Premature sexual development: causes, diagnosis, treatment. Method of a thousand frictions. Age when rapid changes usually stop

Acceleration is a phenomenon that occurs everywhere. Accelerated sexual development teenagers today worry psychologists and doctors. Premature ripening can lead to unforeseen consequences. Outwardly, a teenager may seem quite mature - this is the anatomical features of the puberty period in boys and girls. However, high growth or a magnificent bust are not evidence of stabilization of hormonal levels and final maturation of the brain. Let's try to figure out how physical and sexual development occurs normally in children, as well as what their parents should pay attention to.

What is puberty

Each of us has our own biological clock in the body. This abstract concept explains the timeliness of the growth and development of the body, the appearance and withering of reflexes and functions. Babies suck their fingers and learn to walk, but after a few years, having acquired many skills, they go to school to explore the world. Women get wrinkles over the years, and old people get gray hair. All these and many other natural changes are a consequence of the normal functioning of the endocrine system, as well as the hypothalamus and pituitary gland. These glands are located in the brain and secrete hormonal substances necessary to initiate age-related biological processes.

Each has its own characteristics. But the greatest stress to the body comes during puberty. The changes that occur to a fragile child’s body are countless, but right now we will try to sort everything out.

The development of germ cells and organs in representatives of both sexes occurs in three stages. In girls and boys they do not occur at the same time:

1. Prepubertal. For boys, it begins at age 8 and ends closer to eleven. In girls it begins 1-2 years earlier.
2. Puberty. The age at which children can be considered teenagers also differs. In boys it occurs between the ages of 11 and 17; in girls it usually ends by age 15.
3. Growing up. Girls are considered sexually mature at the age of 15-18 years. The formation of young men is completed by the age of 19-20.

How boys grow up

It begins with the formation of secondary sexual characteristics, the impetus for which is an increase in the concentration of testicular androgens in the body.

The process of maturation of the male reproductive system begins with a change in the size of the genitals. First, the longitudinal diameter of each testicle increases, and the scrotum becomes pigmented and folded. By the age of 11-12, a teenager develops pubic and axillary hair. In rare cases, vegetation in intimate areas occurs before the testicles increase in volume. This is not the norm; such a disorder is caused by excess production of androgens. In medicine, this phenomenon is called accelerated adrenarche.

As testicular volume increases, the size of the penis becomes larger. First, its length increases, and then its diameter. Pigmentation (darkening skin) continues to increase.

Around the age of 13-14, a young man begins to develop hair on his face, neck, and chest. At this age, the genitals may well correspond to the size of adult men, but it is too early to talk about the onset of puberty. Spermatogenesis should indicate this. The first ejaculations and wet dreams occur around the age of 16. Puberty in boys continues until the age of 19-20, but they become fertile, that is, capable of fertilizing a female egg, earlier.

Another change that occurs under the influence of increased secretion of male hormones is the acquisition of characteristic architectonics by the body: an increase in the shoulder girdle, growth of bones and muscles.

How teenage girls change

In girls, it also begins with the appearance of secondary symptoms, and its completion is indicated by the establishment of a regular menstrual and ovulatory cycle. The first noticeable changes are expressed by breast enlargement: under the areola area, the glandular tissue thickens, and the area around the nipple darkens. The growth of the mammary gland is ensured by the secretion of estrogens - at the age of 10-11 years they are produced in sufficient quantities. Often girls are frightened by asymmetry (one breast seems larger), which disappears only during the formation of a mature gland.

The next secondary sign of sexual development in the fairer sex is pubic and axillary hair growth. Most often, hair growth in the armpits indicates the approach of menarche - the first menstruation. Despite the fact that the process of formation of sexual characteristics most often occurs in this sequence, approximately 1% of girls develop hair growth first. The abnormal course of puberty is caused by the increased presence of male hormones in the body.

In parallel with the development of the reproductive system, the architectonics of the body changes. In girls, an increase in body weight occurs due to the build-up of predominantly adipose tissue. It begins to “accumulate” in the body from the age of six. In early puberty, adipose tissue is redistributed and deposited in the hips and pelvis.

Several stages of maturation of boys and girls

So, each of the periods of sexual development can be briefly described as follows:

• A kind of preparation for the upcoming changes is the prepubertal period. Within 2-3 years, the body accumulates enough strength to make a big leap in growth and sexual development. Next comes adolescence, the peculiarities of which every person has to deal with.
• Adolescence (puberty) is characterized by intensive growth, increased work of the gonads, and significant changes in the figure. Representatives of both sexes also change their voice: in boys, due to mutation, it becomes low and deep, in girls it loses its sonority.
• Growing up. Consolidation of acquired sexual characteristics, growth cessation, initiation of active sexual activity and reproduction of offspring.

Negative manifestations of puberty

In addition, with the onset of puberty, girls and boys experience similar health problems. Teenagers often suffer from inflammation sebaceous glands, distribution acne on the face, back, shoulders, sometimes buttocks. Shiny, oily skin aged 12-16 years is prone to acne.

Possible pain in muscles and joints, dizziness and fainting, and lack of coordination. Girls may often have pain in their chest and lower abdomen, and before their first period they may experience severe pain in their lower back.

The complex character of a teenager

The sexual development of representatives of both sexes is accompanied by another important aspect - psychological. About difficulties adolescence Parents know this firsthand. Changes in character and rebellious behavior are predominantly hormonal in origin. A clear sign of “internal withdrawal”, provoked by the entry of large amounts of testosterone and estrogen into the blood of a teenager, are sudden mood swings. Girls are more sensitive to hormonal changes. They can become violent for no specific reason, and five minutes later they become pitiful and tearful.

It is immediately worth noting that such psychic phenomena There is no treatment for teenagers. A properly selected diet can help a child overcome puberty. To mitigate the hormonal “storm” of a teenager, it is important to minimize the daily amount of calories entering the body, primarily excluding fast carbohydrates, chocolate, caffeine, energy drinks and fatty dishes. It is better to give priority in nutrition to animal products containing calcium and protein, especially necessary during the period of active growth. In addition, it is important for girls to constantly replenish iron deficiency. It is found in beef liver, pomegranate juice, apples, and red meat.

If a teenager is having a hard time going through puberty, it is worth contacting a neurologist or psychotherapist. Boys and girls are usually recommended to take vitamins, homeopathic sedatives and adaptogens (extract of echinacea, lemongrass, succinic acid).

What diseases occur in teenagers

As already mentioned, the age-related development of germ cells and the reproductive system in general is not the most favorable period for the body. Adolescence is a kind of “trigger” for the activation of a number of diseases and pathological conditions. During puberty, gastritis often worsens, cholecystitis is detected, diabetes. The first migraine attacks in most girls suffering from this problem occurred during adolescence. Myopia, decompensation of congenital but not diagnosed heart disease in time, scoliosis, flat feet - children aged 10 to 16 years have a good chance of such manifestations. IN severe cases juvenile schizophrenia or oncology develops.

On the other hand, active growth during the formation of boys and girls allows many to “outgrow” asthma, enuresis, and adenoids. It happens that a child’s allergic reactions weaken or disappear altogether.

Disorders of the reproductive system

There are specific diseases that are typical only for teenagers. The most common of them:

Too early: reasons for acceleration

When talking about disorders of sexual development, we have two options in mind: premature ripening and its delay. Sometimes during internal system the body, which determines the rhythm of its life, a malfunction occurs, and natural processes occur earlier or later than expected.

Thus, acceleration is premature sexual development, which begins in boys before the age of 9, and in girls before the age of 8. At such an early age, the body is not yet ready for pubertal changes. In the future, premature sexual development leads to early decline of reproductive functions. In addition, accelerated children often begin an early sexual life, which is dangerous to health, especially in the case of an unplanned unwanted pregnancy.

Pathological causes of acceleration are disorders in the endocrine system, benign and malignant tumors of the brain, pituitary gland, diseases of the adrenal glands and improper functioning of the gonads. If the first signs of acceleration occur, you should consult a doctor. To prevent early offensive puberty, doctors recommend that parents do not overfeed their children, limit carbohydrate intake and send them to a sports section.

Five-year-old mother from the Guinness Book of Records

The most famous case in history of a girl with early puberty is simply shocking. The Peruvian woman was only 5 years and 7 months old at the time of her son’s birth. Despite the fact that the origin of the pregnancy remained unclear, in 1939 her son was born absolutely healthy with a weight of 2700 g. The doctors who performed the caesarean section published a report in which they noted that Lina had menarche at 2 years and 8 months, and by 4 For years, her mammary glands were almost formed.

Early maturation is caused either by natural or pathological reasons. Today, many doctors believe that the cause of premature puberty is hormonal additives in the feed of livestock whose meat we eat, substances released from plastic packaging and plastics. Maturation ahead of schedule does not occur consistently: for example, a boy may suddenly develop sexual desire and a full-fledged erection, and only then develop hair growth.

Delayed secondary sexual characteristics

Another situation that occurs in adolescents is delayed sexual development. This disorder is characterized by the absence of secondary sexual characteristics by the age of 14-15: girls have no hair on their bodies, breasts are practically not developed, and in boys the size of the penis does not increase. Sometimes such a delay in development is considered normal. There is no need to panic ahead of time if the teenager is of asthenic physique.

Also, the reason for the delay may be rescheduled serious disease, anorexia (in girls) or playing professional sports. But if secondary sexual characteristics do not appear by the age of 16, it is simply necessary to consult a doctor: there may be genetic abnormalities.

Girls with male pattern hair, developed breasts and lack of menstruation need a detailed examination - such symptoms can be caused by an abnormal absence of the uterus with functioning ovaries.

The health of a child during puberty must be carefully monitored. It is important that your teenager eats properly and gets enough rest. For preventive purposes, it is advisable to take laboratory and clinical tests of urine and blood every year - this simplest form examination is a fairly effective way to identify inflammatory processes in organism.

Parents are also responsible to their children for their sex education. Lessons in the form of explanatory conversations about the rules of hygiene, the dangers of early sexual activity and contraception should be carried out with every teenager, no matter how mature and omniscient he considers himself to be.

A mandatory period of development for any boy is the age of puberty. If the teenager himself may not realize the importance of changes in his own body, then parents must clearly understand the responsibility of this period and be prepared for it.

Stages of Boy Development

Many parents believe that puberty in boys and their sexual development are equivalent concepts. In fact, this is a misunderstanding of the two terms, because in order to develop secondary sexual characteristics, the boy’s body must prepare, and this process is not that fast.

Doctors believe that puberty is the end of a boy's overall sexual development. There are the following stages of development, which have their own characteristic features:

1. Intrauterine. The beginning of this stage occurs at 12-16 weeks of intrauterine stay of the fetus, when its future gender is finally formed, that is, it is already clear who will be born - a boy or a girl. In the male fetus, it is during this period of intrauterine life that the scrotum and penis are formed. Before birth, the fetal testicles are located in the abdominal cavity, and descend into the scrotum after birth.
2. Childhood (age 9-11 years). External signs of puberty are just beginning to form, but during this period the pituitary gland, a gland that regulates many physiological processes, is already actively functioning. Parents consider the age of 9-11 years insignificant, but it is during this period that the boy needs to be told what pregnancy is, how children are made, and what sexual characteristics distinguish a girl from a boy.
3. Age 13-14 years. This is a very important period of sexual development, since it is now that the sex gonads begin to become active, the boy’s growth accelerates sharply, which means that androgen hormones are actively produced in the body. It is these hormones that lead to the development of secondary sexual characteristics - growth of the penis, enlargement of the testicles.
4. Age 17-18 years. For most teenagers, it is during this period that all stages of puberty are completed, but some boys can continue to grow until they are 20-22 years old - this is considered the norm. This age implies Special attention to a teenager from the parents - you need to explain to him the basic rules of social behavior of a man, teach him to take care of his appearance, gradually instill in him a sense of responsibility for both his future and the future of the family as a whole.

