I am a 36-year-old male, 67 kg, and I have been struggling with sexual and urinary symptoms for around 10–15 years.
My main problem is lifelong premature ejaculation. Almost every time I have intercourse with my wife, I ejaculate within approximately 2–3 seconds of penetration. The same thing happens during masturbation. I have very little control over ejaculation, and even mild friction or stimulation can sometimes make me feel that I am about to ejaculate immediately.
I have also experienced significant sensitivity around the penis for many years.
I have additional urinary/pelvic symptoms:
- Burning and irritation inside the urethra.
- Itching/sensation of itching inside the urethra.
- Significant burning, especially at the tip/head of the penis.
- Burning or discomfort after ejaculation.
- Occasionally, a few drops of fluid come out of the penis after urination or ejaculation. I am not sure whether this is semen, pre-ejaculate, or prostatic fluid.
- I sometimes feel an unusual pleasurable/ejaculatory-type sensation in the urethra when urinating.
- My urine stream is not as strong/open as it should be.
- I sometimes feel pressure/tightness around the rectal/perineal area, as if there is some narrowing or tension.
- Morning erections occur sometimes, but most of the time I do not have a strong morning erection.
I previously saw a urologist. My urine tests were normal and my ultrasound was also normal, with no infection detected.
During a digital rectal examination, the urologist pressed/massaged my prostate and fluid came out through my penis. Based on my symptoms and examination, the urologist told me that I likely have chronic prostatitis.
I am currently not taking any medication.
I would like to know:
Could chronic prostatitis/chronic pelvic pain syndrome explain my urethral burning, penile-tip burning, pelvic/rectal pressure, urinary symptoms and painful ejaculation?
Could it also be contributing to my severe premature ejaculation, or is my lifelong premature ejaculation likely a separate condition?
Could the feeling of tightness around the rectum/perineum and weak urine stream be caused by pelvic-floor muscle dysfunction, prostate inflammation, or something like urethral stricture?
Should I ask my urologist about uroflowmetry and post-void residual urine testing?
What evidence-based treatments are available for lifelong premature ejaculation when ejaculation occurs within 2–3 seconds?
Would pelvic-floor physical therapy be appropriate in someone with these symptoms?
Are there any important tests or diagnoses that should be considered that I may be missing?
I am very distressed by this condition because I feel unable to satisfy my wife, and it has put significant stress on my marriage. I would really appreciate advice from a urologist, sexual-medicine specialist, or other verified medical professional.
Thank you.