In recent years, the medical world has improved its recognition and
understanding of male sexual dysfunction, including the problems men can
experience when engaging in sexual intercourse.
is one form of sexual dysfunction that can adversely affect the quality of a man's sex life.
Reaching climax and ejaculating semen during penetrative sex is the
typical route by which babies are conceived, but premature ejaculation
does not just complicate reproduction, it can also adversely affect
sexual satisfaction, both for men and their partners. The information
here aims to demystify premature ejaculation and outline active
treatment options for those cases where it is desired.
What is premature ejaculation?
Premature ejaculation is a form of male sexual dysfunction.
From the point of view of the man and his sexual partner, premature
ejaculation means the man having an orgasm or "climaxing" sooner than
wanted.
1
Estimates of the number of men affected by premature ejaculation vary
depending on how the problem is defined. A high proportion of men report
being affected by premature ejaculation, whereas a very small
proportion of men actually meet the medical criteria for the most
persistent form.
2
Medically, the most persistent form of premature ejaculation (primary or
lifelong premature ejaculation) is defined by the presence of the
following three problems from the point at which a man becomes sexually
active:
2-4
-
Ejaculation always, or nearly always, happening before sexual
penetration has been achieved, or within about a minute of penetration
-
The man finding an inability to delay his ejaculation every time, or nearly every time, he does achieve penetration
-
Negative personal consequences, such as distress and frustration, or avoidance of sexual intimacy.
Premature ejaculation was once known, in Latin as
ejaculatio praecox (the translation being "precocious ejaculation").
2 It is also called rapid or early ejaculation.
An internet search will also reveal a lot of slang or colloquial phrases
for premature ejaculation, although these often have little bearing on
the reality of lived experience and may instead reinforce false ideas
that are harmful to men's mental health.
For example, such slang terms can lead men to feel they are to blame,
have failed, are alone in their problem, or cannot be treated, while the
opposite is usually the case. Premature ejaculation can cause a lot of
embarrassment in boys and men, with a significant degree of stigma often
attached to male sexual performance.
5
How many men experience premature ejaculation?
Information obtained through surveys puts the "self-reported" prevalence
of premature ejaculation in men as somewhere between 15% and 30%.
2,6
However, the prevalence of medically diagnosed and diagnosable premature ejaculation is much lower.
2,6
This statistical disparity does not in any way diminish the suffering
experienced by men who do not meet the strict criteria for diagnosis.
2,6
In one analysis of nearly 5000 men in nine Asia-Pacific countries, 16%
of men met the criteria for a diagnosis of premature ejaculation (PE) on
the five-question Premature Ejaculation Diagnostic Tool (PEDT).
19 Probably PE was found in 15% of respondents, while 13% of men self-reported PE.
Interestingly, less than half (just 40%) of the men with PEDT-diagnosed
PE self-reported the condition, and just 19% of those with probable PE
self-reported having the condition. A large number of men (some 6% of
respondents) had a negative PE diagnosis on the PEDT but reported PE.
19
Primary or lifelong PE is the most persistent problem in men and
describes a condition where men have rarely experienced sex without
prematurely ejaculating. This is the least common form of the condition
and is thought to affect around 2% of men.
7
However, more loosely defined premature ejaculation remains the
most common form of male sexual dysfunction - more common than erectile
dysfunction.
6,7
Causes of premature ejaculation
Let's discuss the causes of premature ejaculation, from psychological factors to medical causes and erectile dysfunction.
Psychological factors
Most cases of premature ejaculation are not related to any disease and are instead due to psychological factors.
Examples of psychological causes of premature ejaculation include:8,9
- Sexual inexperience
- Novelty of a relationship
- Overexcitement or too much stimulation
- Relationship stress
- Anxiety
- Guilty feelings
- Depression
- Issues related to control and intimacy.
These common psychological factors can affect men who have previously
had normal ejaculation; such cases are often referred to as secondary or
acquired premature ejaculation.
7
Most cases of the rarer, more persistent form - primary or lifelong
premature ejaculation - are also believed to be caused by psychological
problems. The cause(s) of primary or lifelong PE can often be traced
back to early trauma, such as:
7
- Strict sexual teaching and upbringing - affecting young men who have
been brought up under strict ideas that sex should be prohibited until
marriage, for example, making enjoyment of sex more difficult because of
a feeling that it is wrong or a sin
- Traumatic experiences of sex - anxiety and premature ejaculation can
result from problems ranging from a loss of privacy when masturbating
("being caught" masturbating), to sexual abuse
- Conditioning - it is thought that early sexual behaviors can feed
into later experiences of sex. One example is a teenager learning to
ejaculate quickly to avoid being found masturbating.
Biological causes of premature ejaculation are much less common than
psychological ones. In rare cases, the cause can be more serious, such
as nervous system damage as a result of surgery or physical trauma.
10
The following are also possible medical causes of PE
7
(doctors will focus on diagnosis and management of the underlying
condition first and monitor for improvement in sexual function
8):
Erectile dysfunction
Erectile dysfunction is a condition that doctors will want to rule out
or treat first when working with a patient concerned about premature
ejaculation.
6,7
Some men may confuse erectile dysfunction and
premature ejaculation,
believing themselves to have the former when they actually have the
latter. This is because the penis normally loses its firmness after
ejaculation.
6
In some cases of erectile dysfunction, heightened sensitivity caused by
changes to the normal pattern of nerve signals means that much less
stimulation is needed to cause ejaculation.
7
Finally, some studies have found an association between levels of serotonin
- a natural neurotransmitter chemical involved in mood and depression -
and ejaculation problems. Men with low brain levels of serotonin may
have problems with premature ejaculation.
10 However, the role
of such factors remains largely theoretical, especially given that
scientists still have a fairly poor understanding of the normal
physiological processes that produce ejaculation.
2
