Information
about premature ejaculation
Premature ejaculation (PE), also known
as, rapid ejaculation, rapid climax, premature climax or
early ejaculation, is the most common sexual problem in
men, affecting 25%-40% of men. It is characterized by a
lack of voluntary control over ejaculation. Masters and
Johnson stated that a man suffers from premature ejaculation
if he ejaculates before his sex partner achieves orgasm
in more than fifty percent of their sexual encounters. Other
sex researchers have defined premature ejaculation as occurring
if the man ejaculates within two minutes of penetration;
however, a survey by Alfred Kinsey in the 1950s demonstrated
that three quarters of men ejaculate within two minutes
of penetration in over half of their sexual encounters.
Today, most sex therapists understand premature ejaculation
as occurring when a lack of ejaculatory control interferes
with sexual or emotional well-being in one or both partners.
Premature ejaculation (PE) is the most
common sexual dysfunction in men younger than 40 years.
Most professionals who treat premature ejaculation define
this condition as the occurrence of ejaculation prior to
the wishes of both sexual partners. This broad definition
thus avoids specifying a precise duration for sexual relations
and reaching a climax, which is variable and depends on
many factors specific to the individuals engaging in intimate
relations. An occasional instance of premature ejaculation
might not be cause for concern, but, if the problem occurs
with more than 50% of attempted sexual relations, a dysfunctional
pattern usually exists for which treatment may be appropriate.
To clarify, a male may reach climax after
8 minutes of sexual intercourse, but this is not premature
ejaculation if his partner regularly climaxes in 5 minutes
and both are satisfied with the timing. Another male might
delay his ejaculation for a maximum of 20 minutes, yet he
may consider this premature if his partner, even with foreplay,
requires 35 minutes of stimulation before reaching climax.
If intercourse is the method of sexual stimulation for the
second example and the male climaxes after 20 minutes of
intercourse and then loses his erection, satisfying his
partner (at least with intercourse), who needs 35 minutes
to climax, is impossible.
Because many females are unable to reach
climax at all with vaginal intercourse (no matter how prolonged),
this situation may actually represent delayed orgasm for
the female partner rather than premature ejaculation for
the male; the problem can be either or both, depending on
the point of view. This highlights the importance of obtaining
a thorough sexual history from the patient (and preferably
from the couple).
Psychological premature ejaculation factors
Premature ejaculation has historically
been considered a psychological disorder. One theory is
that males are conditioned by societal pressures to reach
climax in a short time because of fear of discovery when
masturbating as teenagers or during early sexual experiences
"in the back seat of the car" or with a prostitute.
This pattern of rapid attainment of sexual release is difficult
to change in marital or long-term relationships. The fact
that female arousal and orgasm require more time than male
arousal is being increasingly recognized, and this may result
in increased recognition and definition of premature ejaculation
as a problem.
While men sometimes underestimate the relationship
between sexual performance and emotional well-being, premature
ejaculation can be caused by temporary depression, stress
over financial matters, unrealistic expectations about performance,
a history of sexual repression, or an overall lack of confidence.
Interpersonal dynamics strongly contribute to sexual function,
and premature ejaculation can be caused by a lack of communication
between partners, hurt feelings, or unresolved conflicts
that interfere with the ability to achieve emotional intimacy.
Neurological premature ejaculation can also lead to other
forms of sexual dysfunction, or intensify the existing problem,
by creating performance anxiety. In a less pathological
context, premature ejaculation could also be simply caused
by extreme arousal.
Some have questioned whether premature
ejaculation is purely psychological. A number of investigators
have found differences in nerve conduction/latency times
and hormonal differences in men who experience premature
ejaculation compared with individuals who do not. The theory
is that some men have hyperexcitability or oversensitivity
of their genitalia, thus preventing down-regulation of their
sympathetic pathways and delay of orgasm.
