Definition of Premature Ejaculation
Variation in the
time between penetration and ejaculation - and premature ejaculation
itself - is common and normal. However, when the time before
ejaculation is really short at every attempt at intercourse, the cause
of the early ejaculation may be neurobiological, medical and/or
psychological. Premature ejaculation has invoked many different
theories, approaches and treatment methods but few of them have been
shown to work.
At the heart of the debate is the
need to find a reliable definition of the term premature ejaculation. In
this context we may need to distinguish between premature ejaculation as
a complaint and PE as a syndrome.
As a complaint, premature ejaculation may
just be a part of the normal variation of time to ejaculation in
different men, or it may be the result of some kind of medical
condition. What this means in practice is that men who only occasionally
come too soon could be said to have natural variable premature
ejaculation, while in those men where early ejaculation is present from
the first sexual encounter and occurs every time they have sex, and
maybe very soon after penetration, there is a diagnosis of lifelong
premature ejaculation to be made. On the other hand, men who say that
they have premature ejaculation but who ejaculate after a reasonable
time, for example perhaps 5 to 10 minutes after penetration, may be
diagnosed as having premature-like ejaculatory dysfunction. (This seems
to me to do nothing more than satisfy the scientists' need for
classification - it does not seem like a helpful category. Surely men
who last ten minutes in bed are normal and do not have any kind of
premature or early ejaculation?)
Certainly men who fall into this latter
category seem to have more of a psychological problem than a real one,
and probably need counseling, and education about what is normal during
sex.
Those men who have lifelong premature ejaculation
and are
desperate to last longer in bed and
indeed to last longer during sex
generally may find a cure explained on this
website.
An alternative treatment
which has been proposed is treatment with
drugs.
The Diagnostic Manual of Mental Disorders
Definitions of PE tend to be subjective, though the DSM (fourth edition,
revised text) also known as the DSMIV-TR, published by the United States
Psychiatric Association, defines it as persistent or recurrent
ejaculation after minimal stimulation before, on, or just after
penetration and before the man wishes it.
The DSM goes on to acknowledge the subjective element in this definition
by acknowledging that the doctor must recognize those factors which
affect duration of the excitement phase of sexual intercourse: these
include age of the sexual participants, newness of the sexual partner or
situation, and how often the man has had sex in the recent past.
So in other words, premature ejaculation
can be though of as only occurring when an early ejaculation causes
distress or interpersonal difficulty. That's an interesting concept,
because
not being able to last long enough in bed is for many men a really
distressing situation. Indeed, most men who come
quickly would be extremely grateful for any cure which enabled them to
last longer during sex.
According to the ICD (10th edition) which is
issued by the World Health Organization, premature ejaculation is the
inability to delay ejaculation enough to enjoy lovemaking, and takes the
form of ejaculation before penetration or very soon after the start of
intercourse, though they define it as within 15 seconds of intercourse
starting, which seems to be extremely restrictive. Many men who cannot
last longer than a minute would consider themselves to have premature
ejaculation. In any event, what is clear is that satisfying intercourse
is often not possible regardless of how long the man lasts before he
ejaculates.
So on the one hand we have a definition which speaks of fifteen seconds
of sex before ejaculation; on the other we have a definition which
requires a man to experience distress during sex. Both of these
definitions are subjective, of course, and the absence of a time cut-off
point which all can agree on makes them of potentially limited use.
After all - doesn't a man know when he has premature ejaculation?
I think the answer to this is - no, not
always, for he may not know how long the average time between
penetration and ejaculation actually is, nor may he know how his sexual
performance compares to other men's, and he may be under pressure from
his partner because, for example, of her failure to reach orgasm during
intercourse, while in fact his sexual performance is quite normal.
Premature ejaculation is the most common male sexual
problem. As we know, one of the fundamental problems with premature ejaculation
is that there is no universally accepted definition, nor is there a drug
treatment for it. (At least, not one approved for use in America.) Even so, most
of us would probably recognize a case of premature ejaculation, especially if
one
were the man in question! The accepted treatment for premature ejaculation
continues to be behavioral therapy - the question is whether or not there is a
better approach, or a more effective one.
Most experts would agree that between a quarter and four
tenths of all men experience ejaculation before they wish it to happen. Of
course, perception is a big factor in this condition, and most doctors or
therapists will use the definition in The Diagnostic and Statistical Manual of
Mental Disorders, Fourth Edition, which is: "Premature ejaculation is persistent or
recurrent ejaculation with minimal sexual stimulation before, on, or shortly
after penetration and before the man in question wishes it."
In addition, when you define premature ejaculation this
way, the definition specifies that premature ejaculation must cause marked distress or interpersonal difficulty.
Another definition is that premature ejaculation is "persistent or repeated ejaculation with
little stimulation before or just after penetration and certainly before the man wishes it,
and over which the man in question has almost no voluntary control." There's
also a rider that the speed of ejaculation must cause the man or his partner
some emotional distress. Well, that of course is highly subjective, and not all
couples are bothered to that extent by a quick ejaculation, even if the man in
question would like to be able to last longer in bed.
The key things, of course, is that (1) there is a short interval between penetration
(intromission) and
ejaculation, (2) that there is a lack of voluntary control over ejaculation and
that (3) there is some emotional upset for one or both partners. Now, those of
us who have counseled men with premature ejaculation might take issue with the
idea that "upset" or "distress" on the part of one or both
partners is a necessary antecedent for the condition to be defined as premature
ejaculation. Certainly I have met many men who wished they could last longer in
bed but who do not allow it to cause them emotional distress or suffering!
There is one definition, in the International Classification of Diseases, Tenth Edition,
that specifies a time limit for the length of lovemaking - fifteen seconds.
Well, that seems nothing less than ridiculous, for many men who ejaculate within
two (or five) minutes would probably consider themselves premature ejaculators,
so fifteen seconds is ludicrous, and in any case, any defined cut-off
time is purely arbitrary.
Having said that, most experts agree that men who ejaculate within one minute of
insertion or penetration have premature ejaculation. Waldinger and colleagues
have done much to define time limits between insertion and ejaculation that may
be considered to fall within the definition of premature ejaculation. Their median
is 5.4 minutes. Such definitions have been welcomed by researchers as a way to
assess the effectiveness of treatments.
Definition of premature ejaculation - what is premature ejaculation?
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