Note:All stages of sexual development are very important and boys should never be left alone with their thoughts. Parents should take an active part in the development of a man, instill some important rules and social norms, explain the changes occurring in him physiologically .

Characteristic signs of puberty in boys

Active maturation in boys begins at 12-13 years old, but this is not a dogma! Some doctors believe that if boys experience early puberty, they will have a stronger sexual constitution in the future. Naturally, we are talking about natural manifestations, and not pathological ones, when the physiological process in question, which occurs at an early age, is caused by some kind of disease.

What will indicate puberty in boys:

1. At 11 years old (the age is indicated approximately, it all depends on the individual characteristics of the body) the boy's penis begins to enlarge– this is not noticeable, the growth of the penis is smooth. The average length of a boy's penis is 4 centimeters, but by the age of 14 he will be 7 cm long, and by the age of 18 - 10 cm. Parents should understand that these figures are not a standard and can vary significantly, so focus on they are not worth it.
2. Testicular development. They become somewhat larger and look absolutely proportional to the growing penis. Parents should remember that in men one testicle is always slightly smaller than the other, so do not be surprised by the disproportion.
3. Hair growth in the pubic area. In boys, by the age of 15-16 years, hair growth in this area is distinguished by a clear diamond shape, and by the age of 17-18 years, the development of hair on the lower extremities ends. In the armpit area, hair begins to grow at the age of fourteen; this process usually ends by the age of 17. The sign of puberty described in this paragraph is also very individual - millions of men live with “bare” legs and are absolutely healthy and happy.
4. Voice timbre correction. This is the so-called “voice breaking”, which begins at the age of 13-14, and the process of forming a constant timbre is completed at the age of 17.
5. Beard and mustache growth. The first vellus mustache appears in boys at the age of 15-16, but the beard begins its active growth only from the age of eighteen. But again, these figures are very conditional, because a lot depends on genetics and heredity. For example, it is well known that representatives of Caucasian nationalities can begin to develop both a mustache and a beard as early as 14 years of age.
6. Engorgement of the nipples. If in girls this symptom is intensely expressed, then in boys this change generally goes unnoticed. Doctors cannot indicate the specific age of a boy when nipple engorgement begins.
7. Maturation of germ cells. Spermatozoa in a boy are formed at the age of 14-15, but their development occurs gradually and continues almost throughout his life. By at least, during the period of male reproductive activity they continue to form.
8. Pollutions. This is the name for the process of spontaneous ejaculation, which most often occurs at night. Parents should prepare the boy for wet dreams, talk about them and explain why it happens and what it means.

Separately, it is worth noting that as a boy reaches puberty, his appearance also changes - his shoulders become wide, but his pelvis remains narrow, and intensive growth of muscle mass and bones is noted. Parents often notice that the boy’s height has increased rapidly, by several centimeters at once.

During active puberty, quite a lot of sex hormones are released, so there is a change in the structure of the skin and the functioning of the sebaceous glands. The sebaceous glands produce sebum too actively, and this leads to the formation of pimples and blackheads. This sign of puberty often provokes the development of complexes in boys, so parents should be attentive to their own child and provide him with psychological support– success in a man’s life, the ability to believe in himself, depends on this.

Possible deviations during puberty

The period of development of boys under consideration may also occur with some deviations.

Late puberty

In general, doctors' opinions about the age of boys when they should go through puberty differ greatly. But if a boy has no pubic hair at the age of 15, and the testicles do not enlarge until the age of 13, then experts talk about deviations in puberty.

Most often, this disorder of puberty in boys is provoked by:

• congenital chromosome abnormalities;
• endocrine diseases, which can be congenital or acquired;
• organ dysfunction gastrointestinal tract caused by severe pathologies;
• diseases vascular system and hearts;
• with complications.

Questions about late puberty in boys should be asked to an endocrinologist - he will be able to find out the cause of this condition and take the necessary measures, if necessary - for example, hormone therapy. But statistically, boys still catch up and eventually reach puberty. However, in a situation of late puberty, parents should be tactful, talk to the child, justifying their attitudes (for example, “this happens” - provide the boy with articles on late puberty, some competent materials), and provide him with maximum attention.

If we are talking about some pathological reasons If the boy has reached late puberty, he will undergo a full examination and be prescribed medications. If there are genetic abnormalities, it is unlikely that it will be possible to correct the situation, but hormones prescribed by a specialist can speed up the process of puberty.

Early puberty in boys

Doctors make this diagnosis if secondary sexual characteristics begin to appear in a boy at the age of 10 years. Moreover, early puberty in boys most often has quite natural causes- for example, if his father had the same deviation, then it is inherited by his child.

If we consider the pathological etiology of early puberty in boys, then we will talk about endocrine disorders. If a boy develops a truly masculine appearance, then the genitals remain unchanged (that is, there is no enlargement of the testicles and penis), then this condition will be called false early puberty. This can be caused by a benign neoplasm located in the testicle or adrenal gland, and it is in these organs that the male hormones androgens are produced. In this case, the boy’s gonads will remain at the same level of development, but his appearance will change greatly.

If the doctor suspects a pathological etiology of early puberty in a boy, then a full examination will be prescribed - an examination of the pelvis and adrenal glands is carried out using a device, a brain examination is carried out using, and blood tests are collected to determine. Treatment of early puberty in boys involves the prescription of medications that can stop the production of sex hormones; in many cases, it is enough just to neutralize their effect on the body. If a tumor of the adrenal gland or testicle is diagnosed, it is advisable to undergo surgical treatment, after which the physiological processes of puberty are normalized.

Puberty of boys is a natural process for which parents, first of all, need to be prepared. Only they can provide psychological support to the child during this difficult period. Of course, you shouldn’t “overload” a teenager with information and constantly bring him into frank conversation - this will irritate the boy. But you'll have to talk to him, as a last resort– provide him with already selected material that explains to the boy in accessible language all the changes that occur in his body during puberty.

Tsygankova Yana Aleksandrovna, medical observer, therapist of the highest qualification category

Puberty is a genetically determined process of transforming a child’s body into an adult capable of reproduction. In a broad sense, the achievement of puberty includes not only a physiological process, but also social adaptation.

Currently average age The onset of puberty in girls ranges from 8 to 13 years, and in boys from 9 to 14 years.

The timing of the onset of puberty is significantly influenced by the child’s gender, race, hereditary predisposition, factors environment, nutritional pattern, socio-economic status. For example, obesity and exogenous supply of hormones can play an unfavorable role.

Physiology of sexual development

Male and female gonads are formed from one undifferentiated rudiment. Development of gonads in both sexes early stages proceeds in the same way (indifferent stage). The gene that determines the differentiation of the gonad according to the male type is localized on the Y chromosome.

The basis for the development of the internal genital organs are the Wolffian (in boys) and Müllerian (in girls) ducts.

The formation of the external genitalia of the male fetus begins from the 8th week of the intrauterine period and occurs under the influence of dihydrotestosterone, formed from testosterone in the fetal testicles. Androgens are necessary for the differentiation of embryonic anlages according to the male type. Leydig cells, which produce androgens, function under the influence of placental chorionic gonadotropin. The genital tubercle forms the penis, and the external genital folds form the scrotum. At 18-20 weeks of intrauterine development, the formation of male-type external genitalia ends, although the process of lowering the testicles into the scrotum occurs much later, by 8-9 months of gestation. After birth, testosterone production is stimulated by pituitary gonadotropins.

When a female organism is formed, the fallopian tubes develop from the upper third of the Müllerian ducts; the middle part of the ducts merges to form the body and cervix. Wolffian ducts regress.

From the 12th to the 20th week of the intrauterine period, the vagina, clitoris, labia majora and minora, and the vestibule of the vagina with separate external openings are formed urethra and the entrance to the vagina. In the female fetus, differentiation of the external genitalia occurs regardless of the state of the gonads.

The triggering mechanism of puberty associated with the activation of the neuroendocrine system is currently not clear enough. However, it is known that this process is initiated by the pulsed secretion of gonadotropin-releasing hormone (LH-RH) by neurons located in the nuclei of the hypothalamus. The development of the hypothalamic-pituitary-gonadal axis (gonadostat) occurs throughout the entire period of a child’s life, starting from intrauterine.

In a newborn child, the hypothalamic-pituitary-gonadal regulation is fully formed. In boys, this system functions up to 6-12 months, in girls up to 2-3 years of life. Then follows a long period (until puberty) of its oppression - the “juvenile pause”. Pulse secretion of LH-RH sharply decreases. Despite the low content of sex steroids in the blood, this period is critical for precocious sexual development (PPD) of central origin.

By the end of the “juvenile pause” - by 6-7 years in girls and by 8-9 in boys - adrenal androgens begin to be intensively synthesized, causing the development of secondary hair growth (pubic and axillary) in girls. In boys, this role is played mainly by androgens of testicular origin. This period preceding puberty is called the adrenarche phase.

The final formation of the gonadostat occurs during puberty. Activation of the LH-RH pulse secretion generator stimulates the production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) of the pituitary gland, which are necessary for the formation of gonadal steroids - androgens and estrogens. The regulation of this system during reproductive age is based on the principle of feedback between these hormones.

In boys, the main hormone of puberty is testosterone, which is secreted by Leydig cells in the testes and partly in the adrenal cortex. Testosterone itself is inactive. In target organs, with the help of the enzyme 5α-reductase, it is converted into active form- dihydrotestosterone. The increasing production of androgens by enlarged testicles causes the development of secondary sexual characteristics (lowering and deepening of the voice, male-type hair growth on the face and body, the transformation of vellus hair into terminal hair, increased secretion of sweat and a change in its smell, an increase in the size of the penis, pigmentation and the development of skin folding scrotum, nipple pigmentation, formation of a male type of face and skeleton, increase in prostate size), regulates spermatogenesis and sexual behavior.

The ovaries produce two main hormones that have the greatest impact on the condition and functioning of the female reproductive system - estradiol and progesterone.

Estrogens are the general collective name for a subclass of steroid hormones produced mainly by the follicular apparatus of the ovaries in women. Estrogens are also produced in small quantities by the testicles in men and the adrenal cortex in both sexes. More than 30 types of estrogens have been isolated from various human biological fluids, three of which are considered the main ones: estrone (E 1), 17-β-estradiol (E 2) and estriol (E 3). Estradiol and some estrone are synthesized in the ovaries. Estrone and estriol are formed mainly in the liver from estradiol, as well as in other tissues from androgens, mainly from androstenedione. The synthesis of estrogen in follicles is regulated by FSH.

Signs of the onset of puberty

As mentioned above, puberty is initiated by the pulsed nature of LH-RH secretion. In boys, the first sign of the onset of puberty is enlargement of the testicles. The testicles in the period from 1 year to the onset of puberty almost do not change in size, length is 2-2.5 cm, volume< 4 мл. Через 6 лет после начала пубертата яички достигают объема 18-20 см 3 , однако нужно учитывать индивидуальные различия среди мужчин.

