Premature Ejaculation

Excerpt

Ejaculation occurs when semen is released and externally expressed from the male reproductive system. The term premature ejaculation describes the phenomenon which occurs when ejaculation happens persistently sooner than a man or his partner would like during sexual activity. About 30% of men are affected but possibly up to 75% in some reviews. It is considered to be the most common male sexual disorder.

There are several different definitions of premature ejaculation. It has been defined simply as an inability to exert voluntary control over the ejaculatory reflex or as the condition where a man reaches orgasm and ejaculates before he desires to do so. Masters and Johnson defined it as "the inability of the male to control ejaculation sufficiently to satisfy his female partner in more than 50% of coital episodes provided that she is not anorgasmic," while Strassberg et al. define it as "the condition where the male has little voluntary control over ejaculation and ejaculates within 2 minutes or less after intromission in at least 50% of coital attempts."

The World Health Organization (WHO) describes premature ejaculation as "the inability to delay ejaculation sufficient to enjoy lovemaking, which is manifested by either an occurrence of ejaculation before or very soon after the beginning of intercourse or ejaculation occurring in the absence of sufficient erection to make intercourse possible." Some have suggested that any ejaculation which occurs less than 1 minute after vaginal penetration is automatically "premature" while others suggest that this intravaginal time should normally be at least 4 minutes long with anything less considered pathological.

The International Society for Sexual Medicine defines premature ejaculation as the following:

1. Ejaculation that always or nearly always occurs before, or within about 1 minute, of vaginal penetration from the first sexual experience (lifelong premature ejaculation) or a clinically significant and bothersome reduction in latency time, often to about 3 minutes or less (acquired premature ejaculation).

2. Inability to delay ejaculation on all or nearly all vaginal penetrations.

3. Negative personal consequences include distress, bother, frustration, and avoidance of sexual intimacy.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) from the American Psychiatric Association defines premature ejaculation as follows:

1. Ejaculation occurs during partnered sexual activity within approximately 1 minute following vaginal penetration and before the individual wishes it, during all or almost all sexual activity (75% to 100% of the time).

2. Symptoms must persist for at minimum six months and cause clinically significant distress to the individual.

3. The dysfunction is not explainable by a nonsexual mental disorder, medical condition, drug side effects, severe relationship distress, or other significant stressors.

Many women may have a severely delayed climax with vaginal intercourse. This is defined as delayed female orgasm rather than premature ejaculation.

Occasional premature ejaculation is not a cause for concern; however, for those individuals who chronically meet the diagnostic criteria, the condition can cause significant anxiety, distress, depression, psychological pain, and marital discord as sexual activity becomes much less enjoyable and relationships suffer significant negative consequences.

Premature ejaculation that has been present for one year or more has a significant effect on the couple and tends to lead to clinical depression, relationship issues, and other problems.

Approximately 30% of men ages 18 to 59 years old have problems with premature ejaculation; however, shame and embarrassment prevent many from discussing this sensitive topic with their physicians.