★ ★ ★ ★ ★★ ★ ★ ★ ★ Verified rating
We left very happy with the doctor-patient relationship
Premature ejaculation is a sexual dysfunction characterized by difficulty controlling or delaying ejaculation, usually associated with a short duration of intercourse. It may be present from the beginning of sexual activity or appear later and can cause worry, anxiety, and dissatisfaction, both personally and within the couple's relationship.
Premature ejaculation occurs when a man ejaculates sooner than desired, either by himself or his partner, during sexual intercourse. It's a sexual problem that affects many men: up to 30% of men have experienced a short intercourse time at some point in their lives. While this doesn't necessarily qualify as premature ejaculation, it does indicate how common problems related to sexual control can be.
The definition of premature ejaculation is controversial and has changed over time. Different scientific societies have different diagnostic criteria, although the three currently accepted criteria are:
There are some cultural factors that can affect the number of men with premature ejaculation, such as ethnicity or cultural background. It is also generally accepted that premature ejaculation tends to decrease slightly throughout a man's life.
There are 4 types of premature ejaculation:
Premature ejaculation can be caused by both psychological and biological factors, and its diagnosis is self-reported, meaning it is performed by the patient. The intravaginal coital latency time (IELT) is commonly used, along with a questionnaire such as the PEDT (Premature Ejaculation Diagnostic Tool).
In cases of secondary premature ejaculation, it is advisable to perform a study to rule out urinary problems (urine culture, urinalysis, PSA and free PSA) and thyroid problems (TSH, T3 and T4).
These questionnaires explore three areas. The first is the duration of intercourse. Next, they analyze the loss of control over the timing of orgasm. Finally, they determine whether the two previous factors have an impact on sexual relations and interpersonal relationships.
Premature ejaculation can be treated with medication, psychological counseling, sexual techniques that delay ejaculation, pelvic floor strengthening, or a combination of these elements:
Premature ejaculation produces three symptoms, although the first of these is the one that essentially defines the disease:
The causes of premature ejaculation depend primarily on the type of premature ejaculation:
The main complaint men have is their inability to control the timing of orgasm, often associated with short intercourse times. Men frequently report a range of negative personal and interpersonal consequences that arise from this inability to delay orgasm.
In the medical history it is essential to explore the three axes that define premature ejaculation: short intercourse time, lack of control over the time of orgasm and negative interpersonal consequences.
To define these parameters and as a measure of the problem—which will later help us evaluate the treatment—we recommend using the IELT (Intravaginal Coital Latency Time) and PEDT (Premature Ejaculation Diagnostic Tool) parameters. In addition, it is advisable to use a questionnaire to assess erectile function, such as the SHIM or the EHS. This way, we can also rule out erectile dysfunction as the cause of the problem.
Since many men experience repercussions not only on their intercourse time but also on their sexuality, it is useful to use IIEF question 12, "How is your level of sexual desire?", to determine if premature ejaculation is having an impact on the amount of sexual intercourse.
In men over 40, it is highly recommended to use the IPSS (International Prostate Symptom Score), a validated questionnaire that measures the presence and severity of urinary symptoms, to rule out a urinary cause. If secondary premature ejaculation is suspected, further evaluation is recommended, including blood tests (complete blood count, blood chemistry, PSA and free PSA, thyroid profile, urinalysis, and urine culture).
The strategy outlined above allows us to define the presence of premature ejaculation, its severity, its cause, and its consequences on the sexual sphere.
If, in addition to premature ejaculation, the patient has difficulty achieving or maintaining an erection, the doctor may order blood tests to check your levels of male hormone (testosterone) and other tests.
The treatment of primary premature ejaculation is usually more complex given its neurobiological component, and requires a high level of involvement from the man, the health professional, and often the patient's partner.
In this case, the cornerstone of treatment is pharmacological treatment, either topical or oral, accompanied by sexual therapy, pelvic floor rehabilitation, and control of anxiety and arousal.
In the case of secondary premature ejaculation, treatment will be more effective the more treatable the underlying cause. Addressing urinary problems, erectile dysfunction, or providing support during a stressful life period is often sufficient to improve mild cases. In more advanced cases, multimodal treatment will be necessary, combining sex therapy, pelvic floor rehabilitation, anxiety and arousal management, and occasional medication.
Regarding the different treatments, it's important to highlight that multimodal treatment will achieve better results compared to simpler strategies. We will need to adapt the treatments to the needs and desires of the patient and their partner, as well as their sex life.
Regarding the available treatments, we will discuss them below:
In our experience, the best treatment is multimodal , combining different strategies into a unified approach. Success depends largely on the man's commitment to treatment and the involvement of the healthcare team needed to support him (urologist, psychologist, physiotherapist).
Finally, a brief mention should be made of surgical treatments . There is much debate about their effectiveness. Postectomy—also called circumcision—has been proposed as a treatment for premature ejaculation, although its efficacy has not been sufficiently demonstrated. Other treatments, such as dorsal nerve ablation of the penis, are considered experimental. Recently, radiofrequency neuromodulation has shown promising results.
We treat our patients at the ROC Chamberí clinic and in the HM Hospitals network of centers in Madrid: Sanchinarro, Montepríncipe, Madrid Río, Rivas, Puerta del Sur, Nuevo Belén, Policlínico HM Moraleja and Nuevo Norte.
Coming soon
We treat our patients at the ROC Chamberí clinic and in the HM Hospitals network of centers in Madrid: Sanchinarro, Montepríncipe, Madrid Río, Rivas, Puerta del Sur, Nuevo Belén, Policlínico HM Moraleja and Nuevo Norte.
Coming soon
We left very happy with the doctor-patient relationship
Our patients' trust reflects our commitment to providing excellent, personalized, and attentive urological care. Every experience motivates us to continue improving and offering the care and support each patient needs.
Excellent urological clinic due to the professionals who work there.
A highly professional clinic, with a very high scientific level and advanced technology. They helped me solve my urological problem.
I can only say one thing, the urology girls are the best you can find in this...
I want to express my gratitude to the Roc team, especially Dr. David Carracedo, for their professionalism, the...
Excellent care, both from Dr. Rojo and Dr. Espinales on a medical level and from the staff of...
Top 100 deal
I've been coming to the Urology department at HM Monteprincipe for a long time and I'm very happy with the care I receive from...
What information does a semen analysis provide, what does an abnormal result mean, and when is it advisable to repeat this test to evaluate male fertility?
...Vasectomy is a highly effective and safe contraceptive method, but questions still arise about whether it is reversible and if it affects male sexuality.
