How To Define PE
The key thing, I think, that defines premature ejaculation is actually this: the man has no control over his ejaculation, that it happens outside of his conscious control, and usually before he or his partner wishes it to do so.
Men who have little or no control over ejaculation may be puzzled to learn that other men can actually decide when to “release” during sexual intercourse.
But the way they do it less mysterious than it seems. Men who can choose when to ejaculate change what they do during sexual intercourse so they can trigger their own orgasm wen they want, usually by speeding up the rhythm and pace of sex. This provides more stimulation to the glans penis and so triggers the reflex of ejaculation. Now, I should add that there are other ways of dong this which represent fundamentally different ways of making love. One of these is the coital alignment technique – a way of helping a woman reach orgasm during intercourse by changing the entire basis of sexual intercourse form thrusting to rocking. You can decide for yourself if this really is a better way of making love here.
Men who can’t do this have an oversensitive ejaculatory reflex, a statement which generally comes down to the fact that they are too aroused when they begin to make love and therefore ejaculate far too quickly for their own liking.
(They ascend the slope of sexual arousal much more quickly than other men, and stay below the point if imminent ejaculation for far too short a time. That means the duration of intercourse is “too short” – a subjective judgment at best, but a very easy tone to make, it has to be said.)
I say this based on many years’ experience helping men to overcome premature ejaculation. While scientists may look for oversensitive nervous networks in the penis, greater penile representation in areas of the neocortex, disturbances in serotonergic neurotransmission, and similar physical issues, they will never be able to separate cause and effect.
In other words, they fail to ask if a man is showing higher than normal sensitivity to stimulation of his penis because his brain has greater activity in its sexual networks, or whether a man’s brain is showing greater activity in its sexual networks because he is already aroused when he begins to enjoy intercourse.
Both anxiety and depression have been linked to rapid ejaculation, and those who have experienced the problem of lack of control during lovemaking will know that anxiety is a large part of a circular process which seems to make a man more anxious about engaging in lovemaking because of the possibility of ejaculating too quickly; needless to say, when he does ejaculate too quickly, he generates more anxiety about the same thing happening next time.
In the light of this rather commonplace observation, it seems to me futile to suggest that the cure of premature ejaculation lies in the administration of pharmaceutical drugs such as SSRIs.
Indeed, it might not be too cynical to suggest that much of the scientific research that has taken place in recent years about brain chemistry and PE is devoted to the pharmaceutical companies’ (or the doctors’) wish to medicalize what is actually a social and emotional condition.
I don’t rule out the possibility that certain conditions such as prostatitis might be responsible for playing a part in the generation of rapid ejaculation, but I do contest the thesis that this is a matter of brain physiology per se, rather than being mediated through emotional or psychological over arousal.
In a study by C. Basile Fasolo MD, V. Mirone MD, V. Gentile MD, F. Parazzini MD, E. Ricci ScD, reported in The Journal of Sexual Medicine 2 (3), 376–382. (doi:10.1111/j.1743-6109.2005.20350.x) there is a report on over 12,000 men, of whom about 2,500 self reported as having premature ejaculation. That in itself makes me suspicious, because a lot of men who ejaculate too quickly would not admit to it under such circumstances (personal interrogation by scientists) because of the shame associated with this condition.
However, if we are to take the data as meaningful, the results of the questionnaire which was administered to these 12,000 men might give some indication of the causative factors lie behind rapid ejaculation.
The men were asked whether or not they ejaculated on the majority of occasions on which they were involved in sexual activity with very little sexual stimulation.
(Those who self reported as having erectile dysfunction were excluded from the research on premature ejaculation.)
Using a combination of odds ratios at the 95% confidence interval, and multiple regression analysis, it was discovered that 569 out of 2658 men with premature ejaculation had had the condition all their lives. The mean age of this group men was 39 years.
An additional 1855 men, whose average age was 50 years, had so-called acquired premature ejaculation. Overall, as perhaps you might expect, the average age of a premature ejaculator was slightly lower than that of a non-premature ejaculator, which suggests that there is a considerable element of learning and discovery in a man’s ability to control his ejaculation. (No surprise there, perhaps.)
There were weak associations between the speed with which a man ejaculated and factors such as consumption of alcohol, the stress of employment, smoking, the possession of the short frenulum and/or hypospadias, and lack of sexual experience (which might be an age-related artifact).
But what does this tell us? It’s hard to know whether or not possessing a short frenulum or hypospadias are in themselves cause of premature ejaculation, or the speed of a man’s sexual response is mediated via the shame/embarrassment of having a penis that is different from the average.
For me, none of this is very significant. Any of these things can be mediated via anxiety, an inference which is supported by the fact that PE is indeed mostly seen in young men.
Interestingly enough, the researchers also discovered that a higher chance of having PE was associated with increased levels of education; the reason for this is not clear, although it may reflect factors such as the average stress levels associated with the socio-economic status of better educated men, or a cultural or social variation in the degree of shame about a man’s sexual performance, or even something more obscure like a cultural attitude to women’s sexual pleasure amongst men who possess lower levels of education.
Associations between rapid ejaculation and physical conditions are hard to establish, although Screponi and his colleagues did examine the relationship between prostate inflammation and prostatitis and PE; they found a degree of positive correlation.
(In fact, men with prostatitis were twice as likely as other men to have PE.) So although this study is far from conclusive, it does enable us to draw a few broad indications about the origin and etiology of premature ejaculation: risk factors include stress, high demands in one’s social or cultural life, congenital anomalies, higher alcohol consumption (which in itself could be an indication of high levels of emotional arousal or stress), and other social factors, all of which contribute to this particularly common male sexual dysfunction.