Treatment for Premature Ejaculation 

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What is premature ejaculation - continued from here.

The consequence of the definition of PE in the DSM IV is that the condition has to cause distress and/or interpersonal problems to be considered PE, which is - to say the least - a very subjective definition, though not for this reason alone should it be discarded.

Of course, both the DSM IV and ICD-10 methods of defining PE are opinion-based, and do not have the backing of controlled clinical and epidemiological research studies. One consequence of this lack of rigor is that the DSM IV definition of PE has little value as a diagnostic test for predicting PE. The key thing here, as you may have realized, is that there is no definition of the time between penetration and ejaculation (also called the intravaginal ejaculatory latency time  or for short the IELT). So the consequence of this can be that men who "last a long time during sex", i.e. who can thrust for up to 20 minutes or even longer between penetration and ejaculation, may, according to the DSM IV, have premature ejaculation if they simply have some doubts or worries about how long they can last. It is hardly helpful for doctors to base a diagnosis of a condition on the fact that a man perceives himself to have it! And there are in fact plenty of men who last for a long time in bed and yet who complain that they have premature ejaculation. All in all, the unspecific and vague DSM IV definition is unhelpful in clinical practice and does not aid research into new methods of treatment.

A New Definition of Premature Ejaculation

The DSM IV definition of premature ejaculation emphasizes the subjective nature of premature ejaculation as a "complaint" from which men suffer. And the imprecise nature of the term "interpersonal distress" leaves the definition open to further subjective interpretation. So it's hardly surprising that proposals for a new definition have been put forward: an approach which would elevate premature ejaculation from the subjective sense of "I want to last longer in bed" or "how can I last longer during sex" to a so-called syndromal approach which incorporates carefully conducted clinical studies which measure the time between penetration and ejaculation.

Premature ejaculation as a discrete clinical entity, a medical syndrome, was first described in 1943 by Schapiro, who drew a distinction between what was to become known as lifelong premature ejaculation and acquired premature ejaculation. More recently, Waldinger and Schweitzer suggested the existence and  definition of a third premature ejaculation syndrome called "natural variable premature ejaculation". And, in order to help the classification even further, Waldinger also suggested that a fourth premature ejaculation syndrome be called premature-like ejaculatory dysfunction - this is the condition experienced by men who last for a long time in bed but who say that they have premature ejaculation.

Let us try and make all this clearer:

Lifelong premature ejaculation

• This is easy to recognize from the following symptoms:
• a man's ejaculation occurs too early on almost every occasion he and his partner have sex
• the problem is not limited to one woman but happens almost every time the man has intercourse with any partner
• the man has premature ejaculation from the first time he has sex onwards
• up to 80% of men ejaculate within 30-60 seconds of penetration and the other 20% ejaculate within 1-2 minutes
• in 70% of these men ejaculation remains very quick throughout life; in another 30% it may get even faster with age
• a number of men ejaculate during foreplay, before they have penetrated their partner or as soon as their penis touches their partner's vagina.

Acquired premature ejaculation

• Acquired premature ejaculation is different. It shows the following symptoms:
• early ejaculation starts at some point in a man's life
• the man has usually experienced normal ejaculation before the start of his complaint
• the premature ejaculation comes on either suddenly or gradually and may even be secondary to something like erectile dysfunction or prostatitis. It may also be caused by thyroid dysfunction, psychological problems and relationship issues.
• Acquired premature ejaculation can be treated by addressing the underlying cause. A physical examination and a blood and/or urine test are always necessary.

Natural Variable premature ejaculation

• In natural variable premature ejaculation, the ejaculation time varies, and the rapid ejaculation occurs from time to time, in various situations or circumstances. It is in fact rather like a normal variation in sexual performance, and a man with it will show the following symptoms:
• rapid ejaculations are not consistent and happen irregularly or unexpectedly
• a man's capacity to control his ejaculation may be less than normal or lacking, but a diagnosis can be made without this symptom
• reduced control of ejaculation is linked to a short or normal ejaculation time of less than 1.5 minutes
• Men with this type of premature ejaculation usually cope well, but need to regain sexual confidence, for which therapy is helpful, because the problem is related to situational problems and should be quickly reversible
• treatment with ejaculation-delaying drugs is not needed

Premature-Like Ejaculatory Dysfunction

• Premature-like ejaculatory dysfunction is a syndrome in men who say they have premature ejaculation despite the fact that they last for as long as most men - 3-6 minutes - and they may even be capable of prolonged sex of up to 20 minutes.
• it is more a psychological condition than a true pathology
• it is often caused by psychological and/or relationship issues
• men with this condition think they regularly or sometimes come far too quickly during sex
• they may become obsessed with their supposed early ejaculation or lack of control, even though their IELT is in the normal range
• they may or may not lack the ability to control ejaculation at the point of no return, the so-called point of imminent ejaculation, but this is not a prerequisite for the diagnosis
• they don't have another emotional disorder which explains the way they are behaving
• assurance that ejaculation time is inside the normal range and the information that emotional / psychological / relationship issues are most probably the origin should help; if not, counseling, sex-education, and therapy (psychotherapy) are needed.