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Premature ejaculation (PE) is considered the most common sexual dysfunction in men, affecting approximately 30% of men. However, in the past, the definition of PE has not been consistent and has changed over time. This has caused confusion, even with urologists. Recent definitions of lifelong and acquired PE help clarify diagnoses for physicians but still make it difficult for men with PE concerns to address their needs. Our intention here is to simplify the new definitions in order to help men deteremine if they should visit their physician or possibly seek over-the-counter medication for treatment.
The most common clinical definitions of premature ejaculation come from the Society of Sexual Medicine and are published in the Journal of Sexual Medicine. In the past, PE was primarily considered a mental disorder. Fortunately, knowledge about how penis sensitivity and serotonin levels in the brain affect the ejaulation response is dispelling beliefs that PE is primarily a psychological issue. It should be noted that erectile dysfunction was also considered a mental disorder prior to the undertanding of its causes.
Prof. dr. Marcel D. Waldinger (MD, PhD), a neuropsychiatrist and Professor in Sexual Psychopharmacology at the Division of Pharmacology of the Departement Pharmaceutical Sciences of the University of Utrecht, in the Netherlands, has published extensively about PE and is often credited for the transition of PE as a pyschosomatic disorder to a neurobiological one. Professor Waldinger published the following table in Premature Ejaculation - From Etiology to Diagnosis and Treatment (2013) which illuminates the shift in thinking towards neurobiological origins.
|Authors||Postulated Etiology and Pathogenesis of PE||Advocated Treatment of PE|
|1917||Karl Abraham||PE is a neurosis, linked to unconscious conflicts||Psycho-analysis and psycho-analytic therapy.|
|1943||Bernhard Schapiro||PE is a psychosomatic disorder, linked to a weak genital system. There are two PE subtypes.||Topical anesthetic creams.|
|1970||William Masters and Virginia Johnson||PE is a behavioral disorder, linked to self-learned behavior.||Behavioral treatment (squeeze technique).|
|1998||Marcel Waldinger||Lifelong PE is a neurobiological-genetic disorder, linked to central serotonin neurotransmission dysfunctions. There are four PE subtypes (2006)||Selective serotonin reuptake inhibitors (SSRIs)|
The following table provides more recent definitions of PE used by urologists and psychiatrists worldwide, albeit still from a psychiatric orientation.
Diagnostic and Statistical Manual of Mental Disorders - American Psychiatric Association
|1980||DSM-III||Ejaculation occurs before the individual wishes it, because of recurrent and persistent absence of reasonable voluntary control of ejaculation and orgasm during sexual activity.|
|1987||DSM-III-R||Persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it.|
|1994||DSM-IV||Persistent or recurrent onset of orgasm and ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it and must also cause marked distress or interpersonal difficulty.|
|2000||DSM-IV-TR||Persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it. The clinician must take into account factors that affect duration of the excitement phase, such as age, novelty of the sexual partner or situation, and recent frequency of sexual activity.|
|2013||DSM-V||Similar to IV-TR with the added contraint: "ejaculation must occur within approximately one minute following vaginal penetration"|
The major concern among experts with the DSM definitions of PE is that they are all authority-based rather than evidence-based. As a result, in 2007, the International Society for Sexual Medicine (ISSM) appointed several international experts in PE to an Ad Hoc Committee for the Definition of PE. In 2014, the committee released new evidence-based definition of PE.
It is always best to see your doctor for any persistent changes that occur with your sexual function including premature ejaculation, erectile dysfunction, pain with ejaculation as well as severe delay or inability to experience ejaculation or orgasm. There may be medical conditions responsible for these changes which can be effectively treated. Using Professor Waldinger's four definitions of premature ejaculation, we offer some additional guidelines which may help you.
If you are experiencing ejaculation times during intercourse of approximately 3 minutes or less and they are occuring recently and it has not happened in the past, you may be experiecing "acquired premature ejaculation" and it is especially important that you see a physician. This condition known as "acquired premature ejaculation" may be caused by underlying physical problems such as hyperthyroidism, erectile difficulties and urological problems such as prostatitis. Visit our physician locator to find a phsyician near you that is an expert in sexual medicine. If there is not one near you, most urologists will be able to help you or see your primary care physician.
If you have experienced premature ejaculation all your life, and you are experiencing ejaculation times of approximately one minute or less (some clinicians use two minutes or less), you may be experiecing "lifelong premature ejaculation". You should consult a urologist in order receive a formal diagnosis. It is likely that this physician will recommend a topical medication because they are effective, easy-to-use and have a low side effect profile. Some urolgists in the U.S. will recommend a daily dose anti-depressant / SSRI for this condition. Although effective, these oral drugs have significant side effects and their use for PE is diminishing.
Some men experience premature ejaculation occasionally. This is normal and may occur for a variety of reasons including enhanced sexual excitement or the length of time since your previously had sex. It may also just be a normal variation in your ejaculation time.
Some men with normal ejaculation times believe that they are experiencing PE because they think that they should be lasting much longer or that they are not satisfying their sexual partner. It is important for men and their partners to understand that normal ejaculation times during intercourse are 5-7 minutes.
Common treatment options for premature ejaculation include selective serotonin reuptake inhibitors (SSRIs), topical anesthetics, behavioral therapy (e.g. squeeze technique) and even penile injection of medication designed to allow men to maintain an erection after ejaculation.
Dapoxetine is a faster-acting SSRI designed to minimize the side effects of other anti-depressants such as Paxil(r) and Zoloft(r). Priligy is the brand name for legally-available Dapoxetine. Priligy is not FDA-approved in the United States.
Topical medications are now the most common treatment option in the United States as they are effective, easy-to-use and have a very low side effect profile.