Diagnosis Of Premature Ejaculation & Definition
Of Premature Ejaculation
Premature ejaculation is often defined by
two things - first, the time between penetration (intromission) and
ejaculation is two minutes or less (though some experts use three
minutes as a cut off point), and second, there is distress of some kind
for either the man or his sexual partner because lovemaking is so brief.
From the man's point of view, this means
he has reduced control over ejaculation; he is dissatisfied with
intercourse, and he or his partner are distressed about it.
Since
many men do not apparently mind that they can make love for so short a
length of time - less than two minutes - before they ejaculate, the added factor of "distress" is needed.
In reality, substantial
overlap exists between men who say they have premature ejaculation and those
who don't
when the length of lovemaking alone is used alone as a defining feature of the condition.
When men are asked to estimate how long
they are capable of making love for, they are found to overestimate the
time somewhat: men with PE think they can make love for two minutes,
when the actual average is 1.8 minutes - men without PE estimate their
capacity at 9 minutes when they can actually make love for 7.3 minutes.
By these criteria, premature ejaculation is present in at least 35% of
males over 18 years of age. It's also not surprising to find that
premature ejaculation is the most common
male sexual
dysfunction with erectile dysfunction and decreased libido close
behind. Men with premature ejaculation are obviously much less happy
about the quality of their sexual relationship, their sex life, and the
quality of their relationship with their partner.
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 me 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.
Definition of premature ejaculation - what is premature ejaculation?
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