Testicles have two main functions: hormone production and sperm production, with the former starting earlier and stimulating the latter. Already a year after the onset of puberty, sperm can be detected in the morning urine of boys (spermaturia). The penis (penis) begins to grow shortly after the testicles begin to grow. As the penis grows, erections occur, followed by wet dreams. On average, boys reach potential fertility by the age of 13, and full fertility by 14-16 years.

Under the influence of androgens, the larynx grows, the vocal cords lengthen and thicken, which makes the voice deeper. A change in voice usually accompanies a growth spurt in the body.

Hair growth (adrenarche) begins from the pubis, shortly after the start of testicular growth. Appearing in small quantities at the base of the penis, the hair gradually becomes thicker and occupies the entire pubic triangle, after which it spreads to the thighs and along the linea alba to the navel. Then, after several months and even years, hair begins to grow in the armpits, near the anus, on the upper lip, near the ears, around the nipples and on the chin. The sequence and rate of hair growth is subject to individual differences. Throughout life, hair continues to grow and become thicker on the arms, legs, chest, stomach and back.

By the end of puberty, young men develop a male type of skeleton: a narrow pelvis and a relatively wide shoulder girdle.

The growth of mammary glands (thelarche) is the first sign of puberty in girls and is observed on average at the age of 10.5 years. First, a small, painful lump appears under the areola on one or both sides. After 6-12 months, compaction begins to be noted on both sides, it increases in size, becomes softer and extends beyond the areola. Within 2 years, the mammary glands reach a mature size and shape, and the nipples become clearly defined. The size and shape of the mammary glands in girls have pronounced individual differences.

Pubic hair appears a few months after the mammary glands begin to grow. In 15% of girls, this symptom appears first. At first these are single hairs on the labia, spreading to the pubis within 6-12 months. Subsequently, the hair grows and covers the entire pubic triangle. Under the influence of estrogens, the vaginal epithelium thickens and cells begin to actively exfoliate from its surface, and the vascularization of the vagina increases. Follicles begin to grow in the ovaries.

When conducting ultrasound examination During this period, you can see many small cysts - follicles. The first menstruation (menarche) usually occurs 2 years after the start of breast growth.

During puberty, under the influence of high levels of estrogen, the pelvic bones grow in width, as a result of which the hips become wider. Adipose tissue increases, and by the end of puberty the volume of adipose tissue in girls is twice that of boys. Fat is deposited mainly in the area of ​​the mammary glands, thighs, buttocks, shoulder girdle, and pubis.

Premature sexual development

PPD refers to the onset of puberty symptoms before the age of 8 years in girls and 9 years in boys. This pathology may be caused by a disorder in the gonadostatic system at various levels. Most authors adhere to the pathogenetic classification of PPR.

There are true, or cerebral, forms of the disease, the pathogenesis of which is associated with premature pulsed secretion of LH-RH by the hypothalamus. Increased synthesis of sex steroids in these cases is due to excess production of pituitary gonadotropic hormones. A feature of true PPD is that it occurs as isosexual, and the biological changes in the body correspond to the stages of normal sexual development, but at an accelerated pace. Excessive secretion of sex steroids increases the growth rate and promotes rapid closure of growth plates.

False (peripheral) forms of PPR, independent of the secretion of gonadotropins, are associated with premature excessive production of steroid hormones by tumors of the gonads and adrenal glands, with McCuen-Albright-Braitsev syndrome, testotoxicosis. In these cases, the sequence of stages of puberty is distorted. False forms of the disease can spontaneously transform into true ones, which is associated with secondary activation of the hypothalamic-pituitary axis.

A special group includes the so-called gonadotropin-independent forms of PPR, in which the autonomous activation of the gonads is caused by genetic disorders. These variants of PPR have all the signs of advanced puberty - enlargement of the gonads, accelerated growth and bone maturation, and the formation of secondary sexual characteristics.

There are patients with the only sign of premature puberty: isolated development of secondary hair growth (premature pubarche) and isolated development of the mammary glands (premature thelarche). These are incomplete forms of PPR.

True precocious puberty

The cause of true PPR can be various lesions of the central nervous system(CNS) of a non-tumor nature (organic, inflammatory, etc.), as well as exposure to adverse factors in the prenatal period (trauma, hypoxia, infections). These children are often diagnosed with hydrocephalic syndrome. The cause of PPR may be arachnoid cysts of the bottom of the 3rd ventricle and the chiasmal-sellar region of the brain. Cysts form during embryogenesis, less often as a result of meningitis, encephalitis, or brain injury.

In some patients with true PPR, the cause of the disease cannot be identified. In such cases, when organic diseases of the central nervous system are excluded, a diagnosis of the idiopathic form of PPR is made. However, the improvement of research methods (the use of computer and magnetic resonance imaging) of the brain makes it possible to more often identify the cause of the cerebral form of PPR.

The constitutional nature of PPD can be assumed if, when collecting an anamnesis, it turns out that in relatives puberty began 2-3 years earlier.

Modern examination methods allow early visualization of CNS tumors.

Hamartoma is one of the frequently detected tumor formations of the central nervous system in children with true PPR under the age of 3 years. Hypothalamic hamartoma is a benign tumor consisting of a cluster of differentiated nerve cells formed during embryogenesis. Essentially, it is a consequence of a malformation of nervous tissue. Lifetime diagnostics became possible only with the introduction of magnetic resonance imaging into practice.

The leading syndrome of hypothalamic hamartomas is PPR, this is due to the fact that the neurosecretory cells of hamartomas secrete LH-RH, which stimulates the formation of LH in the pituitary gland with subsequent excessive production of steroid hormones in the gonads. It should be noted that disruption of the migration of embryonic cells secreting LH-RH can lead to ectopia of these cells, i.e. they can be located outside the hypothalamus. It is believed that PPR in this case develops through the endogenous pulsatile release of LH-RH alone or together with LH-RH secreting neurons of the hypothalamus. It has been suggested that PPR may be caused by the indirect action of glial factors, including the transformation of growth factor alpha, which stimulates the secretion of GnRH in the hypothalamus. Removal of a hamartoma does not inhibit sexual development in all cases. In these patients, secondary activation of astroglial cells in the tissues surrounding the hypothalamus can cause increased secretion of LH-RH, thereby maintaining the clinical picture of PPR.

In children with hamartoma, the disease manifests itself as true PPR at an early age. The incidence of the disease is the same in boys and girls. Neurological symptoms may include minor epileptic seizures in the form of violent laughter, memory loss, and aggressiveness.

Most tumors of the chiasm and hypothalamus in children are poorly differentiated gliomas. In the suprasellar region, astrocytomas are more often detected.

Brainstem gliomas causing PPR are common in neurofibromatosis type 1 (Recklinghausen disease). This disease has an autosomal dominant mode of inheritance and occurs with a frequency of 1:3500 newborns.

Failure of the gene responsible for the synthesis of the neurofibromin protein causes rapid, uncontrolled cell growth. IN clinical picture characterized by pigment spots on the skin from light to dark brown. Neurofibromas are benign small neoplasms that are located on the skin, iris, and central nervous system. Multiple bone defects are characteristic. The pathognomonic symptom of this disease is the presence of pigment spots on the skin of a café-au-lait color larger than 0.5 cm. The pathogenesis of PPR in benign tumors and cysts of the central nervous system is not clear, but pubertal gonadostat indicators were detected in patients. The peculiarity of this process is that neurological symptoms (headaches, seizures, visual disturbances, and others) precede the symptoms of PPR.

Russell-Silver syndrome is characterized by a complex of hereditary abnormalities (presumably an autosomal recessive type of inheritance): intrauterine and postnatal growth retardation and disorders of skeletal formation. Frequency of occurrence: 1:30,000 population. Children are born of short length (up to 45 cm) and low body weight (1.5-2.5 kg) during full-term pregnancy. Over the years, growth retardation persists, and therefore the final height in women is less than 150 cm, in men - slightly above 150 cm. Body weight in adults is normal or even overweight. Anomalies of the external genitalia are common: cryptorchidism, hypospadias, hypoplasia of the penis, scrotum. Asymmetry of the body (face, torso, leg length) is characteristic. The face is triangular in shape, pseudohydrocephalus, large forehead and hypoplasia of the lower jaw, high palate, often with a cleft, protruding ears. Clinodactyly of the fifth finger due to deviation distal phalanx, narrow chest, short arms, lumbar lordosis. Anomalies in the structure of the urinary system are often observed. Intelligence is usually normal. Sexual development begins to progress at 5-6 years of age and is gonadotropin-dependent. Typical increased level LH and FSH against the background of hypoglycemia.

Tuberous sclerosis (Bourneville-Pringle syndrome) is one of the forms of phakomatosis and is characterized by congenital neuroectomesodermal dysplasia with the presence of benign tumors. Occurs with a frequency of 1:10,000 newborns, more often in boys. Presumably, the disease has an autosomal dominant mode of inheritance. Fibrous plaques are an obligate sign of this disease. In the brain, the size of these plaques varies from a few millimeters to several centimeters. They can be single or multiple. Depending on the location, plaques cause various clinical symptoms: headache, vomiting, decreased vision, epilepsy, convulsive paroxysms, hydrocephalus, signs of PPR.

True PPR may be caused by tumors that produce human choriogonic gonadotropin (hCG) (hCG-secreting tumors). These include germ cell tumors of the central nervous system, hepatoblastomas and other retroperitoneal tumors. Germ cell tumors develop from pluripotent germ cells. Many of these tumors can produce hCG during embryogenesis. In the process of disrupted migration, such cells can develop not only in the gonads, but also in other organs and tissues. Germ cell tumors account for 3-8% of all malignant neoplasms children's and adolescence. They are often combined with various genetic syndromes (Klinefelter syndrome, ataxia-telangiectasia, etc.).

Malignant germ cell tumors are 2-3 times more common in girls, and intracranial tumors are 2-3 times more common in boys. In the latter, PPR syndrome, associated with excessive secretion of hCG, is combined with symptoms of diabetes insipidus, increased intracranial pressure, narrowing of visual fields, hemiparesis, etc. Germ cell tumors localized in the brain are intensely vascularized and therefore are easily detected when computed tomography with contrast. In blood serum and cerebrospinal fluid increased levels of alpha-fetoprotein (AFP) and beta-hCG; testosterone levels correspond to puberty. An apparent increase in LH levels is detected (due to immunological cross-reactivity between hCG and LH). However, LH levels do not increase after GnRH stimulation. FSH levels are reduced.

Undescended testicles pose a risk of developing testicular tumors. In the clinical picture, attention should be paid to the volume of the testicles, which increase moderately and do not correspond to the signs of puberty. The reason for this phenomenon is that in children the gonadostat remains immature. Of two gonadotropic hormones (FSH and LH) tumor cells testicles produce LH, which hyperplasias Leydig cells. At the same time, Sertoli cells, which require the action of FSH, remain intact. In boys, PPD develops in an isosexual pattern.

Germ tumors are divided into those that secrete beta-hCG and those that do not. In the diagnosis of germ cell tumors, the determination of AFP and beta-hCG plays an important role. One of the markers of a malignant tumor process is cancer embryonic antigen (CEA).

