Premature Ejaculation has been recognized by modern medicine quite recently. Till 1913, this condition was not mentioned anywhere in medical literature. Dr. K Abraham was perhaps the first to call it ejaculation praecox. Earlier Victorian Physicians were more interested in nocturnal emissions and spermatorrhoea and the bad effect it produced on the mind and body of a person.
Definition of premature ejaculation by American Psychiatric Association and DSM-IV is given as ‘persistent or recurrent ejaculation with minimal sexual stimulation that occurs before, during or shortly after penetration and before the person wishes it.
This definition has variables like the word ‘minimal’ and a description of timing that cannot be standardized. A man may be perfectly happy if he ejaculates within half a minute whereas another may be unsatisfied even if he ejaculates after half an hour of coital activity. The definition also places emphasis on the man’s subjective feelings totally disregarding the female.
In India, our very own Kama-Sutra regards this condition as a normal variation. Here Vatsyayana outlines the ejaculatory response at three levels of duration. In both men and women, the duration of lasting or kala is given as short-timed, medium – timed and long – timed .
This is very well described in Kokashastra or Rati Rahasya. Here pandit Kokka gives three variations in men and women as per the duration for which the sexual act lasts. He classifies them as immediate, intermediate and delayed. According to him, this is just a variation and he suggests idea combinations for men and women based on this kala.
Why premature ejaculation? What is it ‘premature’ to?
It could be so called because due to the early ejaculation there is only partial experience of sexual Pleasure on part of the man which is followed by a refractory period wherein the man cannot get his interest and erection in sex for some period of time which is variable in different men. This results in the woman feeling unsatisfied as she is unable to experience her climax within that much period.
Why did this issue of premature ejaculation come up ? Animals do not seem to have premature ejaculation. This question has perhaps originated because of the ‘Pleasure’ component in human sexual activity. As a result, men and women often complain of experiencing partial pleasures that is perceived only in the genitals and not in the mind. Some believe that sexual contact was in itself the first sin. Hence sex is considered as immoral and it results in considerable guilt and shame which can adversely affect a persons sexual behavior.
Multiple factors may be responsible for a man to experience a premature ejaculation. Some common causes cited are:
1 Excessive excitement in earlier sexual experiences.
2 Sexual abstinence.
3 New partner
4 New setting, surrounding
5 Extremely responsive and assertive partner
6 Early experiences with friends or sex worker wherein the men is pressurized to ejaculate as early as possible
7 Anxiety states like,
Will I ejaculate too fast ?
Will I be able to satisfy my partner?
8 Marital disharmony with hostility towards partner.
Treatment of premature ejaculation
Various research has advocated different approaches for the treatment of premature ejaculation this could be classified as
- start stop method
- squeeze technique