Premature Ejaculation

Is the persistent or recurrent experience of ejaculation with minimal sexual stimulation before or shortly after penetration it therefore occurs before the man wants it to occur. Sometimes, it is misperceived by the male as occurring "too soon" when, in reality, ejaculation is occurring within what is considered an average length of time.The normal physical response is for the man to experience climax, and therefore, ejaculate approximately 2 to 3 minutes after vaginal penetration.

With minimal sexual stimulation, the person often ejaculates earlier than he wants to (before, during or just after penetration). The clinician should evaluate age, novelty of partner or situation, frequency of sexual activity and other factors that can affect duration of the excitement phase.

It is not directly caused by substance use (medication or drug of abuse).

It causes marked distress or interpersonal problems.

Type Codes for the Sexual Dysfunctions

Specify 1 of:

Due to Psychological Factors or
Due to Combined Psychological Factors and a General Medical Condition.

Specify 1 of:

Lifelong (it occurs throughout the patient's active sexual life) or
Acquired (there has been a time when the patient did not have this sexual dysfunction).

Specify 1 of:

Generalized (the disorder occurs with all partners and in all situations) or Situational.

Associated Features:

Most common in younger, inexperienced males, but declines with age.

Differential Diagnosis:

Some disorders have similar or even the same symptoms. The clinician, therefore, in his/her diagnostic attempt, has to differentiate against the following disorders which need to be ruled out to establish a precise diagnosis.

Depression.
Physical Factors - diabetes, hypertension, alcohol abuse, smoking.
Medication - antidepressants, antipsychotics, diuretics and beta-blockers.
Multiple Sclerosis.
Spinal Injury.

Cause:

Erectile dysfunction is often a temporary response to stress or loss of confidence and responds well to psychosexual treatment, especially if morning erections occur. It may also be caused by physical factors,neurological or vascular, by medication, or may be secondary to the ageing process.

The disorder may have an onset later in life or have been in effect for the person's entire life, and it can manifest in specific situations or in almost all situations. There are physical causes which should be considered, but the vast majority of such situations arise from psychological experiences and become associated with fear that it will simply happen again.

Premature ejaculation may also be caused or aggravated by psychological factors such as guilt, fear, performance anxiety, especially in the inexperienced partner or with partners new to each other) and interpersonal issues affecting the couple.

Treatment:

Treatment may involve the clinician simply explaining why premature ejaculation occurs, assuring the person or couple that it is a normal part of the male sexual response, and providing techniques that may assist the man in learning to delay ejaculation.

Such behavioral techniques may include:

The "stop and start" method:

This involves sexual stimulation until the man recognizes that he is about to ejaculate, the stimulation is then stopped for about thirty seconds and then may be resumed. The sequence is repeated until ejaculation is desired, the final time allowing the stimulation to continue until ejaculation occurs.

The "squeeze" method

This involves sexual stimulation until the man recognizes that he is about to ejaculate, at that point, the man or his partner gently squeezes the end of the penis (where the glans meets the shaft) for several seconds whilst withholding further sexual stimulation for about 30 seconds, and then resuming stimulation. The sequence may be repeated by the person or couple until ejaculation is desired, the final time allowing the stimulation to continue until ejaculation occurs.

Counseling and Psychotherapy [ See Sex Therapy Section ]:

If pronounced psychological or interpersonal factors appear to be involved, professional counseling or psychotherapy may be necessary.

Pharmacotherapy [ See Psychopharmacology Section ] :

In some cases antidepressants may be prescribed to control any anxiety.