Chemotherapy plays a leading role in the treatment of germ cell tumors. Radiation therapy has very limited use and is effective in treating ovarian dysgerminomas. Surgical treatment is aimed at removing the primary tumor.

Hepatoblastoma - malignant tumor liver, developing from an embryonic pluripotent anlage. The tumor is usually presented as a whitish-yellow nodule that grows into the liver tissue. Hepatoblastomas occur in children before the age of 3; after 5 years of age, this form of liver tumor is very rare. The exact causes of hepatoblastoma are not clear. Hepatoblastoma can be combined with other childhood tumors, for example, Wilms tumor (nephroblastoma). An increased risk of hepatoblastoma is observed in children who have had hepatitis B during the neonatal period, helminthic infestation, colon polyposis, metabolic disorders - hereditary tyrosinemia, glycogen storage disease type I, etc. In the initial period of development of hepatoblastoma there are no pronounced symptoms, progression is accompanied by symptoms of general intoxication and (rarely) symptoms of PPR due to hCG production by the tumor. Hepatoblastoma is a rapidly growing tumor with a high risk of hematogenous metastasis to the lungs, brain, bones and abdominal cavity. Treatment of hepatoblastoma is surgical, which consists of removing the tumor through partial hepatectomy. The survival prognosis for the 1st stage of the disease for 2.5 years is 90% or more, for the 4th stage it is less than 30%.

Gonadotropin-independent PPR

The clinical picture of McCune-Albright-Braitsev syndrome consists of the following symptoms: asymmetrical light brown skin pigmentation that resembles geographical map; polyostotic fibrous osteodysplasia; PPR and other endocrinopathies. The disease is described only in girls.

The causes of endocrine disorders in McCune-Albright-Braitsev syndrome are caused by mutations of the Gs-alpha protein. The mutant protein activates adenylate cyclase in the LH and FSH receptors on ovarian cells, thereby stimulating the secretion of estrogen in the absence of gonadotropic hormones. It is assumed that Gs-alpha mutations occur in the early stages of embryogenesis. As a result, clones of cells carrying mutant proteins are formed.

The first signs of the disease are associated with characteristic light brown pigment spots on the skin that are present in a newborn or appear during the first year of life.

Fibrocystic dysplasia manifests itself in the form of lesions of long tubular bones. The changed bones become deformed and pathological fractures occur.

PPR in McCune-Albright-Braitsev syndrome is more often detected after the first year of life and occurs in waves. As a rule, the first manifestation is uterine bleeding. They are detected long before the onset of thelarche and adrenarche. Uterine bleeding is caused by a short-term increase in estrogen levels. The ovaries are of normal size, but large persistent ones can be found in them. follicular cysts. Some patients have elevated levels of gonadotropic hormones. In such cases, we can talk about true PPR.

Other endocrine disorders include nodular euthyroid goiter, pituitary adenomas (Itsenko-Cushing syndrome, thyrotoxicosis and increased levels of other hormones).

Testosterone toxicosis is caused by excessive unregulated secretion of testosterone by hyperplastic Leydig cells. It is a familial, autosomal dominant disorder with incomplete penetrance that occurs in males. Excess testosterone production is caused by a point mutation in the LH receptor gene. Mutant genes cause intracellular activation of Leydig cell metabolism in the absence of LH.

Secondary sexual characteristics usually appear at 3-5 years of age, and the first symptoms of androgenization can be observed as early as 2 years of age. The timbre of the voice changes, a masculine physique, acne vulgaris, enlargement of the penis, erections are characteristic, the growth and maturation of the skeleton accelerates. The volume of the testicles is increased, but does not correspond to the degree of androgenization. The clinical picture of testotoxicosis is similar to true PPR.

When studying the gonadostat, high testosterone levels are detected with prepubertal LH and FSH levels. There is no reaction of LH and FSH to the test with luliberin (LH-RH), as well as pulsed spontaneous secretion of LH, characteristic of the puberty period.

A testicular biopsy reveals well-developed convoluted seminiferous tubules, an excess of mature Leydig cells, and germ cells at different stages of spermatogenesis. In some convoluted seminiferous tubules, degenerating germ cells are detected. In adults, the results of the GnRH test are normal; Some patients with damage to the spermatogenic epithelium have elevated FSH levels. In most men with familial testotoxicosis, fertility is not impaired.

Read the end of the article in the next issue.

V.V. Smirnov 1, Doctor of Medical Sciences, Professor
A. A. Nakula

GBOU VPO RNIMU im. N. I. Pirogova, Ministry of Health of the Russian Federation, Moscow

Today we will talk to you about puberty. For everyone who has children, this is a very important question. Puberty has its own characteristics that you need to know. If a teenager experiences delayed puberty, this may indicate serious abnormalities in the functioning of internal organs. Signs of premature development are also a reason to visit a doctor.

Greetings, dear readers! Svetlana Morozova is with you. Every organ and system in our body has a programmed growth rate. For example, in girls, abnormal hormonal levels may indicate, which you can read more about in the corresponding article.

Friends! I, Svetlana Morozova, invite you to mega useful and interesting webinars! Presenter: Andrey Eroshkin. Health restoration expert, registered dietitian.

Topics of upcoming webinars:

• How to lose weight without willpower and prevent the weight from coming back?
• How to become healthy again without pills, the natural way?

Despite the fact that the puberty period does not have a clearly defined time frame, doctors have roughly determined the years when this should occur. What they depend on and how puberty proceeds, I will tell you in my article.

The concept of “puberty”

This concept refers to a series of successive stages, as a result of which a teenager becomes an adult and capable of reproduction. Within the framework of the question, I will only talk about physical maturity, since moral and social maturity depends on many external factors, such as environment, upbringing and much more.

Regulation is carried out by the brain, which, through hormonal signals from the hypothalamus, triggers the final formation of the genital organs. In turn, the gonads begin to produce hormones that give signals to the brain itself, the skeletal and muscular systems, as well as reproductive organs, stimulating them to active development. This subtle relationship manifests itself outwardly in adolescence.

Maturation in boys and girls

From about 12-13 years old, boys and girls begin to develop differently. This applies not only to the genitals, but also to the entire body: bone structure, muscle mass, hair distribution, the formation of vocal differences, etc.

To visualize the differences in the evolution of the body of boys and girls, let's make the following table:

The smell also changes, because under the influence of hormonal changes the composition of sweat and urine becomes different. “Adult” discharge acquires a strong and characteristic aroma.

Interesting fact: when metabolized, male hormones turn into estrogens. The latter are responsible for closing growth areas. But boys synthesize estrogens slowly, so they lag behind girls in height.

However, due to the predominance of estrogen, girls stop growing faster and boys eventually overtake them in height and build. A tall teenage girl and a short boy change places at the end of puberty: he becomes tall, and she may remain significantly shorter than him.

Factors influencing puberty

The time of maturity is individual for each person. There are a number of factors that may influence the onset and course of puberty:

1. Genetics. In girls, in almost half of the recorded cases this period begins at the same age as their mothers.
2. Uncontrolled use of hormones with poor quality food products or cosmetics can lead to disruption of the proper production of their own hormones. Puberty may occur prematurely.
3. Nutrition. Overweight provokes early maturation, as adipose tissue produces estrogens. In addition, fat deposits on the lower body signal that the body is ready for pregnancy and the brain gives a signal for the onset of puberty.
4. Radiation. Moderate radiation leads to faster formation, while large doses of radiation, on the contrary, slow down this process.
5. Ecological imbalance. There are many chemical compounds that affect and delay growth.
6. Difference of races. Representatives of different nationalities reach maturity at different times.
7. Phys. loads in girls. For example, professional athletes and ballerinas who started training very early, from 4-5 years old, may approach menstruation later and even slow down breast growth. Physical development It helps, and it suppresses estrogen.

Unlike girls, in boys, playing sports, on the contrary, improves hormonal levels and leads to proper formation.

Puberty: Disorders

Delay

By delay it is meant that after 13 years, at the latest by the age of fifteen, the girl’s breasts have not begun to grow and there are no periods. Boys have “childish” testicles - just over two cm by the age of 15.

Reasons for delay:

1. The hypothalamic-pituitary part of the brain inhibits development. This may be functional or constitutional in nature. Reasons: , physical and mental fatigue, bad environment and bad food.
2. Tumors of the hypothalamus or pituitary gland, due to which little hormones are released.
3. Primary gonadal insufficiency. For example, for genetic reasons.

It is better to see a doctor and get examined.

Premature development

This is considered the beginning of puberty before the age of eight for a girl and nine for a boy. This can happen for a number of reasons, the main ones being:

1. Tumor, scars, organic disorders in the hypothalamus and pituitary gland. There are more gonadotropic hormones than necessary - as a result, the early evolution of the genital organs. This is called true precociousness. Usually, it corresponds to the gender of the child.
2. Tumors and sores of the adrenal cortex or gonads. Leads to an increase in the release of sex hormones without an increase in gonadotropin. This is called false precociousness. The gonads do not develop as expected. Girls may develop secondary sexual characteristics, not only female, but also male ( adrenogenital syndrome). For boys - only men's.

In both conditions, general symptoms may be present: the child gets tired quickly, complains of headaches, is prone to gluttony, eyeballs may twitch.

The external paradox is expressed in the fact that due to early development, growth zones also close earlier. The man remains short, no higher than one and a half meters.

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Useful warning

Puberty in children is influenced by many external factors. We must know how the body works in order to recognize pathology in it in time. And this is especially true for our excretory system, which is responsible for removing decay products, toxins and harmful substances from the body.

Early development, as well as delay, may indicate an imbalance created due to external reasons, poor nutrition and many other factors. In order to know what processes take place in us and how to make the excretory systems and kidneys function efficiently, I recommend everyone to visit our Online Healthy Body Academy . In it you will receive answers to the necessary questions and advice on maintaining the health of yourself and your children.

That's all for today.

Sluggish ejaculation is a problem that should not be left to chance. It is possible that problems with ejaculation arose under the influence of stress or severe fatigue, but the influence of factors such as inflammatory diseases or neurological ailments, which are highly desirable to cure, cannot be ruled out.

Contents [Show]

How does sluggish ejaculation manifest itself?

Prolonged ejaculation can manifest itself with various symptoms. With this disorder, the ejaculation reflex is involuntarily suppressed under the influence of physiological or psychological reasons. A man may feel that he cannot complete sexual intercourse, i.e. the ejaculation process does not occur. An erection in this case may be quite normal.

Other men may note that ejaculation occurs without delay, but the ejaculation itself is not the same as before: sperm may be released slowly and for quite a long time, and does not “shoot out”. This symptom may also indicate problems with ejaculation.

In general, difficult ejaculation in men is much less common than weak potency or accelerated ejaculation. At the same time, at least 75% of patients with delayed ejaculation can achieve it without problems during masturbation. But in some cases, ejaculation does not occur at all - this condition is called anejaculation. This is an extreme degree of delayed ejaculation, which requires consultation with a specialist.

Why does ejaculation delay occur?

Problems with ejaculation in men, in which ejaculation is too long, can be identified as follows:

1. No sexual contact for more than a week.
2. Active sports and low intake of water into the body.
3. Inflammatory processes of the prostate gland or decreased function of this organ. Most often, prostatitis leads to slower ejaculation.
4. Infections of the genitourinary tract.
5. Surgical interventions on the prostate, including resection of this organ.
6. Neurological ailments: spinal cord pathologies, diabetic neuropathy, etc.
7. Hormonal disorders, including hypothyroidism (lack of thyroid hormones) and hypogonadism (lack of testosterone).
8. Damage to the nerves that control the orgasm process.
9. Taking certain medications, mainly antidepressants or medications for hypertension, as well as diuretics.
10. Psychological problems: conflicts with a partner, lack of confidence in one’s “masculine” abilities, etc.

