Premature Ejaculation

Premature Ejaculation (PE) occurs when a man experiences orgasm and expels semen soon after sexual penetration and with minimal penile stimulation. It has also been called early ejaculation, rapid ejaculation, rapid climax, premature climax, and (historically) ejaculation praecox. There is no uniform cut-off defining “premature,” but a consensus of experts at the International Society for Sexual Medicine endorsed a definition including “ejaculation which always or nearly always occurs prior to or within about one minute.” The International Classification of Diseases(ICD-10) applies a cut-off of 15 seconds from the beginning of intercourse.

Although men with premature ejaculation describe feeling that they have less control over ejaculating, it is not clear if that is true, and many or most average men also report that they wish they could last longer. Men’s typical ejaculatory latency is approximately 4–8 minutes.

Men with PE often report emotional and relationship distress, and some avoid pursuing sexual relationships because of PE-related embarrassment.Compared with men, women consider PE less of a problem, but several studies show that the condition also causes female partners distress.

PREVALENCE

Premature ejaculation is the most prevalent sexual dysfunction in men; however, because of the variability in time required to ejaculate and in partners’ desired duration of sex, exact prevalence rates of PE are difficult to determine. In the “Sex in America” surveys (1999 and 2008), University of Chicago researchers found that between adolescence and age 59, approximately 30% of men reported having experienced PE at least once during the previous 12 months, whereas about 10 percent reported erectile dysfunction (ED).After age 60, ED becomes men’s most prevalent sex problem, however premature ejaculation remains a significant concern affecting 28 percent of men age 65–74, and 22 percent of age 75–85. Other studies report PE prevalence ranging from 3 percent to 41 percent of men over 18, but the great majority estimate a prevalence of 20 to 30 percent—making PE men’s most common sex problem.

There is a common misconception that younger men are more likely to suffer premature ejaculation and that its frequency decreases with age. Prevalence studies have indicated, however, that rates of PE are constant across age groups.

MECHANISM OF EJACULATION

The physical process of ejaculation requires two actions: emission and expulsion.

Mechanism of Ejaculation

The emission is the first phase. It involves deposition fluid from the ampullary vas deferens, seminal vesicles, and prostate gland into the posterior urethra. The second phase is the expulsion phase. It involves closure of bladder neck, followed by the rhythmic contractions of the urethra by pelvic-perineal and bulbospongiosus muscle, and intermittent relaxation of external urethral sphincters.

Sympathetic motor neurons control the emission phase of ejaculation reflex, and expulsion phase is executed by somatic and autonomic motor neurons. These motor neurons are located in the thoracolumbar and lumbosacral spinal cord and are activated in a coordinated manner when sufficient sensory input to reach the ejaculatory threshold has entered the central nervous system.

INTROMISSION TIME

Current evidence supports an average intravaginal ejaculation latency time (IELT) of six and a half minutes in 18–30 year olds. If the disorder is defined as an IELT percentile below 2.5, then premature ejaculation could be suggested by an IELT of less than about two minutes. Nevertheless, it is possible that men with abnormally low IELTs could be “happy” with their performance and do not report a lack of control. Likewise, those with higher IELTs may consider themselves premature ejaculators, suffer from detrimental side effects normally associated with premature ejaculation, and even benefit from treatment.

CAUSES

The causes of premature ejaculation are unclear. Many theories have been suggested, including that PE was the result of masturbating quickly during adolescence to avoid being caught by an adult, of performance anxiety, of an unresolved Oedipal conflict, of passive-aggressiveness, and having too little sex—but there is little evidence to support any of these theories.

Several physiological mechanisms have been hypothesized to contribute to causing premature ejaculation including serotonin receptors, a genetic predisposition, elevated penile sensitivity, and nerve conduction atypicalities.

The nucleus paragigantocellularis of the brain has been identified as involved in ejaculatory control. Scientists have long suspected a genetic link to certain forms of premature ejaculation. In one study, 91 percent of men who have had premature ejaculation for their entire lives also had a first-relative with lifelong premature ejaculation. Other researchers have noted that men who have premature ejaculation have a faster neurological response in the pelvic muscles. PE may be caused by prostatitis or as a drug side effect.