The Problem of Premature Ejaculation
MaCauly Cacioppo
Abnormal Psychology (Psych 430-001)
Liberty University Psychology Department

Abstract

In this paper, you will learn about the various definitions of Premature Ejaculation, the criteria that describes this dis order, as well as the various treatment methods that are involved in over coming it. Men who have this problem are taught various techniques to help manage there ejaculations in a productive way, thereby helping them to have a healthier sex life with their partner. You will also learn about some of the medications that one could take with this problem to help lessen the problem. The chief thing to remember though, is that this is a very manageable problem, one that about 30% of men in the United States will live with, one that they will over come with dedicated effort, a loving partner, and a will to over come it.

Premature Ejaculation (PE), also known as rapid ejaculation, premature climax, rapid climax, or early ejaculation, is when a man reaches orgasm and ejaculation at a rapid pace, and with very little sexual stimulation, either before, or quickly after penetration, and before he means to, and as many as 30% of men in the United states experience PE at some point in their life (Comer, 2010). The most common definition of PE is when a man reaches climax within two minutes of penetration, however this has been some what controversial due to a survey by Alfred Kinsey, in which he demonstrated that three quarters of men ejaculated within that time period, in a little over half of their sexual experiences (Kinsey, et al. 1948).

PE is a complex condition that has baffled Scientist and Psychologists for some time now. The source of such contention is simply the fact that there is no absolute definition of this problem. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR) defines PE as a persistent ejaculation with minimal sexual contact or stimulation before, on, or shortly after penetration, and before the person means it to happen, causes great personal distress and interpersonal difficulty, and is not the result of any form of drug use (American Psychiatric Association [DSM-IV-TR], 2000). The International Consultation on Urological Diseases states that PE is the persistent ejaculation with minimal before, on, or shortly after penetration and before he means for it to happen, the result of which is causes the sufferer and/or his partner great distress or frustration, and the American Urological Association (AUA) Guideline states that PE occurs much sooner than desired, either happening just before, or after penetration, causing distress to either one or both partners (Gurkan, et al. 2008). The similarities between these definitions all include a quick ejaculation, little or no control over orgasm, and stress or frustration for the man and his partner. However, the International Classification of Diseases, Tenth Edition, issued by World Health Organization (WHO) is the only definition that gives us an kind of “cut off” point for PE, they say that PE is the inability to control or put off ejaculation long enough to actually enjoy sex, which is showing in ejaculation before or soon after penetration (World Health Organization, ICD-10, 1993)

The problem with all of these definitions is the fact that none of them really describe specific requirements to diagnoses the problem, and most of them seem to rely on the subjectivity of the Clinician. However, as far as researchers are concerned, Waldinger and his colleagues’ system of Intravaginal Ejaculatory Latency Time (IELT) is a good standard to base PE on; the IELT is the time from vaginal penetration to the start of intravaginal ejaculation, and according to this system, men who have an IELT of less than one minute have a definitive PE (Gurkan, et al. 2008). The main problem with this system however, is that it only covers the problem of premature ejaculation in relation to time between penetration and ejaculation, however it does not take into consideration the other main two points, namely, the lack of control over orgasm, and level of distress and frustration experienced by those involved.

Psychologically speaking, the main causes of PE are high levels of anxiety, young age and inexperience, little understanding of their own arousal, and frequent hurried masturbations or sexual encounters (Comer, 2010). There are also some that say PE is a result of biological factors, in that they have seen many men suffer from PE, as well as some of their first degree family members suffer from similar circumstances (Comer, 2010). A second major theory argues that the brain of a man that suffers from PE has certain serotonin receptors that are overactive, as well as some that are under active, and the final major theory is that men how suffer from PE have a higher concentration of nerves, or greater sensitivity in the area of the penis (Comer, 2010).

One of the major believed causes of PE, is young age and inexperience (Comer, 2010). It is not uncommon for men to experience PE the first couple of times that they have sex. This is due to the fact that these men move through the love making process to fast, seeking instant gratification, and have not learned to slow down and pace themselves, in order to make amore pleasurable love making experience, the remedy to this is simply time. As time goes on, the man will learn to control his arousal, will learn how to properly make love, and to pace himself, essentially becoming more experienced with sex will allow you to make it a more pleasurable experience.

One of the more probable reasons from a man to suffer from PE would be anxiety. Over the last several decades, the typical time of intercourse has greatly increased in our society today (Comer, 2010), due to the fact that sex has become less about propagation and much more about pleasure. Because of this increase, there has been a huge pressure put on men to “perform.” The anxiety alone of a man being afraid that he will not be able to make the experience pleasurable for his partner, is enough to cause problems. On the flip-side, our society has greatly increased its obsession with sex, speaking more towards personal gratification, as apposed to unified pleasure. Giving a sort of “hit it and quit it” mind set, especially in men, in which the man simply wishes to reach climax as soon as possible, with little regard to his partner. Another major source of anxiety could lie in the relationship aspect. For example, the mans partner could already have had sex, and he could still be a virgin, giving him the idea that he had to “measure up” to the other man. Or if you have simply entered into a new relationship with someone, there could be a lot of pressure on the man to show his partner what he can do.

And finally, a possible major cause could be hurried masturbation or sexual intercourse. Comer gives the example of an adolescent male masturbating secretively, and finishing quickly so as not to get caught by his parents (Comer, 2010). Prolonged experiences such as this could lead to a man being conditioned to finish quickly, as well as attaching a sense of guilt to any sexual act, thus resulting in the desire to end it as quickly as possible. Comer also tells the story of Eddie, who's first sexual relationship was with a prostitute whom he and his two friends would share, one would have sex with her, while the other two stood outside the car, standing watch, a lot of the time in the cold, and rushed each other out of anxiety and fear that they cops would show up (Comer, 2010). An experience such as this could easily lead to an individual to being conditioned to finish very quickly, not allowing them to slow down and truly learn to enjoy the act of loving making, as well as teaching them to objectify the love making experience.

