ABOUT PREMATURE EJACULATION
Types of PE
Premature Ejaculation (PE) is either:
- Lifelong (Primary) PE means that you have had the problem from the get-go.
- Acquired (Secondary) PE means that you have previously had control over ejaculation.
Both lifelong and acquired each affect around 5% of men.
Primary PE is usually more ‘severe’ than secondary PE.
Lifelong PE has a measurable effect on quality of life. The author finds it surprising that men with primary PE may not seek for help for many years. Once you realise that Lifelong PE is not a primary pyschological issue then you are more likely to stop beating yourself up about something over which you have little control.
First line treatment for Lifelong PE is pharmacological therapy and not psychological therapy. In other words, the problem is not psychological. The cause of Lifelong PE is frankly not known. However, evidence points towards genetically predisposed dysfunction of the serotonin (5-HT) receptor.
The most common cause of acquired PE appears to be a combination of erectile dysfunction (ED) with peformance anxiety.
Perhaps you notice that your erections aren’t as strong as you’d like. You might try to rush to avoid embarrassment. In other words, you will naturally speed up ejaculation to make sure that you don’t miss the boat! This heightened sense of performance is a form of anxiety. The trouble with perfomance anxiety is that it contributes to the problem it is trying to stop!
Physical causes of PE are less common, but include:
- Chronic Prostate inflammation (Chronic Prostatitis). Pointers include painful ejaculation, pelvic pain, and/or pain on passing urine.
- Thyroid hormone disorder
Diagnosis of PE
The time interval between vaginal penetration and ejaculation is the ‘latency time.’
The latency time provide some guidance as to what is normal although you are unlikely to want to start a stop watch.
The International Society for Sexual Medicine (ISSM) require the latency time for lifelong PE to be around or under 1 minute. The latency time for acquired PE is 3 minutes or less.
The other requirements for a diagnosis of PE would appear to be self-evident:
- ‘The inability to delay ejaculation on all or nearly all vaginal penetrations,’ and
- ‘Negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intimacy.
The author rarely finds the diagnosis of PE difficult. On occasion, a guy will be concerned about PE but report a good 3-5 minutes or longer before ejaculation occurs.
Two other types of PE are worth a mention. ‘Subjective PE’ describes the feeling of PE with a normal latency time. However, the latency time of 1 minute and 3 minutes in the definitions are arbitrary, and some men with subjective PE do seek treatment to prolong time to ejaculation.
‘Variable PE,’ describes inconsistent ejaculatory latency time that includes time in the normal range. This type of PE is likely to be acquired.
Do I need treatment?
Doctors are guided by level of patient concern.
Men with PE often report:
- low satisfaction with their sexual relationship
- low satisfaction with sexual intercourse
- less frequent intercourse
- low self-confidence
- mental distress, anxiety, embarrassment, depression
The Premature Ejaculation Prevalence and Attitudes survey found that ‘Only 9.0% of men with PE reported having consulted a physician for the condition.’
We encourage you to seek help if PE is causing issues in your life. The best known ‘PE Score’ is The Premature Ejaculation Diagnostic Tool (PEDT) Questionnaire which is a useful guide as to whether you are experiencing significant PE. Take the test now.