Definition of Premature EjaculationWhat Is Premature Ejaculation? The Medical View
When we consider the question " what is premature ejaculation ?", we need to remember that there are three criteria listed in the medical definition of premature ejaculation.In lay language: 1 The persistent or repeated onset of orgasm and ejaculation without much sexual stimulation, before, at the moment of, or shortly after penetration and before the man and/or his partner want it to happen 2 Marked distress or relationship difficulty because of it 3 It's not due to drink or drugs Having said that, premature ejaculation is only to be expected in a sexually naive young man who is having sex for the first time, or in one who is sexually inexperienced, or in a man who has not had sexual intercourse for some time, so that he is considerably more excited than normal. These are factors that should be taken into account when considering whether a man can indeed be said to have premature ejaculation or not. One researcher (Bernard Althof) has expanded the definition of premature ejaculation to include four aspects of sexual function: 1 A man's ability (or lack thereof) to control the time before he ejaculates in order to satisfy his partner or himself 2 That a man should have voluntary control over his ejaculation 3 That the man or his partner are significantly distressed by the condition 4 That the symptoms of rapid ejaculation are not the consequence of some other sexual disorder of any mental, physical or behavioral problem As we've said elsewhere on this website, premature ejaculation is very common. While estimates of how common it is vary widely, most studies agree on a figure of between twenty and forty percent of men. It is, in fact, so common as to be considered normal. Since men don't usually go out of their way to seek help for premature ejaculation (PE), it may be even higher than we think. By contrast, retarded ejaculation occurs in between one and four percent of men. The physiology of ejaculationA typical ejaculation is between one and five ml in volume, most of which comes from the seminal vesicles. There are three phases of ejaculation: emission, where the semen moves out from the seminal vesicles into the base of the penis; bladder neck closure, which should prevent ejaculate going into the bladder; and propulsion, where the semen leaves the meatus of the penis and is propelled into the vagina of the man's sexual partner. Emission is associated with the sense of one's orgasm being now inevitable (the "point of no return") and is governed by the sympathetic nervous system. The second phase of the ejaculation is bladder neck closure, during which the bladder neck is closed by the action of the sympathetic nervous system. Finally, the powerful ejaculation of semen is mediated by nerve complexes in the spine, stimulated by the sensory nerve endings of the penis responding to friction on the touch receptors of the penis, and possibly also by the distension of the urethra with the semen which has entered it during the emission phase. There are many theories as to why men come quickly (remember "quickly" refers to a man's lack of satisfaction and possibly that of his partner; it does not necessarily imply that quick ejaculation is unnatural in a biological sense). Indeed, it's intuitively obvious that rapid ejaculation is evolutionarily sensible if you might be subject to predation; therefore, contrary to popular thinking, prolonging sex and delaying ejaculation may both be learned responses. However, we do know that one of the reasons men come quickly is that they are out of touch with their bodies and the signals which it may be sending them. So, for example, the signals of impending ejaculation that would encourage a man to slow down his pelvic thrusts and so prolong intercourse may be blocked by anxiety. Unfortunately, a finding that rather confuses this issue is that men who ejaculate quickly during sex also come on average twice as quickly during masturbation, compared to men who are not classed as premature ejaculators. The implication is that anxiety is presumably non-existent or much lower during masturbation rather than sex, though of course this may not be true where men have deep-seated sexual conflicts. Sex and relationships carries a useful definition of premature ejaculation which they express as follows: There isn't actually any universally agreed definition of what premature ejaculation consists of. But we can think of it as a man not being able to control when he reaches orgasm and ejaculates, which means he is not fulfilling his own desires about the length of time for which sex lasts, nor, most likely, his partner's either. Clearly this means that what upsets one man or one couple may be of no concern whatever to another couple. This implicit aspect of the definition is borne out by research which shows that the duration of intercourse bears little relationship to whether a man calls himself a premature ejaculator or not.Masters and Johnson's definition of premature ejaculation depended to a large extent on the level of satisfaction of the woman during sex. They talked about premature ejaculation being a condition where the woman could not achieve orgasm in 50% of intercourse attempts. Well, as we know all too well, very few women ever reach orgasm through intercourse, and it's hardly the man's fault if a woman is completely unable to achieve orgasm during vaginal penetration: for most women, clitoral stimulation is very necessary for an orgasm to occur. Anxiety
and stress would seem to be important factors in premature ejaculation,
though their importance has been questioned by some researchers. For example,
when masturbating - which may not cause much anxiety - men with
premature ejaculation still come to orgasm twice as quickly as non-premature ejaculators.
