Many men wonder how long they should “last” prior to ejaculating during sexual activity. There are several definitions of Premature Ejaculation. The International Society for Sexual Medicine (ISSM) defines PE as:
“A man sexual dysfunction characterized by ejaculation which always or nearly always occurs prior to or within about one minute of vaginal penetration, and the inability to delay ejaculation on all or nearly all vaginal penetrations, and negative personal consequences, such as distress, bother, frustration and/or avoidance of sexual intimacy.”
Under this definition, we can see the common aspects of PE included in all definitions:
Short ejaculatory latency
Lack of perceived self-efficacy or control about the timing of ejaculation
Distress or interpersonal difficulty
The DSM 5 has accepted the ISSM definition but added that the condition needs to be present for at least 6 months and occur in 75% or more of sexual intercourse events. The DSM 5 further specified types of PE:
Lifelong PE occurs when a man has always struggled with the dysfunction. Two out of three men diagnosed with PE fall into this category, which indicates the likelihood of a biological vulnerability.
Acquired PE occurs with a man who previously had the ability to control ejaculation later developed the condition.
Generalized PE occurs when a man has these symptoms with all his sexual partners.
Specific PE occurs when a man has a variable pattern of normal ejaculation with some partners and rapid ejaculation with other partners, which indicates psychological factors contributing to the symptoms.
Anteportal ejaculation occurs when a man ejaculates prior to penetration and this is the most severe type of PE. Men with this condition many times seek medical attention when they are trying to conceive a child. 5% of men with lifelong PE have anteportal ejaculation.
It is important to note that some men will report concerns of PE symptoms, but they merely do not have appropriate sex education or their perception of an issue is due to relationship dynamics or psychological problems within the individual.
There is a misconception that PE will diminish by age, but this has not been found. PE is the most common sexual dysfunction in men, and it has been found that 20 to 30% of men have PE. This diagnosis is consistent among all ages from 18 to 70 years old.
Why Do I Have PE? Why Does My Partner Have PE?
For many years, clinicians thought PE was a psychological or learned condition. Research has now shown that there may be underlying physical causes, or biological predispositions, although men with the condition will still manifest a psychological response that can worsen the condition and negatively impact the man’s relationship.
There are different biological theories as to what could contribute to a man having PE:
Dysfunction of serotonin receptors: it has been found that some receptors delay and some speed up ejaculation.
Genetic studies have shown that in twin studies, males in the same family can have PE, lending itself to evidence that there is a genetic predisposition to PE.
50% of men with hyperthyroidism have PE; however, when the condition was treated, only 15% of men had the same PE symptoms.
It has been found that increased penile sensitivity or nerve condition abnormalities can cause PE symptoms.
Although the pathophysiology of PE is not completely understood, the overlap between biological and psychological contributions lends itself towards treating PE from a multi-disciplinary standpoint.
No psychological explanations for PE are based on evidence-based research to date.
In 1927, Karl Abraham, a psychoanalyst, attributed PE to a man’s unconscious hostile feelings towards women and passive pleasure as a child in losing control or urination. Further, Dr. Abraham explained a man’s unconscious motivation to be deriving a woman of sexual pleasure by not ejaculation into her vagina and “soiling her”.
Other psychoanalytic thoughts during that time held the position that PE is due to a man’s unresolved narcissism during infancy and their selfishness with not wanting to pleasure their partners.
In 1943, Bernard Schapiro defined PE as a psychosomatic disorder; a bodily symptom that expresses the man’s psychological conflict. These theories see anxiety being present prior to symptoms of PE.
In 1970, William Masters & Virginia Johnson characterized PE as an “early learned experience”. They based this conceptualization on reviewing case histories of men with PE to find that men with PE often had first sexual experiences that were characterized by haste and nervousness.
In 1989, Helen Singer Kaplan attributed PE symptoms to a “lack of sexual sensory awareness” as the here-and-now cause of PE. She found that men didn’t develop sufficient feedback regarding their level of sexual arousal and would often go from low levels of arousal to ejaculation without being aware of how the transition happened.
Today, sex therapy and psychotherapy can utilize parts of all of many of these early theoretical approaches to conceptualizing and treating PE, addition to advancements made in the field.
Once symptoms of PE occur, regardless of the cause, many men develop performance anxiety. Performance anxiety can maintain symptoms of PE well beyond any biological contribution. Performance anxiety distracts men from focusing on their level of arousal so they are unable to exert voluntary control over sexual arousal and ejaculation.
Men developed distorted thought patterns with the belief that focusing on their arousal will only lead to more rapid ejaculation, thus causes them to stop focusing on their sexual response in the moment.
The Overall Negative Impact of PE is Significant
The presence of PE has a significantly negative impact on the man and his relationship.
68% of men with PE experience a decrease in sexual self-confidence.
50% of single men with PE report avoidance of relationships or reluctance to establish new relationships.
67% of men report being too embarrassed to speak with their physician about having PE.
47% of men do not know that treatment for PE even exists.
Men with PE are likely to focus on controlling their orgasm, anxiously anticipating that they will ejaculate too soon and are flooded with feelings of embarrassment and fear of losing their erections. Secondary erectile dysfunction can develop in this situation.
Men with PE are not likely to be able to focus on sexual arousal and satisfaction. Men with PE scored lower on all aspects of intimacy (emotional, social, sexual, recreational, and intellectual) and had lower levels of satisfaction in these areas. Men’s partners were typically distressed about the quality of men’s performance and the disruption to their intimacy. Many women may see themselves as the problem, while others can get angry that their partner’s don’t “fix” the problem. Men often believe their partners don’t understand their frustration and humiliation. Overall, this interpersonal interplay leads to relationship dissatisfaction.