To accurately determine the cause of delayed ejaculation, a diagnosis should be made by taking a spermogram and undergoing an external examination. It is highly advisable to do this, because neglect of medical examinations and subsequent treatment can even lead to irreversible male infertility, especially in the presence of inflammatory processes in the pelvic area.

How to speed up ejaculation?

To speed up the onset of ejaculation, experts recommend using the following methods:

1. Treatment of inflammatory and other diseases if they cause sluggish ejaculation.
2. Increasing the duration of foreplay, i.e. preliminary intimate caresses, at the very beginning of intimacy. This will contribute to a stronger arousal of the man and, as a result, will reduce the time until ejaculation occurs.
3. Changing the technique during sexual intercourse. Thus, men are advised to refrain from inserting the penis into the vagina until they feel strong excitement– preferably before the feeling of impending ejaculation appears. It is at this moment that the penis should be inserted into the vagina - in this case, strong ejaculation will be practically guaranteed.
4. Using a technique such as abstaining from orgasm during the first 10 minutes of sexual intercourse. This seemingly paradoxical effect allows you to improve blood flow and speed up the onset of ejaculation later and make it more intense.
5. Stimulation during sexual intercourse simultaneously of the prostate and the frenulum of the penis. You can ask your partner to perform similar actions - in most cases this will speed up the onset of ejaculation.
6. If a man is used to achieving orgasm only through masturbation, then he will have to enlist the help of his partner. It is advisable to gradually get used to a new (and more natural) way of receiving pleasure. So, first you can try to achieve orgasm by self-stimulating the penis, then ask the woman to perform the necessary movements. Next time, you can start sexual intercourse by stimulating the penis with your hands, and finish it by inserting the penis into the vagina. Gradually a new conditioned reflex will be developed, and ejaculation will occur during the usual method of sexual intercourse.
7. Refusal to watch pornographic films and other similar products. Oddly enough, although watching the corresponding video leads to a quick readiness for sexual intercourse, it subsequently reduces arousal from the appearance and actions of the real partner, so in the end the effect is negative.

In addition, a man who wants to normalize the process of ejaculation should avoid alcohol abuse. It is known that alcoholic drinks only initially increase sexual desire, and achieving orgasm while intoxicated becomes quite difficult.

If, in addition to giving up bad habits, a man keeps his body in acceptable physical shape, eats well and tries to minimize the effects of stress, then sooner or later problems with ejaculation will become a thing of the past.

In the treatment of sluggish ejaculation, medications can also be used both to combat existing chronic diseases that caused this problem, and to normalize the ejaculation process.

If the cause of early ejaculation is psychological factors, then a man can be helped by a drug such as Generic Dapoxetine. This remedy strengthens erection, ensures its sufficient duration, promotes faster recovery male body after intimacy.

In addition, the use of the drug relieves a man of nervousness and increases his confidence in his abilities, which is important for normalizing the duration of sexual intercourse.

Therefore, Dapoxetine can be used both for early ejaculation and for insufficient ejaculation due to low potency. You can buy Dapoxetine on this website, getting the desired result at an affordable price.

If you combine taking the drug with the treatment of existing diseases, take care of yourself and avoid various harmful factors, you can successfully solve problems with ejaculation and enjoy full-fledged intimate relationships. An integrated approach to eliminating sexual dysfunction will allow a man to restore his previous abilities within a fairly short period of time.

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How to speed up ejaculation? Give me some advice, because nothing works

Concomitant diseases such as diabetes, spinal and sacral injuries, prostate diseases, or painful sensations in the urethral area. In most men, an implicit delay in ejaculation is nevertheless caused not by physiological, but by psychological reasons. The first and main thing is stress. A man who is always worried and in constant doubt constantly keeps the muscles of the perineum under control, thus preventing himself from relaxing and freeing himself from nervous tension. At the same time, anxious men are conventionally divided into two categories. The first is those who have just begun sexual activity and, due to upbringing (or other reasons), are paralyzed by guilt and fear. The second category includes older men who, due to circumstances, are accustomed to keeping all emotions under control, or who are too casual about sex and need stronger stimulation. In addition to physiological and psychological reasons, the following can interfere with ejaculation: taking certain medications, including a number of antidepressants; chronic alcoholism and excessive alcohol consumption in episodic cases; sexual fatigue associated with an overly active sex life, or due to distractions during sex; physiological incompatibility: for example, the partner’s vagina is too wide for a man’s small penis, which reduces mechanical stimulation during friction.
A man suffering from delayed ejaculation needs stronger stimulation and increased eroticism with foreplay. A woman should delay sexual intercourse, engaging in lovemaking until her partner is on the verge of orgasm, and only then can she allow him to insert his penis into the vagina. For the most intense stimulation, some couples are advised to switch to the “woman on top” position, when the partner is on her knees with her legs spread to the sides. In this position, a woman can increase stimulation by performing thrusting movements on the penis. You can alternate oral sex with attempts at vaginal sex to increase arousal. Or vaginal sex with mutual masturbation. A partner can help a man relax by simultaneously stimulating the frenulum and prostate. And finally, sexologists recommend this non-trivial method: a man should set a goal to abstain from orgasm for 10 minutes of sexual intercourse. Often this paradoxical technique helps to speed up the onset of ejaculation before the scheduled date.

Big dick: to be or not to be

What is the most important organ in men? Right! Who said "heart"? The security officers have a warm heart and cold hands, and what makes a man a man is his dignity. There is no other organ in the male body that evokes so much emotion and conversation.

Great Chinese sex

Most people in China are completely satisfied with their sex lives. The views of modern Chinese on sex are explained by the peculiarities of Chinese culture. The spiritual leader of the Celestial Empire, Confucius, said: “Love is the beginning and the end of our existence. Without love there is no life."

Devil Deflorator

The devil is an ancient ritual deflorator in an animal mask, which until recently performed its functions during the Sabbaths. According to Margaret Murray, the devil is a horned deity of the Paleolithic era, against whom the church waged a bitter struggle from the 13th to the 17th centuries.

Late sexual life of men

The findings of various sociosexological studies indicate that the vast majority of men begin sexual activity before the age of 21. This statistical pattern has been noted in the past, which may be why parents become concerned when their son turns 20 and has not yet crossed the sexual Rubicon.

Tricks during and before orgasm

Caresses during orgasm do not increase the intensity of arousal if they do not involve pain nerves in the game. Muscular squeezing, pinching, patting, biting excite the same type of nerves as the nerves that cause orgasm. This increases the sexual excitement. However, no rudeness should be allowed.

Sexual infidelity gene found in women

The French have a saying: you can find a woman who has never had a lover; but it is impossible to find a woman who has had only one lover. In this regard, I don’t even want to think about the outburst of righteous feminist anger that will be caused by the report of a study by a group of British scientists led by Robin Baker, which proved that almost one hundred percent of women (100%) are unfaithful to their legal husbands.

Threesome love

According to various sources, from three to 15 percent of married couples have tried a threesome at least once. Among non-married couples, this percentage is at least twice as high. Threesome sex is a far from clear-cut topic. Even those who believe that there are no prohibitions in sex for them have very different attitudes towards this type of bed fun. Someone is sure that sex is a matter of two and only two, and everything that goes beyond this framework is dirty and immoral.

How to learn to kiss

All over the world, when people find themselves in a romantic situation, they feel an unconscious need to kiss. This is one of the most useful discoveries I made during my research career. It seems that representatives of the opposite sex are programmed to kiss and are just waiting for this.

A man who “doesn’t want” and who “can’t”

A person's sex life depends on many factors. In order for a man’s sex life to be normal, it is required that he have a desire to enter into intimate relationships (sexual desire) and the ability to do so (sufficient erection and the ability to make frictional movements in the vagina for a certain time without ejaculation), that is, normal potency.

Sexual harmony

What should those who are dissatisfied with their intimate life and want to change it do? At the very first stage - learn to find mutual understanding with your partner (partner) and not be afraid to tell him (her) what you want, master sexual literacy, and then “aerobatics”, search, experiment and most importantly: do not forget that sex is communication between two equal partners, and not just a search for one’s own pleasure.

Rules of oriental sex

As you know, sex begins with the head. The sexual culture of the East is based on principles other than European ones. This is, for example, the cult of the naked body, admiration for sensual pleasure. Everyone knows that in countries such as Japan, China, India, Nepal, sexuality is viewed not so much as an art, but as a science.

Vaginismus: when a woman cannot

If sexual disorders in men are very diverse, then in women everything is simpler. Basically, the weaker sex faces three problems. This is pain during sexual intercourse, lack of sexual desire and difficulty with orgasm and the onset of arousal. Men believe that they are much more vulnerable sexually.

Habits will tell you about erogenous zones

At the dawn of its development, sexology “professed” an extremely mechanistic approach, attaching decisive importance to erogenous zones. No one has “canceled” them; they really exist in women and men. They are very individual. How to “calculate” them? The fact is that if a woman constantly licks her lips, touches them with her fingers or bites a pen, this indicates the sensitivity of the so-called oral zone.

Sexual pretense

Sexual pretense is deceiving one's partner by acting out sexual reactions or one's own satisfaction. In some cases, pretense may be the best way out, allowing a person to spare the feelings of a partner; however, once it becomes commonplace, it can cause many problems. A woman who fakes an orgasm undermines communication with her partner rather than supporting him.

Intimate massage

Both men and women can experience pleasure in different ways. But if you really want to take your partner to the pinnacle of bliss, you should learn how to give him an intimate massage - as, in principle, he can give you an intimate massage. After all, it is these games, alternating with gentle stroking, that give us no less pleasure than making love.

About masturbation

Masturbation can be defined as a way of providing sexual pleasure to oneself through one form or another. physical stimulation. Most often, masturbation is performed by rubbing, stroking, squeezing or otherwise affecting the genitals; however, it can also be produced by self-stimulation of other parts of the body - breasts, inner thighs or anus.

What happens to our body during physical love

In the physiology of sexual intercourse, the excretory system, blood circulation, muscles and nervous system play an important role. During sexual intercourse, the functioning of a number of glands becomes more intense. If the discharge that follows the satisfaction of the instinct is too late, salivation decreases.

Fashionable kisses: world practice

As happens in high fashion, some kisses become popular for a while, and then they are replaced by others. Take lip-sucking kissing, for example: it was described 2,000 years ago in the Indian love manual, the Kama Sutra. Then it was temporarily forgotten, and now, with the development of mass communications, the creation of cinema and television, kisses of this type have become especially popular.

Natural aphrodisiacs

As soon as they are not called: this is “stimulating food, the name of which comes from the name of the Greek goddess of love Aphrodite”, and “substances and products that stimulate sexual instincts”, and “substances that can enhance sexual energy, sensuality”, “stimulants sexual desire”, etc., etc.

Sexual incompatibility is not a reason for divorce

There is an opinion that divorce is like a tsunami, for which no one is to blame, it just “happened that way.” In fact, like any disaster, it has its cause. Its name is “sexual incompatibility.”

