Let’s move on to the next piece of our mosaic created by varicocele, premature ejaculation. Can we cure premature ejaculation by varicocele treatment? Again, to answer this question, we’ll rely on modern scientific data. Low testosterone, premature ejaculation, and erectile dysfunction are the medical conditions caused by varicocele. It should be noted that not only varicocele may predispose a man to premature ejaculation, but overactive thyroid, prostatitis, genetic factors, poor overall health status and obesity, enuresis, and erectile dysfunction as well. Premature ejaculation is more common in black men, Hispanic men, and men from Islamic backgrounds and may be higher in men with a lower educational level.
- an intratesticular temperature increase;
- hypoxia or lack of oxygen in the testicular tissues;
- and accumulation of free radicals in the form of reactive oxygen species in the testicles which may cause damage to DNA, RNA, and proteins, and may provoke cell death.
These three factors, in turn, result in degeneration of spermatogenesis, decreasing of sperm quality and quantity and lowering of the testosterone production.
Prevalence of premature ejaculation.
A large-scale survey on the prevalence of premature ejaculation was conducted by H. Porst et al. in 2007. The study included 12,133 men aged 18-70 in the United States, Germany, and Italy.
They found the prevalence of premature ejaculation 24.0% in the United States, 20.3% in Germany, and 20.0% in Italy and it did not change significantly with age. It means that premature ejaculation is not just a dysfunction in young people, as can be heard often, and unlike erectile dysfunction, it stays at the same level in all age groups.
Despite, most men have used certain ways to manage their condition: particular positions, breaking stimulation, masturbation, drinking alcohol, only 9.0% of them discussed it with their physician and almost all of them were not satisfied with the result. The last result, in turn, shows that no adequate medical treatments have been developed so far for premature ejaculation.
Treatment strategies available for premature ejaculation.
The International Society for Sexual Medicine has proposed intravaginal ejaculatory latency time equal or less than 1 minute as a criterion for the premature ejaculation diagnosis. Men’s typical ejaculatory latency is approximately 4–8 minutes.
According to the recommendations of the European Association of Urology (2016) if premature ejaculation causes few if any, discomfort, treatment may be restricted to psychosexual counseling and education. Furthermore, it is essential to treat first erectile dysfunction and prostatitis if present.
Psychological strategies include ‘stop-start’ programme and the ‘squeeze’ technique. In the first method, she stimulates his penis until he feels the urge to ejaculate and stops until the sensation to pass and then resumes stimulation. In the second technique, she squeezes the glans just before
ejaculation until her partner loses his urge.
For some young men masturbation before anticipated sexual intimacy may be a good choice.
Dapoxetine is the only pharmacological treatment approved for
premature ejaculation in many countries except for the USA. All other medications mostly including antidepressants are off-label suggestions. Dapoxetine has been investigated in 6,081 patients suffering from premature ejaculation and showed a three-fold increase of a stimulation time from baseline average <0.5 minutes. It was effective from the first dose and increased ejaculatory control, decreased distress, and increased satisfaction. However, all these medications can cause erectile dysfunction, diminished libido, and anorgasmia
Two surgeries allowing to get rid of premature ejaculation forever come from South Korea: selective dorsal neurectomy and penis head growth using a hyaluronan gel injection. Nevertheless, the International Society of Sexual Medicine has endorsed none of these approaches yet, about 75% Korean urologists recon them as safe and efficient treatments.
Kwak TI et al. (2008) performed penis head growth on 38 patients, suffering premature ejaculation and followed up for five years for possible side effects. Compared to starting values the latency time increased from 84.2 s. till 378 s. at six months and 352 s. in five years after treatment. There was no significant difference in term of the patient’s and the partner’s satisfaction between 6 months and five years.
In another study Zhang GX et al. (2012) made selective removal of dorsal penis nerves for 40 men with premature ejaculation and achieved an increase of latency time from 1.1 to 3.8 min. The authors concluded that
the surgery is efficient in prolonging and controlling ejaculation, whereas an erectile function is not affected.
And finally, some topical anesthetic agents like lidocaine cream showed an increase in latency time from one minute in the placebo group to 6.7 minutes in the treatment group. However, the use of topicals is sometimes avoided due to the loss of sensation in the penis as well as for the partner.
It was only a glance at the main treatment approaches for premature ejaculation, without considering the pros and cons, and side effects of them, to outline an overall picture of the problem and to move on our topic “can we cure premature ejaculation by varicocele treatment.”
Cure of premature ejaculation by varicocele treatment.
Although several studies have shown a higher incidence of premature ejaculation in men with varicocele, the work of Ahmed, A.-F, et al. (2015) demonstrated a firm correlation between them.
In this study, 73 patients with varicocele suffering from premature ejaculation were undergone surgical varicocelectomy while the other group of patients (56 men) with the same diagnoses refused from surgical intervention. As an outcome of this study significant improvement of premature ejaculation was achieved:
- In the first group, 41.1% of patients showed improvement of premature ejaculation compared to 5.3% in the control group.
- Testosterone content and International Index of Erectile Function values in group 1, but not in group 2 also improved compared with the pre-operative values.
- The size of the testicles increased after varicocelectomy but decreased notably in the second group.
A significant improvement in premature ejaculation, erectile function, and the testosterone level was observed in varicocele patients after
varicocelectomy. And what is important, no varicocele recurrence or severe postoperative complications were noted until the end of the study; the follow-up period lasted six months.
These results suggest that varicocele is linked to premature ejaculation and hormonal function of testicles and by repairing a varicocele we can improve these characteristics of our sexual life. So, if you are one of them who suspect yourself to have a premature ejaculation, carefully examine your testicles for the presence of a varicocele and consult with your health care provider on the practicability of varicocele repair. Remember, about a third of men suffer premature ejaculation and prevalence of varicocele is about 15% among the general population of men.
Ahmed A.-F. et al. Impact of varicocelectomy on premature ejaculation in
varicocele patients. Andrologia 2015, 47, 276–281
Hatzimouratidis K. et al. EAU Guidelines on Erectile Dysfunction, Premature Ejaculation, Penile Curvature and Priapism. European Association of Urology 2016.