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Functional and psychogenic causes of premature ejaculation

1. Rare sexual intercourse leading to sexual abstinence and physiologically induced anxiety.
2. Anxiety and fear during sexual intercourse, related either to external factors or to the man’s anxiety and concern about the possible dissatisfaction of his partner, as well as the problems of marital relations.
3. The habit of a quick onset of ejaculation in young men due to unfavorable conditions for coitus or in long-term relationships with a frigid wife who insists on a quick end to coitus.
4. Intensive, exciting erotic influence of the partner (her high activity during coitus or extreme sexual attractiveness for this man).
5. Installation on the rapid removal of their own sexual tension in the absence of a man’s desire to deliver to the partner satisfaction and indifference to her sensual experiences.
6. Lack of awareness of the approximation of ejaculation, which allows a man to take any action in time to prolong coitus (due to the individual hypersensitivity of the sympathetic nervous system).

Organic causes of premature ejaculation:
– Diseases of the prostate gland of congestive or inflammatory genesis.
– Secondary pathogenetic form of premature ejaculation. It is a neurological complication of the chronic prostate (regional sympatosis). The main difference from a purely urological pathology is the preservation of accelerated ejaculation after sanation of the prostate gland.
– Primary pathogenetic form of premature ejaculation (paracentral lobules syndrome) – is the primary lesion of the cortical centers of urogenital automatism regulation as a result of pathogenic factors in the antenatal period, with birth injury, less often with craniocerebral injuries, in fact, it is about the formation of very low thresholds ejaculatory reflex excitability, which is why a man’s ejaculation and orgasm occur with minimal sexual stimulation.

The main diagnostic criteria for paracentral lobules syndrome:
1. The first ejaculations are ahead of the awakening of the libido, sometimes arising from a teenager in an inadequate setting (running, fright).
2. The presence of daytime emissions (especially inadequate).
3. Frequent night emissions and emissions after 40 years.
4. Mental masturbation, when ejaculation occurs only due to erotic fantasies without mechanical stimulation.
5. Accelerated ejaculation from the onset of sexual activity.
6. Ejaculation is already on the surface caress or attempt to introitus.
7. Ejaculatory ataxia – repeated sexual intercourse does not initially affect their duration, and then with the next coitus anejaculation suddenly occurs.
8. Enuresis in history, since the cortical centers of urination and ejaculation are located nearby – in paracentral lobules.
9. The absence of prolonged coitus effect in the use of alcohol or the use of local anesthetic ointments.
10. Presence of neurological symptoms: the most typical sign is the inversion of the reflexogenic zones of the Achilles reflexes, often there is a non-permanent anisocoria, symptoms of oral automatism, signs of intracranial hypertension.

Signs of premature ejaculation of psychogenic origin:
1. With coitus, sexual arousal in a man initially increases gradually, then suddenly increases dramatically and leads to ejaculation.
2. Paradoxical reaction – ejaculation occurs the sooner, the longer a man seeks to delay it.
3. Due to increased nervous excitability, ejaculation occurs the faster, the weaker the erection of a man (normally, the opposite happens).
4. The selectivity of the disorder (with one partner, the man is able to control the duration of coitus, but not with the other). 5. Erotic dreams, in which premature ejaculation often occurs (patients consider them evidence of the severity of the disorder).
6. The atmosphere of haste and nervousness during intercourse, the need for rapid removal of the penis from the vagina during the practice of interrupted coitus, which enhances arousal and accelerates the onset of ejaculation, especially in individuals with an unbalanced nervous system.
7. Spontaneous periods of lengthening of the coitus (under the influence of situational factors, rest)
8. The presence of anxiety-neurotic symptoms.
9. Lengthening of sexual intercourse under the influence of tranquilizers and alcohol.

Paracentral lobules syndrome is classified in adapted ICD-10 as premature ejaculation due to organic brain damage (F06.82), and accelerated ejaculation in urogenital pathology as premature ejaculation due to diseases of the male genital organs.
Note that there is currently no convincing evidence in favor of the predominant role of both organic (possibly constitutional) and psychogenic factors in the pathogenesis of accelerated ejaculation. Most foreign experts associate premature ejaculation with the presence of psychological causes (K. Imielinsky, 1986; X. Kaplan, 1987; U. Masters and V. Johnson, 1998, etc.) or indicate the absence of reliable research results that could explain why some men have difficulty controlling their ejaculatory response (M. Metz et al., 1997). In recent years, it has been suggested that premature ejaculation may be caused by impaired neurotransmission of serotonergic 5-hydroxytrptamine (5-HT). This has led to the development of targeted therapy for the treatment of premature ejaculation, which aims to alter the 5-HT system.

Examination of patients with premature ejaculation includes a standard sexological examination. Anamnesis involves the identification of childhood enuresis. Neurological examination focuses on the asymmetry of innervation (anisocoria, inversion of the reflexogenic zones of Achilles reflexes). During urological examination, first of all, it is necessary to exclude inflammatory processes of the urogenital tract, including prostatitis. Additional examinations: ultrasound of the prostate, consultation with a urologist, a neurologist, craniography, CT, psychodiagnostics.

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