Delayed ejaculation– this is a serious violation of male sexual function, which is expressed in difficulty in ejaculation. Some men need prolonged sexual stimulation in order to achieve ejaculation; for others, even this does not bring the desired result.

All men are concerned about not only the size of the penis, but also the ability to satisfy a woman, giving her maximum pleasure. Problem with ejaculation in men may be temporary and occur due to constant stress or chronic diseases.

But in case slower ejaculation becomes a permanent cause, you should definitely consult a doctor, as it may indicate serious disorders in the male body. But despite this, ejaculation problem is not a disease. With the help of special techniques, exercises and medications, you can completely control suppression of ejaculation.

What is delayed ejaculation?

In order to understand how to delay ejaculation, you need to know exactly what this problem is that prevents men from achieving full sexual satisfaction. In medicine, it is also called anejaculation.

The ejaculation process itself consists of several stages:

1. Increasing sexual arousal.
2. Increased excitement.
3. Ejaculation.

Long ejaculation is accompanied by the necessary level of sexual arousal and a full erection, but the release of seminal fluid does not occur for a long time after the start of sexual intercourse. Accordingly, as a result of this, serious problems arise with achieving orgasm, which introduces a serious imbalance in the intimate relationship of the couple.

Premature ejaculation is considered an equally common problem among representatives of the stronger half. Ejaculation inhibition recommended if the duration of sexual intercourse is less than 4–6 minutes. Such a short sexual contact will not bring the desired satisfaction to either the man or his partner.

Delayed ejaculation It is diagnosed if the duration of sex increases to 30–60 minutes and even after that the man does not ejaculate. In order to find out how to delay ejaculation, what Taking medications will require the help of a specialist - a sexologist, andrologist, psychotherapist, endocrinologist, neurologist.

Many men have the completely opposite problem associated with premature ejaculation. As a rule, this happens a few minutes after the start of sexual intercourse. That is why the question often arises - how to delay ejaculation?

Classification of delayed ejaculation

Approximately 82% of men ejaculation problems do not prevent them from achieving orgasm - but most often this happens during oral sex, manual stimulation of the penis. The remaining 18% of men are unable to achieve orgasm under any circumstances despite all their efforts.

In such cases, before how to delay ejaculation, you should definitely seek help from a doctor. Under no circumstances should you self-medicate or use any methods or medications on your own.

For men interested how to speed up ejaculation, you need to know that there are several varieties of this condition. The following types are distinguished according to severity:

• relative anejaculation – a man cannot achieve orgasm during classic sex, only through oral sex or petting;
• complete anejaculation is the most severe form of pathology, in which, in any case, a man fails to achieve orgasm during any type of sex.

Depending on when and how they arose problems with ejaculation, the following varieties are distinguished:

• primary form - the problem continues from the very beginning of sexual relations;
• secondary form - delayed ejaculation occurred some time after the start of sexual life.

Based on the frequency of manifestations of this problem, there are permanent and situational delayed ejaculation. With a permanent form of pathology, problems with orgasm occur extremely often and deprive a man of confidence in his sexual abilities. The situational type of delay appears only sometimes, depending on certain circumstances - against the background of frequent stress, chronic fatigue, and various diseases.

Disadvantages of long-term sexual intercourse

Long lasting ejaculation, how to speed up this process - such questions often arise for men. But in some cases, long-term sex can only be beneficial. Many women do not have time to receive full sexual pleasure during intercourse, which lasts 5–7 minutes. With prolonged sex, which lasts more than half an hour, a woman can experience orgasm several times.

But for most women, sex for 10–15 minutes is enough to experience orgasm, possibly multiple times. The duration of sexual intercourse for 30–60 minutes leads to the fact that both the woman and the man are completely exhausted, and they have no opportunity to complete the sexual act.

In addition, it should be understood that difficulty ejaculating very often becomes the cause of serious problems that arise for married couples who dream of having children.

Symptoms of delayed ejaculation

In order to find out how to control ejaculation, it is necessary to know exactly all the manifestations of this pathology. The main symptom of the problem is considered long ejaculation. If sexual intercourse lasts more than 30–50 minutes, this indicates serious problems with male sexual function.

How to induce ejaculation? This question arises for every man who, even after prolonged sexual contact, still does not ejaculate. If it does occur, the volume of sperm released is significantly less than usual.

At the same time, more than half of men can still achieve orgasm during masturbation, and a little less often - when stimulating the penis of their partner. If your partner has delayed ejaculation, methods the treatments for which can be very diverse, this brings serious discomfort to the intimate life of the couple.

Delayed ejaculation, causes which can have both psychological and physical character, in the vast majority of cases, makes a woman doubt her attractiveness. She is sure that if a man cannot get full pleasure from a sexual act, the whole reason lies precisely in her - that is, in the complete absence of her attractiveness to her partner. Accordingly, this introduces a serious imbalance in the life of the couple.

Causes of delayed ejaculation

how to achieve ejaculation, you need to know exactly what reason triggered the development of the problem. Doctors conditionally divide all factors that provoke the development of problems with timely ejaculation into two groups:

1. Physiological.
2. Psychological.

In most cases problems with ejaculation associated with the presence of chronic or infectious diseases, as well as various pathologies in the male body.

In some cases, in order to find out how control ejaculation, it is necessary to take into account the psychological factor. Frequent stress, problems at work and in personal life lead to a person literally completely losing his sexual abilities.

The reasons for the development of delayed ejaculation can also include frequent consumption of alcoholic beverages, as well as certain medications. Quite often, the development of a problem is observed due to a combination of several factors, and therefore, in order to determine the root cause of the pathology, it is imperative to seek help from a doctor.

Physiological reasons

Before how to learn to control ejaculation, it is necessary to take into account all factors of physiological origin. They can be associated with various pathological changes in the body, diseases and other disorders.

The main physiological reasons:

• congenital pathologies of the male reproductive system;
• inflammatory process in the prostate gland;
• any damage nerve endings in the pelvis;
• diseases of the cardiovascular system;
• infectious processes in the body;
• pathologies of the urinary tract;
• disturbances in the hormonal system;
• surgical interventions performed on the internal or external genital organs;
• neurological pathologies – stroke, sclerosis;
• spinal cord pathologies.

In some cases, the main factor provoking the issue is how to control ejaculation, factors of physiological imbalance of partners act. For example, the reason may lie in a man’s penis being too small or a girl’s vagina being too large.

Psychological reasons

In order to find out how to delay ejaculation It is imperative to take into account the psychological state of the man. In most cases, the main psychological factors include the following:

• depression, increased nervousness;
• lack of confidence in one's masculine abilities;
• problems in personal life;
• frequent stressful situations, problems at work;
• insufficient or incorrect sex education, religiosity;
• dissatisfaction with the appearance of the partner.

Some men are accustomed to frequent masturbation, during which they receive a bright, intense orgasm. This leads to the fact that during regular sex they cannot be fully satisfied.

Medicines and drugs

When contacting a doctor with a question, how to speed up male urination, you must inform him about all medications you are taking. In some cases, they can provoke serious problems in a man’s sexual life:

• diuretics;
• antidepressants;
• antihypertensive drugs;
• preparations containing alcohol;
• psychotropic medications.

In addition, alcoholic beverages and drugs consumed before sex have a huge impact on the control of ejaculation. The age of a person is also important. The older a man is, the more difficult it is for him to achieve orgasm.

Diagnosis of delayed ejaculation

In order to find out how to speed up ejaculation, you need to consult a doctor - a urologist or andrologist. He will conduct a full examination of the body and prescribe everything necessary tests and laboratory tests. This will help determine the root cause of the problem, as well as select the optimal treatment method.

Basic diagnostic methods:

1. Visual inspection and palpation of the patient's genital organs.
2. Analysis of urine.
3. Blood test to determine testosterone.
4. Laboratory testing of hormone levels.
5. Ultrasound of the pelvic organs.

To answer the question, Is it harmful for a man to hold back his ejaculation?, in some cases, additional consultation with a psychotherapist or sex therapist may be necessary.

Treatment for delayed ejaculation

If a man is worried delayed ejaculation, treatment prescribed only by the attending physician. The specific method of therapy depends on the cause of sexual dysfunction.

If there is an addiction to alcohol or drugs, a special rehabilitation course is prescribed, aimed at eliminating this type of addiction. Frequent stress and depressive states are treated with sedative medications, and sometimes antidepressants are also used.

If problems in a man’s sexual life are caused by taking certain medications, the doctor must stop them or prescribe other medications with a similar effect.

Drugs that accelerate ejaculation prescribed exclusively by the attending physician. Under no circumstances should you take any medications on your own, as the consequences of self-medication can be the most dangerous for the male body.

Medication and procedures

Problems with ejaculation in men caused by physiological factors are treated with medications. The main goal of therapy is to eliminate the root cause of the pathology.

Pharmacology offers:

• cyproheptadine;
• amantadine;
• yohimbine;
• buspirone.

Physiotherapeutic procedures, which significantly enhance the effectiveness of medications, will be an effective addition to drug therapy. All procedures can be divided into two main groups – calming and stimulating.

Calming physiotherapy:

• electrosleep;
• color radiation treatment;
• acupuncture;
• electroacupuncture;
• pine baths.

Stimulating physiotherapeutic procedures have an activating effect on the condition of the male reproductive system. The main methods of stimulating nature include:

• ultrasound therapy;
• electrical stimulation;
• laser puncture;
• galvanization;
• electrophoresis.

In addition, the patient is recommended to completely abandon bad habits and lead a healthy, active lifestyle. Difficulty ejaculation - who treated it with what? and which methods were most effective? This question quite naturally arises for every representative of the stronger sex who is faced with a similar problem. But only a doctor can answer this, and he will select the optimal treatment method.

Psychotherapy

If the cause of problems in a man’s sexual life lies in psychological factors, psychotherapy becomes a mandatory element of treatment. The patient is recommended to have regular consultations with a psychotherapist. At the same time, to achieve the most effective result, it is best for a man to attend psychotherapy sessions together with his woman.

The help of a sex therapist can be invaluable. A specialist will help you decide sexual problems and improve the couple’s intimate life. Consultations should be regular. The doctor will recommend special exercises to control ejaculation that will help a man improve the quality of his intimate life.

Prevention of delayed ejaculation

In order to prevent the development of problems in the sexual life of partners, you need to be extremely careful about your lifestyle. Ejaculation control requires a person to completely abandon any bad habits - smoking, drug use and alcoholic beverages.

Good sleep and rest are very important. Even with maximum workload, you need to sleep at least 7–9 hours a day. This will help the male body fully recover and gain strength.

It is recommended to regularly engage in your favorite sport, take walks in the fresh air, and eat right. A man's diet should consist of a large amount of fresh fruits, berries, vegetables, seafood, nuts and dried fruits. Such products have an effective effect on the male reproductive system and normalize its functioning.

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What is delayed ejaculation and anejaculation?

