The causes of premature ejaculation
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Risk factors for premature ejaculation (PE) - what are the causes of premature ejaculation?Premature ejaculation (PE) is one of the most common sexual dysfunctions among men. But no one really knows what causes it, how often it occurs, or indeed how to define it. You might look at the length of intercourse or how satisfied the two partners are - but then it becomes a subjective definition. More formally, you might use the DSM-IV definition by the American Psychiatry Association: premature ejaculation is "persistent or recurrent ejaculation with minimal sexual stimulation before, or shortly after penetration, and before the person wishes." Using these different and very broad definitions, researchers have come up with estimates of PE of between 4% and 66%. This isn't much help. Perhaps the most important aspect of any definition of premature ejaculation is that the man has no control over his ejaculation - in other words, he cannot choose when to ejaculate during sex. Scientists have offered various suggestions about what causes premature ejaculationA hypersensitive penis, greater penile representation in the cortex of the brain, central serotonergic neurotransmission disturbances, and so on. Then there are links with emotions: anxiety and depression have both been linked to PE, but of course the association may just be a matter of chance. Researchers also distinguish between lifelong premature ejaculation (LPE) and acquired premature ejaculation (APE) - a false distinction in my view, since the condition may occur spontaneously with a new partner even in men of considerable sexual experience. Acquired premature ejaculation has been linked to various organic conditions such as neurological disorders affecting the conus medullaris and acute bacterial prostatitis. Drugs can also induce the condition. The researchers who conducted the study on which this page is based (see citation at bottom of page) collected information from 2,658 men with premature ejaculation and 9,900 who did not have premature ejaculation. All the men had a physical examination and answered questions about sexual activity and any related problems. The data was derived from a simple questionnaire which was composed of questions about age, weight, height, marital, educational and professional status, smoking, alcohol and drug consumption, level of physical activity, and how often the men had sex. A medical history was also completed to allow investigation of factors such as high blood pressure, diabetes, cardiovascular diseases, and any unusual features of the penis, testicles, and prostate. The definition used here was the one mentioned above, the one relating to frequent ejaculation with very little sexual stimulation before or shortly after penetration - and certainly before the man wishes it to happen: in other words, the DSM-IV categorization of the American Psychiatric Association. The men were asked if this applied to them: they were also asked if they could get a satisfactory erection. If not, they were described as having erectile dysfunction. Using these criteria, 2,658 subjects (21.2%) were defined as having premature ejaculation. But to reiterate the point, since this definition asks about the person's wishes, this may not relate to all the men in the study who ejaculated quickly. (Some men may be very happy with a quick ejaculation after vaginal insertion.) Odds ratios (OR) were used to estimate the relative probability of premature ejaculation (PE) and the 95% confidence intervals (CI) were computed with multiple logistic regression. Of the 2,658 subjects (21.2%) with premature ejaculation, 569 (with an average age of 39 years) had life-long premature ejaculation. Another 1,855 (with an average age of 50 years) had acquired premature ejaculation. (The remaining 234 did not know if they had LPE or APE.) Overall, men with premature ejaculation had a very slightly lower average age than those without - which suggests sexual experience (or age) contributes to a reduction in quick ejaculation - a means to stop premature ejaculation is described on this information page. It would be instructive to conduct a survey of the various factors thought to affect ejaculation times in two groups of men - one with premature ejaculation and one with retarded ejaculation, since differences in neurological activity and other physiological factors could reveal the degree to which the problem is organic or psychological. However, these researchers found that the frequency of premature ejaculation did not noticeably change with age: when using a control group of men under 30, men aged 30–49 years were at greater risk of PE while men between 50 and 70 or over 70 were not. in some cases, of course, premature ejaculation can develop alongside or after erectile dysfunction. Astonishingly, erectile dysfunction is present in almost half of men suffering from premature ejaculation. Interestingly, in men with premature ejaculation linked to erectile dysfunction, the main risk factor was increasing age. Among men who had premature ejaculation, smoking more than 10 cigarettes a day increased the risk of erectile dysfunction, but this is is also seen in men without premature ejaculation. Other possible risk factors for premature ejaculation identified in the study included physical activity, which did not affect the risk of PE, and moderate consumption of alcohol, which did pose a slight increase in the risk of suffering from PE. Oddly enough, men who were retired seemed to have less premature ejaculation than working or unemployed men - though this may be an age-related factor. A decreased risk of premature ejaculation was found in men with diabetes, though there was no perceived link to high blood pressure, cardiovascular disease, hyperlipidemia or neuropathy. Interestingly enough, the presence of a short frenulum or and hypospadias did seem to have some bearing on a man's chance of developing premature ejaculation - although this could be caused by increased anxiety rather than the physical condition itself. As the researchers observe, the study is rather limited, since the men who took part were volunteers, self-selected, and so any men who were too embarrassed to answer the questions would not have been included, for example. Given this, the results revealed that a large number of conditions affects the risk of a man having premature ejaculation. It's true that premature ejaculation is mostly a young man's problem. This undoubtedly has a lot to do with anxiety implications. In this study the frequency of premature ejaculation decreased with age. The researchers also found that the more educated men had more tendency to premature ejaculation than the less well-educated - a finding which contradicts previous research. Perhaps this is actually about a cultural aspect of the condition, or some other factor, rather than socioeconomic status per se - such as, perhaps, the availability of treatment for the condition, or the level of shame attached to it. Men under emotional stress, such as those experiencing the effects of separation or divorce, were more likely to seek treatment for premature ejaculation. And in fact, occupational stress was thought to be a cause of sexual problems (not only premature ejaculation) by over half the men who took part in a survey of sexual dysfunction in Germany. Oddly enough, while diabetes is associated with erection problems, diabetic patients may find that the emission phase of their sexual ejaculation cycle is disrupted, so that ejaculation may not take place: in effect, diabetes has a protective effect against PE. Screponi and his colleagues looked at the level of chronic prostatitis in men with premature ejaculation, and found that there was some evidence to support the idea that chronic prostate inflammation could contribute to the development of some cases of quick ejaculation. In the current study men with prostate secretion and/or phlogosis showed a risk of premature ejaculation twice as high as men without. The mechanism of a link, if indeed any exists, remains unproven. In conclusion, this study confirms what is already broadly known about risk factors for premature ejaculation: that is, men seeking treatment for premature ejaculation have experienced stress-related problems such as high demands in employment, unemployment, separation, divorce, or they have genital anomalies such as hypospadias, they drink rather more than might be good for them and they tend to be young. As the authors say, this suggests that several factors contribute to this [premature ejaculation] common male sexual dysfunction." No surprise, there, then.
C. Basile Fasolo MD, V. Mirone MD, V.
Gentile MD, F. Parazzini MD, E. Ricci ScD, the Andrology Prevention Week
centers** (2005) |
