Defining Premature Ejaculation – Introduction
The most common erotic disorder among men is premature ejaculation, when ejaculation begins before it’s desired during sexual interaction and causes personal distress or interpersonal challenge. Although common, and detrimental to men’s sexual health and well-being, the definition of PE remains controversial, because there is no standard definition. This page aims to give an in-depth review of what PE is, what it falls under, its epidemiology, etiology and management.
Defining Premature Ejaculation
PE has changed over the years and this reflects the multifactorial character of the disorder. The earliest definition of PE relied on the amount of time spent having sex, a threshold of two minutes or less. But this definition has been criticised as being arbitrary and disregarding the personal and environmental conditions that lead to PE.
Another definition of PE, also put forward by the ISSM in 2007, focused on the pain experienced by the sufferers and their partners. – PE can be defined by the ISSM as: male sexual dysfunction in which ejaculation occurs, most of the time or all of the time, before or within 60 seconds after a vaginal penetration; inability to postpone ejaculation on all or almost all vaginal penetrations; negative side-effects (distress, trouble, frustration and/or avoidance of sexual intimacy).
This definition takes the subjective character of PE into account and places greater emphasis on the psychological and interpersonal aspects of the condition causing distress and distress. PE diagnosis is, however, undermined by the absence of objective definitions of intercourse time, and interpretations of what counts as ‘a short’ interval of intercourse range widely.
Classification of Premature Ejaculation
The ISSM divides PE into two subtypes: persistent and acquired. Lifelong PE means an ongoing or recurrent ejaculation pattern within approximately one minute of vaginal penetration, from the onset of sex. Acquired PE, by contrast, is a patterned discharge occurring within approximately one minute of vaginal penetration, after a normal ejaculatory delay.
This classification helps guide the clinical assessment and treatment of PE, as PE in life tends to be genetic and neurobiological, whereas acquired PE can be psychological, relational and medical.
Epidemiology of Premature Ejaculation
PE has a wider prevalence depending on definition and population. As per the ISSM definition, the PE rate among men aged 18-75 years is estimated to be between 20–30%. Yet, by definition of duration, PE is much less prevalent, approximately 35%.
Etiology of Premature Ejaculation
PE is a multifactorial, biologically and psychologically complex etiology. Lifelong PE is thought to be mainly genetic and neurobiological in nature, including changes in the serotonergic system, changes in the autonomic nervous system, and genetic predisposition.
Experiencing PE, however, can be correlated with various mental, relational and medical factors, including depression, anxiety, relationship issues, sexual trauma, performance anxiety, prostatitis, erectile dysfunction and drugs.
Management of Premature Ejaculation
The treatment of PE involves a multifaceted approach that encompasses pharmacological, psychological and educational interventions.
1. Pharmacological Interventions:
PE treatment consists of SSRIs, TCAs and topical anaesthetics. Several studies have proven the usefulness of SSRIs like paroxetine, fluoxetine and sertraline in reducing latency and boosting sexual satisfaction. Such drugs act by raising brain levels of serotonin, which facilitate delayed ejaculation. Other drugs that work include TCAs (clomipramine, for example), but they come with a higher dose of side effects than SSRIs. They promoted topical anaesthetics like lidocaine and prilocaine, which act by weakening the penis and prolonging sex. It can also induce unwanted effects, such as genital paralysis, and spread to the partner, which can interfere with sexual satisfaction.
2. Psychological Interventions:
Such interventions would involve cognitive-behavioural psychotherapy, psychoeducation and sex therapy that could help both individual and couple cope with the psychological and relational underpinnings of PE. Indeed, these sorts of interventions can enhance communication, ease anxiety and competition, and boost sexual pleasure. Using CBT, a person can pinpoint negative thoughts and beliefs about sexual performance. Psychoeducation would teach the man and woman normal sexual function, sexual skills and sexual liberties. Sexual therapy will educate the couple on new ways of communicating, sexual desires and interests, and develop a healthier sexual relationship.
3. Educational Interventions:
Education and counselling in the domains of normal sexual functioning, sexual skills and sexual entitlements might give an empowered man and his partner greater control over PE. Any additional reliable knowledge about PE, its cause, and treatment options could positively influence anxiety and performance stress. Conveying sexual skills (for example, the “stop-start” method) might allow for better regulation of the ejaculatory response. Sexual rights might help bring up the ideal and most rewarding sexual experience for them, through consent and respect.
Conclusion: Defining Premature Ejaculation
Ultimately, premature ejaculation is a multifactorial, complicated syndrome that undermines the sexual health and wellbeing of millions of men and their partners. Dissension and discussion around this condition has stemmed in part from the absence of a consensus definition. Recent developments in the epidemiology, etiology and treatment of PE now make it possible to formulate evidence-based guidelines and recommendations for the diagnosis and treatment of PE.
Future research in PE needs to focus on the establishment of objective and consistent PE measures, the processes underpinning the condition and risk factors, and the efficacy of new and personalized management protocols involving individual and contextual factors that affect PE. This will enable men and their partners to live better, more wholesome sexual lives and mitigate the pain of this most prevalent sexual issue.
