As we all know, premature ejaculation is actually very common – it’s the most common male sexual dysfunction. It is not fully understood what causes PE, but it’s clear that both physical and psychosocial factors play a role.
Historically, the etiology of PE has been attributed to a variety of psychogenic causes including psychodynamic formulations from Dr James Semans in the 1950s, Dr Masters and Virginia Johnston in the 60s, and Helen Singer Kaplan in the 70s.
They all believed that PE was more or less either learned behaviour or a conditioned response caused by early sexual experiences – sexual experiences that were rushed and associated with anxiety.
It is true that this viewpoint has a compelling commonsense appeal: we all know that sexual experiences in adolescence and early adulthood can be furtive, hurried, and unsatisfactory.
We also know that they can be associated with a great deal of anxiety, since the social pressures on adolescents and young adults to be sexual, and to behave in a particular way, is considerable.
Nonetheless although many of us feel that we know what premature ejaculation is, and maybe even what causes it, there is no hard evidence that specific psychological traits or personality styles are closely linked with rapid ejaculation.
However, we do know that depression and anxiety disorders can appear as sexual dysfunctions of some kind.
The essence of the problem is that it’s difficult to separate cause and effect as far as psychosocial events are concerned: for instance is a man ejaculating quickly because his relationship is in difficulties, or is it more likely that his tendency to ejaculate quickly will be the cause of relationship difficulties?
Another factor that is important in considering both the etiology and the treatment for premature ejaculation is the fact that the man is not in a sexual relationship in isolation.
While he may feel anxiety about sex and lowered self-confidence, together with the interruption of intimacy that premature ejaculation inevitably brings, his partner is most likely to be affected by the impact on her self-esteem.
She may, perhaps, conclude that her partner doesn’t care about her, or that he can’t be bothered to improve his sexual performance for her sake.
She may think then the relationship may not be important to him.
Obviously, therefore, the effect of premature ejaculation on not only the man, but also his partner, and the relationship as a whole, needs to be considered when determining an effective treatment strategy.
Perelman also observes that although there was a large early literature which proposed a wide range of psychological etiologies, significant evidence has accumulated in recent years of organic factors playing a role in the variability of male ejaculatory latency.
But is it surprising that a review of the literature reveals that male ejaculatory latency is distributed along a normal curve similar to many other human characteristics? Hardly.
The organic factors that have been proposed as accounting for this type of curve include central nervous system effects such as hypersensitivity of serotonin receptors, variability in sex hormone levels, variability in sexual “arousability”, a hypersensitive ejaculatory reflex, and even a theory that rapid ejaculation is actually the normal sexual male condition.
This latter suggestion arises from a historical perspective which suggests a male who copulated rapidly would be less at risk from predators than a male who took his time over reproduction.
Perelman observes that sexual therapy, in all its guises, can be effective as a treatment for premature ejaculation, but it does not work in all cases.
But from my experience this is more about the man’s determination to apply the techniques that he’s been given as a remedy for premature ejaculation rather than a reflection on the effectiveness of the techniques themselves.
It’s also important to note that sex therapy is actually an expensive and time-consuming business which may only be available for a certain class of individual.
It is also true, regardless of how many men have access to this therapy of this kind, that there are few scientific studies on effectiveness of rapid ejaculation treatment in the long term.