Mostly due to difficulties in researching sexual issues, the frequency of premature ejaculation in the male population is not actually know with any degree of certainty.
For one thing, there are different degrees of the condition: it may occur in all situations, with all partners (generalized premature ejaculation), or it may occur only at certain times with certain partners (situational).
It may be present for man’s entire life (lifelong premature ejaculation), or it may be acquired later in life.
Furthermore, anyone who is working in the field of sex therapy will know only too clearly that when a man is stimulating himself during masturbation, he subjectively experiences himself as having a much greater degree of control over ejaculatory latency than when he’s enjoying sexual relationships with a partner.
Could this mean there are interpersonal dynamics at work in the etiology of premature ejaculation? Of course!
However, as far as its frequency in the population is concerned, my own experience dealing with men who have sexual difficulties makes me think the majority of men ejaculate more quickly than they would like and they don’t have much control over their ejaculation
The majority of men means over 50% of the general population.
It’s also worth recording at this point that the female partners of men who regard themselves as having rapid ejaculation report lower levels of sexual satisfaction, and higher levels of interpersonal difficulty, than partners of men who do not see themselves as having premature ejaculation.
Hartmann and his colleagues have reported that men with PE tend to think about ejaculatory control (or lack of it) and tend to experience anxiety during sex, while men who do not have this problem seem to think about sexual arousal and sexual satisfaction.
In an article published in the Journal of Sexual Medicine in 2006, he proposed that the best therapy for premature ejaculation would be a combination of sex therapy and pharmaceuticals.
Etiology of Ejaculation Problems
Just to recap briefly about the mechanism of ejaculation: as you may be aware, ejaculation is the end product of the sexual response cycle which begins with arousal, moves through the so-called plateau phase, and ends with ejaculation and orgasm, followed by resolution or recovery.
Of course, ejaculation is a physical event caused by a reflex in the body, while orgasm is a mental phenomenon which is subjectively experienced as feelings of great pleasure.
Ejaculation itself is composed of two events: emission and expulsion. The emission phase involves the deposition of seminal fluid into the posterior urethra, an event which is experienced as the point of ejaculatory inevitability, commonly known as the point of no return. This terms describes a physiological reality, because once emission has occurred, ejaculation is but seconds away.
Ejaculation is the muscular expulsion of seminal fluid from the penis, a sophisticated series of events involving co-ordinated contraction of a number of muscles around the pelvic area, in particular the bulbospongiosus muscle.
In the run-up to ejaculation a man will experience a number of bodily sensations and changes associated with the peak of arousal, including the movement of the testicles upwards, myotonia, raised blood pressure, rapid heart rate and muscular tension.
These are the signals which can be used to enable a man to recognize that he’s on the verge of ejaculation, and which, if he’s sufficiently motivated, can be used as an indicator that prompts him to change his behaviour and enables him to delay his ejaculation during sexual intercourse.
In essence, what a man with premature ejaculation must do to find a complete remedy for the condition is to reduce the level of his mental and physical arousal so that it remains below the point of no return as he receives sexual stimulation.
The Role of the Nervous System
The central nervous system obviously plays a major role in the ejaculatory reflex, involving both serotonergic and dopaminergic neurons.
The exact neurological pathways that control the ejaculatory reflex are the subject of continuing research; what is known for certain is that the serotonergic system is involved in ejaculation, and there are close associations between the level of serotonin in certain male mammals and the speed with which they ejaculate.
Waldinger and his colleagues have been the most active proponents of the brain chemistry explanation for rapid ejaculation, but it does seem clear that in most cases of the etiology of premature ejaculation is the product of a combination of emotional, psychosocial, and physical factors.
If you regard the point of ejaculation as the product of a number of factors, it is clear that for any individual, there may be considerable differences in the particular combination of factors that leads them to ejaculate quickly.
All that can be said about the causes of premature ejaculation, is that they are a a reflection of both man’s genetic disposition to short ejaculatory latency time, interacting with social, relationship, emotional and psychodynamic issues.
And it has to be said that this is not a particularly helpful explanation of the condition: after all, we all know that Genes + Behavior = Outcome.
In many trials of treatments for PE, it is the intravaginal ejaculatory latency time (IELT) which is used as a kind of diagnostic measure, as well as a measure of the success of any treatment method.
However, many clinicians actually ignore the IELT and use their own subjective impression of whether a man is a premature ejaculator or not. Clearly this is unsatisfactory for scientific research.
A fact that Perelman emphasizes is that while some men naturally last longer than others, it’s a man’s ability to actually identify the signals that his body gives him in advance of his approach to the point of no return that allows him to exercise some kind of control over premature ejaculation by changing his behaviour.
In other words, for a man to voluntarily delay ejaculation, he must choose to respond to the sensations that he receives before he ejaculates in such a way that he delays his orgasm.
Many men report that they try and avoid ejaculation by focusing on distracting thoughts, although as you may already know, this rarely works.