Premature ejaculation

    
     Premature ejaculation (ejaculatio praecox, rapid ejaculation, or early ejaculation) is the most frequent male ejaculatory disturbance. During the last century, premature ejaculation has been considered from both a medical and a psychological view, often resulting in contrasting psychotherapeutic and drug treatment approaches.
     Premature ejaculation is often cited as being the most common male sexual dysfunction.
     The exact prevalence, however, is unknown as this appeared difficult to determine. Although it has been estimated that as many as 36% of all men in the general population experience premature ejaculation.
     For many decades, premature ejaculation was considered to be a psychological disorder that had to be treated with psychotherapy. However, psychological treatments and underlying theories mostly relied on case reports, series of case report studies, and opinions of some leading psychotherapists and sexologists. They were not based on controlled studies.
     As in the case of low desire, there are no objective criteria for premature ejaculation. As such, this sexual dysfunction depends on the subjective rating of satisfaction by both partners. In this situation, it is easier to define what is not premature ejaculation: if both partners agree that their lovemaking is not negatively affected by efforts to delay ejaculation, then there is no dysfunction. Duration of intercourse is not a good measure of the presence of premature ejaculation because a man may manage five minutes of intercourse, but only by engaging in extreme mental and physical manipulations. For example, he cannot engage in foreplay because any touching of his genitals or those of his partner leads to such high arousal that he ejaculates. During intercourse he does not touch his partner for the same reason, and he thinks distracting thoughts (about taxes, job worries, street traffic and so forth) to avoid arousal to ejaculation. This situation is not pleasurable for either partner and so would qualify for a diagnosis of premature ejaculation regardless of the duration of intercourse. Additionally, the myth that men should be able to make the earth move for their partners may result in a man wishing to prolong intercourse beyond what his partner actually desires in an effort to be a great lover. In this case, the partner may be very satisfied with the quality of lovemaking and the duration of intercourse, but the male client may feel inadequate. This situation would not warrant a diagnosis of premature ejaculation, and attempting to treat it as such would not be successful. Once again, the importance of a thorough assessment is clear. The motivations of both partners and their sexual behaviors and thoughts must be explored and noticed.
     However, despite the lack of empirical evidence for etiology and a clear definition of the symptom picture, premature ejaculation responds well to eventual treatment.
     For most men, anxiety inhibits arousal, but for some the physical sensations associated with anxiety are incorporated into sexual arousal and ejaculation happens even more rapidly. In other cases, the emphasis on achievement interferes with awareness of pleasurable sensations.
     Therapists can use some of the standard sexual therapy strategies to treat male orgasm dysfunction for men with no obvious physical factors.