Difficulty in ejaculation is an involuntary suppression of the ejaculation reflex. We can talk about delayed ejaculation, “when it is impossible to finish,” in cases where ejaculation occurs only after a very long period from the beginning of sexual intercourse, despite the desire to speed it up. This period can last for an hour or more. Throughout this time, the erection may be completely normal or its intensity may fluctuate slightly. A man can experience sexual arousal and have a full erection, but stimulation of the penis does not lead to ejaculation. Delayed ejaculation is much less common than accelerated ejaculation. The disorder may be permanent or may occur from time to time. Delayed ejaculation occurs in 2 out of 1000 men. Moreover, about 75% of men with delayed ejaculation can achieve it through masturbation. It is necessary to distinguish normal delayed ejaculation from pathological one. In the first case, this disorder is a consequence of characteristics inherited from the parents that manifest themselves during the normal process of puberty. Pathophysiological factors include injuries, diseases, surgical interventions, hormonal disorders, the use of certain medications that affected the normal process of zyakulation. Anejaculation is an extreme form of delayed ejaculation, in which the latter does not occur for such a long time that the patient and his partner stop sexual intercourse. All variants of ejaculation disorders can be divided into two categories:

1. absolute inability to achieve ejaculation
2. relative anejaculation, when ejaculation is absent during sexual intercourse, but is present during masturbation during petting or during sleep.

What reasons influence delayed ejaculation?

1. Psychogenic causes - delayed ejaculation caused by psychological disorders. One of the most common reasons for prolongation of sexual intercourse in a man is the formation of an inadequate erotic stereotype, which does not coincide with the sensations characteristic of sexual intercourse. In some cases, with high sexual excitability, the method of masturbation was formed as a result of receiving a release from random mechanical or emotional influences not related to the genitals. Subsequently, there is a desire to repeat the orgasm from this stimulus and the formation of dependence on it. Conventional intimate relationships could not provide the desired scenario needed to achieve ejaculation. On the contrary, with reduced excitability of the ejaculatory center, masturbation was carried out against the background of the need to further increase stimulation. With the onset of sexual activity, it turned out that the mechanical effect on the genitals during intimacy was “too weak.” As a result, arousal did not increase to the level necessary to obtain sexual release. However, sexual fantasies that include desired actions can cause ejaculation without any problems.
2. Nutritional reasons - alcohol abuse. At chronic alcoholism there is a decrease in the excitability of the ejaculation center in the lumbar spinal cord. In chronic alcoholics, functional factors associated with marital conflicts and suspicions of the wife of infidelity may be superimposed on organic causes.
3. Malformations of the bladder neck - Müllerian cyst, Wolffian duct anomalies.
4. Iatrogenic: caused by organ dysfunction after surgery on the prostate or bladder and caused by postoperative neurological problems - proctocolectomy, aneurysmectomy abdominal region, aortic lymphadenectomy.
5. Neurogenic causes - diabetic neuropathy, Parkinson's disease, multiple sclerosis, spinal cord injury.
6. Infectious causes - urethritis, tuberculosis of the genitourinary system.
7. Endocrine causes - hypogonadism, hypothyroidism.
8. Medicinal causes - taking diuretics, antidepressants and serotonin reuptake inhibitors.

What are the psychogenic causes of delayed ejaculation?

A common psychological reason is the unconscious suppression of ejaculation by the man himself, when he fears the woman is pregnant or when he considers sex a “dirty and shameful” activity. In some cases, there may be a fear of not satisfying a woman, an unconscious fear of “sexual insufficiency,” which leads to an involuntary prolongation of intimacy until ejaculation disappears. For some men, moral and ethical considerations may influence the duration of sexual intercourse. The reason for the delay may also be the insufficient erotic attractiveness of the partner, to whom the man does not experience pronounced sexual attraction, or imbalances in the structure of the genital organs (the vagina is too wide compared to the size of the penis), which reduces mechanical stimulation during frictions. Delayed ejaculation is also noted as a consequence of fairly deep conflicts associated with the partner’s personality (for example, sexual trauma, which is a specific inhibitor and is associated with the real or perceived infidelity of the partner), as well as in the presence of deviant inclinations, for example, homosexual, sadistic, masochistic, etc. ., which are also a specific brake. In addition, there is the concept of “autosexual” orientation, when a man with delayed ejaculation notes much more pronounced arousal and satisfaction from masturbation than during normal sexual intercourse. The most common form (about two-thirds of all cases) is primary ejaculatory failure, in which the patient has never been able to ejaculate into the vagina. Secondary failure is called in cases where a man who previously ejaculated normally loses the ability to ejaculate intravaginally or achieves this extremely rarely. In both cases, ejaculation can usually be induced through masturbation (in about 85% of our patients) or stimulation from a partner (in about 50% of our patients), but outside of sexual intercourse.

What is the diagnosis of this pathology?

The task of diagnosis is to identify possible physiological and psychological causes of the disease. Anamnesis, especially medical history, the fact of admission is of leading importance. pharmacological drugs, as well as examination data of the external genitalia. In the absence of obvious causes, a thorough psychosexual examination is indicated.

Hospital Anxiety and Depression Scale (HADS)

This questionnaire is designed to help your doctor understand how you are feeling. Consider each statement carefully and in the right column, select the answer that most closely matches how you felt last week. Circle the number corresponding to the answer you chose (ignore the meaning of these numbers). Don't think too long about each statement, as your first reaction will always be more correct. Each statement corresponds to 4 answer options, reflecting gradations of symptom severity and coded according to the increasing severity of the symptom from 0 (absence) to 3 (maximum severity). The total score is calculated separately for the anxiety subscale and for the depression subscale. Odd-numbered items (1,3,5,7,9,11 and 13) constitute the anxiety subscale, even-numbered items (2,4,6,8,10,12,14) constitute the depression subscale. Fill out the questionnaire, calculate the score and bring it to the doctor.

Age-related androgen deficiency assessment scale.

Fill out the scale, count the points and bring it with you to your doctor's appointment.

What is the treatment for delayed ejaculation?

It is carried out on the basis of the reasons that influenced this violation. Here it is important to distinguish a clearly defined sexual disorder from episodes that occur from time to time, when a man is unable to achieve intravaginal ejaculation or when he needs prolonged sexual intercourse and long frictions for it to occur. Occasional difficulties with ejaculation are not a sign of sexual dysfunction and are often caused by fatigue, tension, ill health, too frequent intercourse, or exposure to alcohol or medications. In addition, a man may be unable to ejaculate if he has no special feelings for his partner (for example, if he performs sexual intercourse simply because he feels it is expected of him).

1. Sexual education includes clarification of the characteristics of orgasmic function, ridding the patient of existing myths, teaching stimulating techniques, trigger moments of orgasm. Treatment is aimed at eliminating ejaculation problems and is designed to help the couple adapt their behavior to existing difficulties. Success here depends, first of all, on the partner’s willingness to cooperate, on her ability to rebuild intimate relationships in such a way as to eliminate or compensate for factors that impede ejaculation.
2. Reducing the effect of expecting failure is achieved by prohibiting ejaculation during masturbation; sexual activity should only be with a sexual partner.
3. The patient should be focused on genital stimulation and, if possible, enhance it.
4. Sometimes it is recommended to resort to anal stimulation; such patients often benefit from prostate massage.
5. For emotional disorders, drug and physiotherapeutic therapy is carried out.
6. Neurological disorders are successfully corrected by electrical stimulation.
7. Psychogenic disorders are eliminated with the involvement of a partner. Treatment of incompetent ejaculation is based on an in-depth analysis of the underlying psychological factors in combination with exercises to focus sensation.

What is the sex technique for delayed ejaculation?

It consists of several successive stages:

• ejaculation caused by masturbation alone;
• ejaculation caused by masturbation in the presence of a partner;
• ejaculation caused by manual stimulation from the partner;
• vigorous stimulation of the penis by the partner, carried out until ejaculation is inevitable, and then rapid insertion of the penis into the vagina.

In most cases, after a man has ejaculated into the vagina once or twice, the suppression of this act or the fear associated with it completely disappears. In some cases, if these procedures fail, ejaculation (induced by manual stimulation) on the woman's vulva may help. After a man gets used to the sight of his sperm on his partner’s vulva, he can perform intravaginal ejaculation much more easily.

What drugs are used for delayed ejaculation?

The basis of drug therapy for delayed ejaculation is the effect on the central dopaminergic and antiserotonergic mechanisms.

• Dopaminergic drugs are used for delayed ejaculation caused by taking antidepressants.
• Dopamine reuptake inhibitors are effective in 66% of antidepressant-induced withdrawal cases.
• drugs alpha-2 antagonists, alpha-1 agonists, blockers calcium channels(achiv with yohimbe), used to prevent delayed ejaculation 1.5 hours before sexual intercourse in cases of clomipramine-induced anorgasmia.
• 5-HT1A receptor agonists eliminate slow ejaculation in 8 out of 10 patients, if this disorder is caused by anxiety disorders.
• antagonists of 5-H serotonin receptors may be recommended for continuous or intermittent use.

What physiotherapeutic techniques are used for delayed ejaculation?

Sedative methods:

• Therapy using special artificial color emitters acting directly through the eyes is called the visual color stimulation method. In this case, a complex effect of four factors is carried out: color, rhythm, modulation of light signals and the level of illumination of the light field. The human eye serves as a receiver for drug-free and non-invasive correction of the regulatory structures of the brain (hypothalamus, pineal gland, pituitary gland), and through them the neuroendocrine, immune and other systems.
• Electrosleep therapy. It has a sedative effect due to inhibition of the activity of the reticular formation and activation of serotonergic neurons. Transcranial electrical stimulation operates on the same principle.
• To eliminate pathological dominant relationships in the central nervous system, it is necessary to create a new, stronger focus of excitation, i.e. new dominant. Most effective method is galvanization of the reflex collar zone according to Shcherbak. It is possible to use electrophoresis with vitamins and other medicinal substances using the orbital or endonasal technique.
• It is advisable to influence physical factors to reflex zones. Laser puncture or electroacupuncture is performed. In acupuncture, the first stage is 1-3 courses of 10-12 procedures for 60 minutes (inhibitory method) - general strengthening, relieving neurosis. The second stage is 1-2 courses of acupuncture on local points for 5 minutes (exciting method), and on general points (inhibitory method) 60 minutes.
• Baths. The aromatic substances contained in pine baths have a sedative effect by influencing the olfactory nerve. Iodine and bromine, capable of penetrating the blood-brain barrier, have a sedative and tranquilizing effect directly at the level of the central parts of the nervous system.

Trophostimulating methods:

• SMT on the reflexogenic zones of the spinal centers of erection and ejaculation. Taking into account the leading role of disorders of the neuro-reflex centers of the spinal cord, the effect is carried out at the level of the SI-SV segments, which ensures activation of blood circulation in this area and an increase in efferent and autonomic impulses in response to the involvement of sensitive conductors.
• Rectal electrical stimulation. A special electrode is inserted into the rectum and anal stimulation is performed. The mechanism of therapeutic action consists of:
  • - emptying the prostate of stagnant secretions and its decay products;
  • - improving lymph and blood circulation in this organ;
  • - increasing the tone of muscle tissue;
  • - stimulation of metabolic processes.
• Ultrasound therapy. Ultrasound has a trophic, anti-inflammatory effect by stimulating reparative regeneration, activating microcirculation in the area of ​​influence and increasing the activity of cellular lysosomal enzymes. They act on the sacral spinal segments in a continuous manner.
• Galvanization of the panty area is used to improve the trophism of the spinal segments and restore damaged neuro-reflex connections.
• Peloid therapy. The use of mud applications on the panty area causes local hyperemia and stimulates repair processes. Irritation of skin thermomechanoreceptors causes the formation of reflex reactions in the segmental and subcortical structures of the brain, which are closed on the effectors corresponding to the reflex zone. A combination with treatment with rectal mud tampons is possible.
• Ultratone therapy. The effect is applied to the spine and perineum, moving the electrode with longitudinal and circular movements along the spine D8-L2, then along the perineum and along the inner perineum of the two third thighs.

