Premature Ejaculation
Premature ejaculation (PE) is the most common sexual dysfunction in men younger than 40 years. Most
professionals who treat premature ejaculation define this condition as the occurrence of ejaculation prior to the
wishes of both sexual partners. This broad definition thus avoids specifying a precise duration for sexual
relations and reaching a climax, which is variable and depends on many factors specific to the individuals engaging
in intimate relations. An occasional instance of premature ejaculation might not be cause for concern, but, if the
problem occurs with more than 50% of attempted sexual relations, a dysfunctional pattern usually exists for which
treatment may be appropriate.
To clarify, a male may reach climax after 8 minutes of sexual intercourse, but this is not premature ejaculation
if his partner regularly climaxes in 5 minutes and both are satisfied with the timing. Another male might delay his
ejaculation for a maximum of 20 minutes, yet he may consider this premature if his partner, even with foreplay,
requires 35 minutes of stimulation before reaching climax. If intercourse is the method of sexual stimulation for
the second example and the male climaxes after 20 minutes of intercourse and then loses his erection, satisfying
his partner (at least with intercourse), who needs 35 minutes to climax, is impossible.
Because many females are unable to reach climax at all with vaginal intercourse (no matter how prolonged), this
situation may actually represent delayed orgasm for the female partner rather than premature ejaculation for the
male; the problem can be either or both, depending on the point of view. This highlights the importance of
obtaining a thorough sexual history from the patient (and preferably from the couple).
The human sexual response can be divided into 3 phases: desire (libido), excitement (arousal), and orgasm. The
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) classifies sexual disorders into 4
categories: (1) primary, (2) general medical condition–related, (3) substance-induced, and (4) not otherwise
specified. Each of the 4 DSM-IV categories has disorders in all 3 sexual phases.
Premature ejaculation may be primary or secondary. Primary applies to individuals who have had the condition
since they became capable of functioning sexually (ie, postpuberty). Secondary indicates that the condition began
in an individual who previously experienced an acceptable level of ejaculatory control, and, for unknown reasons,
he began experiencing premature ejaculation later in life. With secondary premature ejaculation, the problem does
not relate to a general medical disorder, and it is usually not related to substance inducement, although, rarely,
hyperexcitability might relate to a psychotropic drug and resolves when the drug is withdrawn. Premature
ejaculation fits best into the category of not otherwise specified because no one really knows what causes it,
although psychological factors are suggested in most cases.
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