Premature ejaculation is believed to be
a psychological problem and does not represent any known
organic disease involving the male reproductive tract or
any known lesions in the brain or nervous system. The organ
systems directly affected by premature ejaculation include
the male reproductive tract (ie, penis, prostate, seminal
vesicles, testicles, and their appendages), the portions
of the central and peripheral nervous system controlling
the male reproductive tract, and the reproductive organ
systems of the sexual partner (for the purpose of this discussion,
the partner is assumed to be female) that may not be stimulated
sufficiently to achieve orgasm.
If the premature ejaculation occurs so
early that it happens before commencement of sexual intercourse
and the couple is attempting pregnancy, then pregnancy is
impossible to achieve unless artificial insemination is
used. Perhaps the most affected organ system is the psyche
of the partners. Both partners are likely to be dissatisfied
emotionally and physically by this problem.
Causes of premature ejaculation
The cause of premature ejaculation is considered
psychological, although no one really knows.
Primary premature ejaculation
In primary premature ejaculation, in which the male has
never experienced sexual relations without also experiencing
premature ejaculation, a deep-seated emotional disturbance
may be present and the causes may be multiple.
Sometimes, the behavior is a conditioned response resulting
from teen masturbation practices (see Introduction), but,
sometimes, the patient has deep anxiety about sex that relates
to one or more traumatic experiences encountered during
development. Examples may include family incest, sexual
assault, conflict with one or both parents, or other serious
disturbances.
In most cases, a primary care physician or a urologist
should consult with a psychiatrist, psychologist, or other
professional in cases of primary premature ejaculation.
Secondary premature ejaculation
With regard to secondary premature ejaculation, some type
of performance anxiety is often a major factor.
Performance pressure (ie, fear of failure
to satisfy the partner) can arise from various precipitating
events. ED is a common precipitating event. If the male
is afraid his erection will not last, because of either
actual instances of previous ED or imagined failure of his
erection, this may precipitate premature ejaculation. The
patient may have used the phrase, "Honey, you excited
me so much I just could not hold back," which might
be a way for him to avoid admitting to the humiliation of
being unable to keep his erection throughout intercourse.
If he climaxes quickly, he then has an excuse to justify
his inability to maintain his erection.
However, a careful history is needed because the situation
may be complex.
Perhaps ED is not a part of the problem.
Possibly, his partner has belittled him
with comments such as "You must not be much of a man,
since you cannot stay hard until I am satisfied." In
addition, she actually may have difficulty achieving climax
through intercourse and may require direct clitoral stimulation
to reach a climax. If she does not communicate this to him
(and she may conceal it because of feelings about her own
inadequacy), then he will always fail to provide coital
satisfaction for her.
Because most physicians are not trained
sex therapists, sorting out conflicts in the relationship
and then referring couples for counseling to professionals
with experience and training in that area is important.
If a physician has some training or experience in the treatment
of premature ejaculation and is comfortable managing the
problem, then the physician may choose to begin treatment
(eg, counseling, medication, both). If the patient does
not respond favorably or if the physician is not comfortable
with the treatment of premature ejaculation, then referral
to a sex therapist, psychologist, or psychiatrist is the
next step.
Premature
ejaculation treatment
In clinical cases, various medications
are being tested to help slow down the speed of the arousal
response. Medications that are anti depressant prescription
medications will often result in a delaying of the orgasmic
reflex. These prescriptions are from a family of drugs called
SSRI's. Representative brand names of SSRI drugs would be
Prozac, Zoloft, Celexa, Effexor, and Lexapro.
Psychological treatment is focused on improving
mental habituation to sex and physical development of stimulation
control. No drug is approved by the FDA for the treatment
of premature ejaculation. Ant there is no conventional synthetic
cure that can effectively claim to treat premature ejaculation.
But, herbal remedies have shown much better results. Desensitizing
creams containing local anesthetic agents can also be useful
for some men with premature ejaculation. These agents are
not approved by the FDA specifically for this use, but they
are believed to be of at least some efficacy and are a minimal-risk
option for patients.