What problems arise in a married couple when ejaculation is delayed?

Delayed ejaculation in normal marital relationships may initially even favor the achievement of sexual satisfaction in the wife, who, with prolonged sexual intercourse, can experience orgasm several times. Failure to ejaculate can be a source of sexual pleasure because it makes prolonged sexual intercourse possible. Some patients report that they are able to maintain an erection for 1-2 hours to the great satisfaction of their partners, many of whom admire it. However, when a woman discovers that her partner is incapable of intravaginal ejaculation (complete intercourse in the vagina), her reaction often changes. The relationship becomes burdensome for both the woman and the man, despite the man's desire, they cannot achieve orgasm in certain time. The circumstances are even worse in conflictual relationships between spouses, when they no longer attract each other erotically. She begins to feel that her partner does not find her attractive enough, that he does not get pleasure, or that he is “delaying” the onset of orgasm out of selfishness. If sexual partners want to have children, then failure to ejaculate can cause even greater distress and even mutual accusations and quarrels that can destroy the most beautiful relationships. The situation can become dramatic when a woman experiences sexual indifference to a man, and instead of sexual pleasure, she develops an aversion to sexual intercourse with him. If a woman, at the insistence of her partner, is forced to have intercourse with him, then it is difficult for her to endure intercourse for too long, and she usually shows impatience about this. This causes subsequent conflicts and further delays the onset of ejaculation. Thus, a vicious circle is created, which worsens both life together, and a condition associated with delayed ejaculation.

What is retrograde ejaculation?

This ejaculation disorder is characterized by the release of seminal fluid into the bladder. The diagnosis of retrograde ejaculation is established when sperm are detected during a urine test after sexual intercourse.

What are the reasons for the lack of ejaculation after sexual intercourse?

• congenital malformations of the posterior urethra and bladder neck, urethral valves, congenital anomalies of the bladder triangle, bladder exstrophy.
• acquired disorders of the normal structure: urethral strictures, sclerosis of the bladder neck.
• Iatrogenic disorders: transurethral resection of the prostate, bladder neck incision, transvesical adenomectomy, sympathectomy, colorectal or anal surgery.
• neurological causes: spinal cord injury, multiple sclerosis, diabetic neuropathy.
• pharmacological causes: antihypertensive drugs, alpha blockers, antipsychotics and all antidepressants that lead to partial paralysis of the bladder neck.
• idiopathic causes: in cases where the etiological factor could not be determined.

What treatments are used for retrograde ejaculation?

Drug therapy can be effective in the absence of anatomical and neurological disorders. The following drugs are commonly used: ephedrine sulfate, midodrine, brompheniramine maleate, imipramine. If the cause of retrograde ejaculation is congenital, acquired or iatrogenic changes in the bladder neck, sometimes they resort to special surgical techniques corrections.

When does painful ejaculation occur?

Painful ejaculation or one-orgasmia occurs with many problems: the presence of prostate adenoma, infections, exacerbation of chronic prostatitis, chronic pelvic pain syndrome, colliculitis, obstruction of the ejaculatory ducts. Also found when taking antidepressants, alpha blockers.

The material was prepared by urologist-andrologist, physiotherapist, dermatovenerologist Oleg Viktorovich Akimov.

Why does premature ejaculation and delayed ejaculation occur? How to deal with these problems? We will look at this in this article. This problem affects many men and causes concern on the part of their sexual partners.

Ejaculation, or ejaculation, is the release of sperm from the male genital organ during arousal. Delayed ejaculation is caused by dysfunction of the reproductive system in men. In addition, there are also such pathologies of ejaculation:

Anejaculation is the absence of emission of seminal fluid during orgasm in a man;

Anorgasmia – lack of orgasm in general;

Retrograde ejaculation - the release of seminal fluid occurs towards the bladder. Outwardly, it can be observed as the fact of absence of ejaculation.

It should be noted that delayed ejaculation during sexual intercourse can also be observed as primary or secondary. Primary is a process that is observed in men from the very beginning of sexual life. The secondary one is acquired after some time. It can be caused by stressful situations or psychological problems, eliminating which you will return to normal sex life.

After contacting a urologist and passing the necessary tests, the doctor will help determine the exact cause of this disease.

Physical reasons

Now let's look at the main reasons for delayed ejaculation.

There are two main aspects that influence the occurrence of this problem: psychological and physical disorders in men.

Physical factors that affect delayed ejaculation can be caused by injuries to the scrotum or penis, prostate adenoma, various surgical interventions in the male reproductive system, certain infections or urethritis.

Neurological problems in the patient's spinal cord, bilateral sympathectomy, diabetic neuropathy or stroke may also be the cause of delayed ejaculation.

Hormonal imbalances caused by problems in the functioning of the endocrine glands can lead to this problem in men. Among them, the most common are hypogonadism and hypothyroidism.

Congenital pathologies in the structure of the urethra, Müllerian or Wolffian duct cysts, as well as the “plum belly” syndrome cause delayed or absent ejaculation. Such disorders are already present at birth and may not be visible until sexual activity begins. Delayed ejaculation in men is only an indicator of the presence of pathology in the development of the organs of the genitourinary system.

Disorders acquired as a result of surgical intervention in the sacrolumbar spine, pelvic organs, trauma to the genitals as a result of hypothermia or burns cause problems with ejaculation.

If you have severely burned your genitals, you should immediately seek medical help to avoid negative consequences for the body.

Psychological reasons

Among psychological problems, the delay can be caused by stress, nervous strain or overwork, depression, and fear of intimacy. Strict religious upbringing and a depressed state also matter.

Other reasons that can trigger the occurrence of such a delicate problem

Taking certain medications can cause temporary dysfunction of the genital organs, as well as abuse of alcoholic beverages or drugs. Intoxication with these substances causes a deterioration in the general condition of the body as a whole.

Wearing tight underwear can delay ejaculation. Because it pinches the blood vessels leading to the penis. And also panties made of synthetic fabric, in which the skin can rot, negatively affect the health of a man’s genitourinary system. It can also lead to infections.

Symptoms of delayed ejaculation

There is a main symptom of this problem, characterized by a forced prolongation of sexual intercourse to achieve ejaculation. According to statistics, about 75% of men speed up the onset of ejaculation by masturbating their penis with the participation of their partner. This is due to the fact that they are unable to achieve orgasm directly during intercourse.

Pain during ejaculation is also the main symptom of ejaculation disorders. This may indicate the presence of other possible diseases genitourinary system of a man, especially if there is darkening of the urine after sexual intercourse.

The inability to conceive a child is another symptom of ejaculation disorders. If a woman’s body is healthy, but the girl does not become pregnant, then most likely the cause is the man’s infertility. It was developed against the background of ejaculation disorders or diseases of the reproductive system.

Diagnosis of the disease. What tests are prescribed?

First of all, if this problem occurs, you should contact a urologist or andrologist. First, the doctor listens to the man’s complaints, the symptoms he noticed in himself, and also collects a detailed medical history. The specialist then examines the patient, recording any changes or abnormalities. Afterwards, tests are prescribed that need to be taken:

• general urine analysis;
• bacterial sowing;
• analysis for the presence of sexually transmitted infections;
• Ultrasound examination of the genitourinary system.

After all the tests have been completed, a secondary consultation with a doctor follows, where he carefully examines the results and conducts another examination (if necessary).

If no problems were identified during the study, the patient is sent for examination to a psychiatrist or psychosexologist. Consultations with these specialists help to identify the presence of psychological problems that cause such dysfunction.

Delayed ejaculation: treatment. What methods are used in this case?

Treatment depends directly on the diagnosis made by the doctor. This may be drug therapy using medications prescribed by a doctor. If ejaculation disorders were caused by taking certain medications, then adjustment of the dosage and method of using these medications is necessary. Or in some cases, it is necessary to completely stop taking medications and select more suitable analogues.

Drug treatment most often includes taking antibiotics and painkillers.

Sometimes doctors prescribe medications to be injected directly into the penis. Treatment in this way is considered radical. This therapy is carried out extremely rarely, but as a result the problem completely disappears.

Physiotherapy (electrophoresis, electrosleep, ultrasound therapy) and herbal medicine are also used. Massage procedures are also prescribed to restore blood circulation in the genitals. When performing rectal electrical stimulation or transcranial electrical stimulation, pain may occur. But this treatment is considered very effective for ejaculation problems in men. A sex therapist or psychotherapist can prescribe treatment only if it has not been identified organic reasons dysfunction of the genital organs. For the effectiveness of therapy, the patient’s sexual partner is most often involved in consultations. Then everything happens more productively.

In general, treatment of ejaculation disorders should be a whole range of procedures. It is impossible to cure it by eliminating only physical pathologies. Therefore, this problem is usually caused by more than one reason. Needs to be supported healthy regime nutrition and sleep, carry out regular sports training, avoid drinking alcohol. Psychological training will help reduce stress and nervous fatigue after a working day.

Sexologists say that delayed ejaculation is most often welcomed by the woman. Because this gives her time to experience multiple orgasms, but as a result of these manipulations the man begins to feel like a bad sexual partner.

Some men have the opposite problem - premature ejaculation. In this case, ejaculation occurs too early. If you need to delay ejaculation, but you can’t do it yourself, you can use some advice given by sexologists:

Protect yourself with thick condoms;

Do Kegel exercises daily;

Use various techniques in sexual intercourse;

Take medications to delay ejaculation.

Data medicines should be taken only as prescribed by a doctor and under his supervision. Since they can be addictive and negatively affect human health.

Ring for men

Many men prefer to buy a ring to delay ejaculation, as it stimulates even the female genital organs, thereby delivering more pleasure to their partner. This tool can be purchased at a sex shop.

The price can vary greatly between models depending on the manufacturer and the included features. You can also purchase anesthetics in a sex shop to prolong sexual intercourse, but you must follow the instructions. A large number of applied anesthetic may lead to complete loss sensitivity in a man. Immediately before sexual intercourse, wipe off the residue, otherwise your partner will not feel penetration.

Delayed ejaculation in men is still treated with drugs such as Viagra or Levitra. These products can be purchased at pharmacies only with a doctor's prescription. Since they are very strong in their effect and are addictive with constant use.

Gel lubricant

Delayed ejaculation also causes a negative attitude towards sex in some women, especially if the girl does not have enough natural lubrication. Therefore, before you get intimate, find out your sexual partner's preference. If necessary, use intimate gel lubricant to reduce friction. It is designed to prolong sexual intercourse and increase the sensitivity of the head of the penis. And the woman experiences strong arousal and reaches orgasm faster.

Don't hesitate, contact a specialist on time!

If delayed ejaculation causes great discomfort, consult a urologist for a genital examination. Men are usually embarrassed to admit even to themselves that there are gaps in the intimate area, and turning to a specialist causes panic. Therefore, many people prefer treatment folk remedies, if there is a delay in ejaculation not for the first time.

A little conclusion

Modern urological clinics offer their qualified assistance, ensure the anonymity of their clients, and also approach this problem with understanding.

In such an institution you can not only undergo an examination, but also take the necessary tests and conduct research. Do not self-medicate. It is better to immediately contact a specialist who will help you get rid of this intimate problem.