And, indeed, it turns out there is no discernible difference in levels of
anxiety between the two groups of men. Premature Ejaculation DefinedPremature ejaculation is a common male sexual problem controlled by disturbances of serotonergic neurotransmission and some serotonin receptors, and, to a lesser degree, oxytocinergic neurotransmission in the central nervous system.The current definition of premature ejaculation is of limited use, and a proposal has been put forward to categorize premature ejaculation into four more clearly defined syndromes, which will be more useful when considering the results of research into the effects of various drugs on premature ejaculation. When men ejaculate very quickly, many experts currently believe the problem may be due to either anxiety or a neurobiological pathology. this leaves open the question of what exactly constitutes premature ejaculation; the major problem in finding a consensus in definition is that premature ejaculation is a very variable condition, affecting some men for all their lives from their first sexual encounter onwards, while it affects others only occasionally. This has led to the suggestion that men who have had life-long premature ejaculation and who ejaculate very quickly - say within a minute of penetration - should be given medication to deal with the condition. Lifelong premature ejaculation has the following characteristics: Ejaculation occurs too soon every time a man makes love, and with every partner he has This premature ejaculation occurs from the first time a man has sex and continues thereafter The man ejaculates within two minutes of penetration or even before he has attempted to penetrate his partner The speed of a man's ejaculation does not slow down as he gets older; indeed, it may even speed up. The current thinking around lifelong premature ejaculation like this is that drug treatment may be effective. Acquired premature ejaculation is defined in a different way: A man has had normal sexual experiences before he develops premature ejaculation. The onset of this condition may be gradual or sudden. It may be linked to other physical or emotional conditions such as relationship problems, urological dysfunction, erectile dysfunction and so on. There's a tendency to over-classify among some researchers, and in my opinion that is exemplified in the following categories of premature ejaculation which have been proposed: Natural variable premature ejaculation - this is, as you might expect, a variation in a man's natural sexual performance, such as might occur with a new partner or with higher than normal anxiety. It's supposedly characterized by: an ejaculation time of less than one and a half minutes, a reduced ability to control ejaculation, and inconsistent and irregular ejaculations. In essence, this is in large part a confidence issue, and men who have it are not candidates for treatment with drugs. Premature ejaculatory dysfunction - this is a man who complains of coming too soon, yet whose ejaculatory function is in fact almost normal (upwards of three minutes, and sometimes much longer, up to twenty minutes, perhaps). In other words, the problem is all in the man's imagination - he performs well in bed, but he refuses to accept this fact, and underestimates how long he is able to thrust before he ejaculates. There haven't been any studies which have identified hormonal problems in men with a tendency to rapid ejaculation. In one research study of the pituitary - testicular axis, men who experienced premature ejaculation (and this included all men, both those who showed anxiety and those who did not, those who sought out sex and those who avoided it alike), no differences of any significance were discovered in luteinizing hormone levels, total testosterone levels and free testosterone levels between men with PE and a control group. Other researchers (Fanciullaci et al.) have discussed the idea of penile hypersensitivity and a rapid bulbocavernosal reflex as possible causative factors in premature ejaculation. While it's true that other investigators have demonstrated that the lack of conscious control over ejaculation may be due to a hypersensitive and excitable glans, producing excessive neural stimulation, this hardly explains why men can learn to control their rapid ejaculation. On balance it seems more likely that the cause is psychogenic. However, Xin et al compared
somatosensory evoked nerve potentials (a measure of nerve reaction to
stimuli) in men with premature ejaculation and other men without and
discovered that the average latency was significantly
lower in both the dorsal nerve and the penile glans in men who experienced
premature ejaculation. In contrast, work by Paick
et al investigated the penile sensitivity of a group of men with a
lifelong premature ejaculation (LPE) and a group of men without and
reported there was no
statistically significant difference in the men's' response to vibratory threshold.
Nor did they find any statistically significant differences
in the sensitivity of the men's' glans, the sensitivity of their penile shafts, or
the sensitivity of their frenulums. The researchers concluded that penile
hypersensitivity, as measured by reaction to vibration, does not appear to be a
major factor in the causation of premature ejaculation.
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