Premature Ejaculation – Understanding the Disorder and What Causes it
As a male, you might be reading this and wondering if you truly suffer from premature ejaculation (PE) or if you simply do not last as long as you’d like to when making love and just have poor sexual stamina.
Clinical premature ejaculation is a very real disorder and is one of the most common sexual dysfunctions in men (along with erectile dysfunction).
Here are some clinical observations related to premature ejaculation straight from doctors that treat patients and researchers that survey large samples of men to find out what exactly is going on with men that reach orgasm too quickly. Read through the specifics of what premature ejaculation is and how to determine if you suffer from this dysfunction. You’ll also see what some of the factors are that may lead to PE or may also occur alongside PE.
In another recent article, the Fleshlight Stamina Training Unit was mentioned as a tool to help improve your sexual performance. If you believe that you are suffering from premature ejaculation, the STU can certainly be of benefit to you, but you will see that you would be wisest to consult your doctor to run a panel of tests for any other underlying causes.
What Exactly is Premature Ejaculation
The definition of the diagnosis of premature ejaculation is one that is constantly evolving.
The current Diagnostic and Statistical Manual of Mental Disorders (DSM-5, the guidelines that Psychiatrists use to diagnose a patient) identifies several factors that must be present in order for a diagnosis of premature ejaculation (American Psychiatric Association).
- A persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately 1 minute following vaginal penetration and before the individual wishes it;
- The symptom in Criterion A must have been present for at least six months and must be experienced on almost all or all (approximately 75–100%) occasions of sexual activity (in identified situation contexts or, if generalized, in all contexts);
- The symptom in Criterion A causes clinically significant distress in the individual;
- The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition.
What is Premature Ejaculation – Simplified
- Are you unable to avoid reaching orgasm within about a minute after penetration and does this happen regularly?
- Has this been occurring consistently for at least 6 months?
- Does this significantly add stress to your life? Does is add stress to your partner’s life?
- Have you ruled out other things that could cause PE-like symptoms in your life, such as significant stress, medications, or other medical conditions?
Who Suffers from PE?
In 2007, a survey of over 12,000 men in the United States, Germany, and Italy, the prevalence of premature ejaculation was approximately 22% in men aged 18-70 (Porst, et. al).
Men that reported to suffer from PE reported to have used a variety of tactics to improve the quality of their sexual intercourse. Over 50% had used special positions during sex, pauses and breaks during sex to regain control, specially timed masturbation, and having more intercourse than usual to attempt to combat their lack of stamina.
Shockingly, only 9% of men reported speaking with their doctor about their condition and over 80% of those men had to initiate the conversation about premature ejaculation with their family physician.
Even more upsetting is the fact that 91% of men that spoke with their doctor about their PE dysfunction were not satisfied with the results that the treatment offered.
A whole lot of men are having an issue with reaching orgasm too quickly and very few are getting help. Those that are asking for help are finding that the help isn’t working. What’s needed here?
Factors that can Contribute to PE
Research on premature ejaculation is vast, but there doesn’t appear to be one clear contributing factor that causes PE. While research continues on all of these areas, there isn’t an obvious remedy that every man can take that will help his problem.
This list, however, may spark an idea or cause you to look a bit more closely at improving a certain area of your life.
1. Psychological Problems
Certain psychological problems have long been touted as the cause of premature ejaculation. This includes sexual performance anxiety, relationship issues, or psychological issues.
It is easy to pin the blame on anxiety for causing PE. For most men, it seems to make sense that the thing that you’re most anxious about happening, always happens. Doctors, however, aren’t certain that performance anxiety is the root cause here.
Men with underlying anxiety disorders, however, are more likely to experience performance anxiety related to sex and PE. (Rajkumar et al, 2015)
Other psychological issues can also affect PE. Risky sexual behavior is often associated with occurrences of premature ejaculation. This can include the fear of discovery (such as having sex in public places), sex with prostitutes, or fear of pregnancy or sexually transmitted diseases when practicing unsafe sex.
Social phobia also highly co-occurs with PE and PE is the most highly associated sexual dysfunction associated with men who suffer from social anxiety.
2. Other Sexual Dysfunctions
Hypoactive (low) sexual desire, erectile dysfunction, and sexual dysfunction in the male’s partner (female sexual dysfunction) are the three main co-occurring sexual dysfunctions that present with premature ejaculation.
a) Low sexual desire causing PE is thought to stem from an unconscious desire to end sexual relations as soon as possible. Alternatively, low sexual desire may stem from continual frustrations with PE. It’s a vicious cycle.
b) Erectile dysfunction, or inability to have and maintain full erections, is also associated with PE and patients that have PE and low desire are often found to have severe erectile dysfunction.
c) Female sexual dysfunction (FSD) is common in women and can include anorgasmia (failure to orgasm), low sexual desire, sexual aversion, and sexual pain disorders. In some cases, the FSD may be caused by her partner’s PE, and in other cases, the PE may be caused, or exacerbated by the FSD. It is important to consider the partner’s role when treating men with PE.
3. Endocrine (Hormonal) Risk factors
a) Low serum testosterone levels have been sometimes associated with premature ejaculation. Testosterone plays a large role in the sexual response of men and new data indicates that it may have a central role in the ejaculation mechanism.
b) Prolactin – is a hormone that provides the body with sexual gratification after sexual acts. This is what is thought to cause the refractory period after orgasm. Low prolactin levels have been found to be co-occurring with some instances of PE and it is not know currently if they are a consequence or a cause of PE.
c) Thyroid hormones – many men with thyroid hormone disorders have sexual dysfunctions as well.
Prostatitis is inflammation of the prostate gland, by bacterial infection or other factors. A common symptom of prostatitis is painful ejaculation. A very high amount of patients suffering from premature ejaculation are found to have inflammation of their prostates. Sometimes, antibiotic treatment is sufficient to help delay ejaculation.
Clinical reports that attempt to link circumcision and premature ejaculation are varied and mostly inconclusive. The thought is that circumcision affects penile sensitivity and sexual satisfaction, which can be related to premature ejaculation.
Premature ejaculation is a very real and very prevalent disorder that affects millions of men around the world. As you have seen, there are many different reasons why a male might suffer from PE and there does not seem to be one direct cause/treatment.
In the next article, you’ll read what the current treatment plans are for patients that suffer from premature ejaculation. You’ll see that a variety of methods are used and not one single one can be touted as the best way to treat this condition.
>> Next Article >> Premature Ejaculation – Current Treatment Options
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5®), Fifth Edition. Washington, DC: American Psychiatric Association, 2013. [Ref list]
Porst H, Montorsi F, Rosen RC, et al. The Premature Ejaculation Prevalence and Attitudes (PEPA) survey: prevalence, comorbidities, and professional help-seeking. Eur Urol 2007;51:816-23; discussion 824. 10.1016/j.eururo.2006.07.004 [PubMed] [Cross Ref]
McMahon CG, Jannini EA, Serefoglu EC, Hellstrom WJG. The pathophysiology of acquired premature ejaculation. Translational Andrology and Urology. 2016;5(4):434-449. doi:10.21037/tau.2016.07.06.
(Rajkumar et al, 2015) RP, Kumaran AK. Depression and anxiety in men with sexual dysfunction: a retrospective study. Compr Psychiatry2015;60:114-8. 10.1016/j.comppsych.2015.03.001 [PubMed][Cross Ref] [Ref list])