PE can be treated by both medical and psychological means. One of the first methods published was in 1956 when Urologist Dr. James Semans describes the “stop-start technique” (Gurkan, 2008). The method is preformed when the mans partner stimulates his penis until near climax, at this point, the partner will stop stimulating, until the felling subsides. This whole process is repeated several times until ejaculation is controlled voluntarily (Gurkan, 2008). An approach very similar to Dr. Semans technique was proposed by sex therapists Masters and Johnson in 1970, there techniques differed in that the partner squeezes the frenulum until the erection is lost, then the partner would resume stimulation. The idea behind this school of thought is to teach the man to control himself, as well as to help him to regain confidence in his sexual performance, reduce his anxiety, as well as it would work to decrease tension between the two of them, in the fact that they worked through this problem together, and became more comfortable with the situation.

These are the standard behavioral therapies that are employed to help men over come this problem. However, patients reported that though this course of action works in an immediate sense, it lacks long lasting efficiency. The cooperation of a loving partner help boost their self-esteem, lessened their anxiety, and bolster their passion. However, they, in many cases, were still having long term problems. This is why many therapist have decided to combined pharmaceutical agents, as well as the behavioral therapies. The medications used, though many of them are not FDA sanctioned for these purposes, are used to help fix any sexual disruptions. These included Topical desensitizing drugs, and oral medications, these in conjuctor with the couples sex therapy have greatly improved the mans issues (Gurkan, 2008).

As far as topical treatments go, there is little variety, and the vast majority of them work to desensitize the penis, so as to allow them to last longer, which sounds like an unpleasant trade off. In several of the medications, lidocaine was a common local anesthetic, which is coincidentally the same chemical used in dentistry, as well has minor surgical procedures (Gurkan, 2008). The idea, as was said earlier, is to lessen the physical feelings, essentially numbing the penis, thus resulting in a longer duration, but giving less pleasurable feeling (Gurkan, 2008). This form of medication can cause side effects such as penile hypoaesthesia, erectile dystfunction, female genital anaesthesia, and skin reactions (Gurkan, 2008). Some men, upon using the products in clinical trials, stated that their penis would go completely numb, which would result in the lose of erection, which did not help the problem (Gurkan, 2008).

Many of the medications used to treat PE are not sanctioned to do so, for example, anti-depressants, anti-anxiety, as well as SSRI’s are all different medications used to treat PE as an “off-label” treatment method, due to many of the side effects that the medications have on the consumer. The use of SSRIs to treat non-depressed PE patients has shown some positive out comes, with the most common negative side effects being nausea, yawning, fatigue, and loose stool, however many of these symptoms will dissipate after 2-3 weeks of use (Gurkan, 2008). Some of the more extreme cases will also experience bleeding, priapism, weight gain related to type II diabetes mellitus and bone density lose (Gurkan, 2008). Patients who take long term SSRIs also sometime report decreased sexual desire, as well as Erectile Dysfunction (Gurkan, 2008). Another area of curiosity, especially when it comes to the use of oral medications, is whether or not someone should uses this treatment over the long term, or on-demand treatment, though their is not clear margin as to which of these choices are better (Gurkan, 2008).

Alternative treatments are being looked into, in combination with the two other forms of treatment already discussed. Alternative forms of treatment include different forms of masturbation techniques, muscle strengthening exercises, as well as desensitizing bands, which when worn during masturbation, do not constrict blood flow and help PE sufferer gain control over his ejaculation (Gurkan, 2008). There are also surgical approaches to treating PE, but none of them are sanctioned as medical standard. Two of these such procedures include of a dorsal neurectomy and a glandular augmentation (Gurkan, 2008).

Concerning the dorsal neurectomy, the dorsal nerve of the penis sends sensations from the glans of the ejaculatory center to the spinal cord, than to the brain (Gurkan, 2008). There are two main trunks of nerve that branch of into a number of different branches as they approach the glans. In this procedure, one or more nerves are cut to allow for a desensitization of the penis. The second procedure is a glandular augmentation, which is when fillers are injected into the glans, the main idea of this procedure is to increase the size of the glans for more of cosmetic reasons, however, a side effect of the procedure is the decreased sensitivity (Gurkan, 2008).

Overall the prognosis of PE is good, though there are no sanctioned forms of treatment, it is definitely something that numerous men in the past have been able to over come. Through the combination of behavioral therapies, as well as medical regimens, men can work through the various anxieties, and adverse feelings that could be causes of their dysfunction, and learn to have a healthy sex life with their partner. What is important to remember is that this issue is one that we are still working to solve. But, as you have seen, the studies have shown that with work by the man, as well as his partner, combined with a carefully worked out treatment plan, the problem is absolutely manageable, and easy to live with.

References

American Psychiatric Association. (2000). Premature Ejaculation. In Diagnostic and statistical manual of mental disorders (4th ed., text rev.). doi:10.1176/appi.books.9780890423349.7443

Comer, R. J. (2010). Abnormal psychology. (7th Edition ed., pp. 422-423). New York: Worth Publishers.

Gurkan, L., Oommen, M., & Hellstrom, W. J. G. (n.d.). Premature ejaculation: current and future treatments. (2008). Asian J Andro, doi: 10.1111/j.1745-7262.2008.00369.x
Kinsey, A. C., Pomeroy, W. B., & Martin, C. E. (n.d.). Sexual behavior in the human male. (1948).
World Health Organization. The ICD-10 classification of mental and behavioral disorders: diagnostic criteria for research. Geneva: World Health Organization, 1993.