board: it can impact any age group, whether young or adult, in specific phases or throughout life.

This type of issue can have consequences on personal self-esteem, causing frustration and dissatisfaction in those affected, thereby undermining sexual well-being in the couple's relationship.

Premature ejaculation can be classified into different types based on varying symptoms and causes:

1. Primary or "Lifelong" Premature Ejaculation
2. Secondary Premature Ejaculation
3. Situational Premature Ejaculation

Let’s explore these in detail.

Primary or "Lifelong" Premature Ejaculation

In primary or "lifelong" premature ejaculation, symptoms begin with the onset of sexual activity, starting from the first sexual encounters in youth, and persist into adulthood throughout life.

The causes may include:

• Hypersensitivity of the distal area of the penis (glans, frenulum, balano-preputial groove).
• Abnormal serotonin levels, a neurotransmitter responsible for proper sexual health. When this hormone drops too low, it becomes more difficult to control ejaculation.
• Anatomical-functional issues. For instance, if the individual has a short frenulum or phimosis, he may experience hypersensitivity in the distal area of the penis, which can lead to premature ejaculation.

Secondary Premature Ejaculation

In secondary premature ejaculation, symptoms appear almost suddenly. This condition mainly occurs in adulthood and is often caused by secondary issues that arose shortly before the symptom manifested.

Causes may include:

• Infections of the lower urinary tract or genitalia (prostatitis, vesiculitis, urethritis).
• Hormonal imbalances: testosterone levels, thyroid hormones, variations in prolactin, and other hormones related to male sexuality.

Situational Premature Ejaculation

Situational premature ejaculation occurs under specific conditions, often with a particular partner, and is generally found in anxious individuals. In this case, the causes are predominantly psychological, as intrusive thoughts can trigger physical responses that hinder performance.

“To determine the right therapy for this dysfunction,” explains Dr. Barletta, “it is essential to first understand the cause. This begins with a thorough diagnosis to identify the best treatment approach for the issue. The therapeutic options include the use of:

• Desensitizing creams or sprays
• Serotonin reuptake inhibitor medications
• Antibiotics in cases of ongoing infections.

In specific cases, such as individuals suffering from hypersensitivity of the glans, having a short frenulum, or phimosis, surgical therapy may be necessary, such as frenulotomy or circumcision with selective neuropathy.”

In the case of situational premature ejaculation or when required, it may be helpful to address the issue from a sexual perspective. “In this regard,” the specialist concludes, “our team includes psychologists specialized in this area who can offer their consultation either in person or remotely through telemedicine services, allowing individuals to discuss the problem and begin a therapeutic journey.”