Prof. Emanuele Giannini is a specialist in endocrinology and sexology from the University of Aquila. He is the first specialist to start lecturing on sexology in Italian universities. Because of his achievements, he was included in the list of Italian top scientists. Prof. Giannini is president of the Italian Association of Andrology and Sexual Medicine, general secretary of the Italian Association of Endocrinology. He is a member of the board of directors of European and world scientific societies. Within the framework of the Third National Conference on Sexual Medicine, organized by the Bulgarian Association of Sexual Medicine, which took place last week in Sofia, he gave a lecture related to his experience in the treatment of premature ejaculation. – Prof. Giannini, when do we talk about premature ejaculation and what proportion of men have such a problem? We may talk too often! 1 in 5 men suffer from uncontrollable ejaculation. We are talking about the presence of such a problem in the case of frequent or recurrent ejaculation with minimal sexual stimulation, occurring before or shortly after penetration, without the man wanting it, when there is an impossibility for it to linger long enough for a satisfactory act. This can be ejaculation that occurs before or very soon after penetration, or ejaculation that occurs with a weak erection, which does not allow intercourse. In this, the man suffers because he cannot exercise any or little control over ejaculation, which causes him anxiety and stress. This dysfunction always or almost always occurs before or less than 1 minute after penetration. This inability to delay ejaculation leads to negative personal consequences such as stress, anxiety, feelings of dissatisfaction, and sometimes even avoidance of sexual activity. It is the most common sexual problem for men, but it is not the most common reason for a visit to the doctor. There are several reasons that contribute to premature ejaculation. Stress and depression undoubtedly affect emotional health and can make the condition worse. Recently, however, attention has been paid to biological factors. If the sexual history includes physical complaints, the doctor should order certain tests. The problem may come from the condition of the prostate gland or from neurological conditions. Sometimes premature ejaculation goes away within weeks or months. Limiting stress leads to improvement. For another part of men, however, the problem drags on for months and years, and then professional help is needed. There are several reasons for this – there was no known cure until now. The problem itself is underestimated by many doctors, they consider it not a disease, but rather a psychological problem. The treatment that was applied was expensive and time-consuming – visits to a psychoanalyst, sessions, the use of antidepressants outside their indications.- What causes this dysfunction? In general, the problem is related to the violation of the quality of sex, thus affecting the quality of life itself. In some of the patients the problem is rather psychological, in others it is a combination of psychological and physiological factors. I can outline several main causes, such as internal (leading to depressive symptoms), neurobiological (birth damage and lower serotonin levels), endocrylogical (hyperthyroidism, high testosterone levels, low prolactin levels), inflammation of the lower urinary tract- genital tract and prostatitis, which occur most often in young men as a result of their lifestyle. A factor for such a problem can be the so-called comorbidity – a problem with other sexual diseases such as erectile dysfunction. In such patients, treatment of one condition may cause the other. – What is the difference between congenital and acquired premature ejaculation? As a specialist, I have my own view. I do not consider them as separate cases. I always work on the basis of the risk factors, regardless of when the problem appeared. – Is it possible that one such condition is an indication of another? Yes of course! As I have already said, it can be the cause of premature ejaculation, the presence of prostatitis or a mental disorder. Quite a few health problems can lead to this problem, such as hormonal imbalance, thyroid disease, inflammation, neurological diseases and infections. Diabetes is another health problem that premature ejaculation can be associated with, which highlights the need to reduce sugar intake. It is also known that the use of narcotic substances can be responsible for the presence of such a problem and impairment of sexual function in general. The side effects of taking antidepressants, statins, anxiolytics, and corticosteroids are largely to blame for sexual dysfunction in men. NEWS_MORE_BOX – What are the psychological aspects of this ailment? The main problem is the inability to control ejaculation. Hence the broken self-esteem and depression. The impossibility of ejaculation control and the subsequent ejaculation before the man wished, are often the cause of disorder in the couple’s relationship, alienation. Premature ejaculation is neither a disease nor a handicap, because after all, a man who ejaculates quickly is actually functioning perfectly normally – he has an erection, experiences an orgasm, ejaculates and can leave offspring. However, uncontrolled and premature ejaculation still leads to problems in the sexual relationship, because often, the satisfaction and pleasure from it is not enough for either the man or his partner. The real problem for many men with premature ejaculation is that they have fallen into a vicious circle of “failure” and “guilt”, are systematically “surprised” by ejaculation and have low “sexual” self-esteem.which can escalate even to restricting sexual activity out of fear of “not exposing yourself”. – What is the role of the woman in such a case? For most of the women surveyed, the concept of sexual satisfaction includes not only the sexual act itself, but also kisses, caresses and other forms of sexual stimulation – and they are as important as penetration itself. If we consider the number of men affected, it means that many women are also affected. Many couples have accepted to live like this. And there are many ways to give pleasure, intercourse is not the only one. – Do men easily admit to their problem and seek the help of a specialist to solve it? This very much depends on the culture of each country. I think it is not a problem for the modern man to share. And if he is worried, with the right technique we can interrogate him and get him to share. Treating the man, we treat the woman, the couple. – What is the modern treatment of premature ejaculation and what is the success rate of the different therapies? The modern treatment is one – Dapoxetine. It is the first and only oral medication for the treatment of premature ejaculation and is a small revolution in this field. Before him, various medications were used, most often their “offlabel” indications – such as antidepressants, local anesthetics. Another method was and is psychological treatment. It is traditional, but it requires a skilled psychologist. This therapy requires a lot of time and money, and its result is not always clear. Dapoxetine, on the other hand, resembles a short-acting antidepressant, but unlike them, it has a very rapid absorption and elimination. It has a short half-life and this makes it suitable for intake as needed. It is not psychoactive, it has an effect from the first dose. Improves a man’s control over ejaculation. That’s why my treatment for premature ejaculation includes a specialist sexologist and dapoxetine. – Are there other methods for treating sexual dysfunction? Behavioral therapy is one possible approach to treating premature ejaculation. The so-called “pressing” technique is most often used. When a man feels that premature ejaculation is occurring, he interrupts intercourse. Then he or his partner with three fingers (preferably thumb, index, middle finger) press the head of the penis for 20 seconds, after which intercourse is resumed. The method can be repeated as many times as necessary. If applied successfully, this technique allows the man to learn how to delay ejaculation by squeezing and eventually control it without squeezing. This approach helps about 60 – 90% of men with premature ejaculation, but requires the cooperation of both partners. – Is leading a healthier lifestyle required in such cases? Alcohol and smoking are an age-old enemy of the body and affect every bodily function, including the sexual system. Naturally, the healthier a man lives,the better he will perform in sex. One of the things most susceptible to disorder in unhealthy eating is the reproductive system. This can lead to sexual disorders, including premature ejaculation. Most modern diets consist primarily of genetically modified foods, preservatives, highly processed products that are devoid of natural fiber, water, protein and enzyme content. This type of food is an extremely insufficient source of nutrients necessary for the healthy functioning of the body. To begin with, one can start by avoiding all types of refined sugar, sweet syrups and glucose. If possible, sugar should not be present in a healthy diet. Refined sugars are the most common cause of obesity and diabetes. It also reduces the levels of testosterone, which plays a major role in the proper functioning of the reproductive system. It is good to completely exclude soy products from the man’s menu. Historically, Buddhist monks in Asia used soy to eliminate sexual desire. This is because soy helps produce estrogen. This can lead to a hormonal imbalance in a man, which can invariably harm his sexual function.