In my previous article posted, we learnt about premature ejaculation, what is this actual condition and how it is defined.
Today we will learn about Statistics, Diagnosis & Type of Premature Ejaculation, Why and how it happens?
Statistics of PE:
Premature Ejaculation-PE is a common sexual complaint. You are not alone!
Estimates vary, but as many as 30-40 % men across the world including India experience problem of PE at some time of life.
Approximately 30%-70% of American males experience premature ejaculation. The National Health and Social Life Survey (NHSLS) indicate a prevalence of 30%, which is fairly spread across all adult age groups.
Diagnosis of PE:
As per DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition ), the specific criteria for premature (early) ejaculation are as follows:
In almost 75-100% sexual activity, the experience of ejaculation occurring during sexualintercourse within 1 minute after vaginal penetration and before the individual wishes it.
The problem above has persisted for at least 6 months. The symptoms above cause significant mental stress to the person. The dysfunction cannot be better explained by any other nonsexual mental disorder, any medicaldisease, the effects of a drug or medication, etc
Severity of P.E.
The severity of premature (early) ejaculation is broadly defined as follows:
Even the severe form is not uncommon. Many times men approach the doctors with complaint that they are not able to penetrate the vagina. They ejaculate on minor physical stimulation and it is occurring again and again. Not able to achieve pregnancy is another big concern. If the premature ejaculation is so severe that it happens before commencement of sexual intercourse, conception will not be possible unless artificial insemination is used.
Types and Characteristics of P.E.
Premature ejaculation can be Chronic (lifelong) or acquired (recent).
With chronic (lifelong) premature ejaculation, the person has been experiencing premature ejaculation since he became sexually active (ie, post puberty). Usually it is seen that premature ejaculation starts occurring from the beginning of his sexual activity probably the first sexual intercourse or even the discharge occurs early on masturbation as well.
With acquired (recent) premature ejaculation means that the condition began in an individual who previously experienced an acceptable level of ejaculatory control and had successful sexual relationships and only now has developed premature ejaculation in the recent past (few weeks to months).
How to approach a person with Chronic (lifelong) or acquired (recent) Premature Ejaculation
In patients with Chronic (lifelong) premature ejaculation, the treating doctor or sexual therapist should enquire about the following:
ü Atmospher at Work or school
ü Relationships with friends or brother /sisters
ü General attitude toward sex by himself and or family
ü Previous psychological problems
ü Early sexual experiences
ü Any bad feelings about sex that relates to 1 or more bad experiences encountered duringgrowing years of life
ü Type of the relationship / sexual engagement (eg, married / non married / live inrelationship)
ü Sexual attitude and response of the female partner
ü Non sexual aspects of the current relationship ( comfort level & trust factors)
Clues from above and similar questions usually point toward possible reasons/factors that may be addressed specifically with therapy by the treating physician or sexual therapist.
In patients with acquired (recent) premature ejaculation, the treating doctor or sexual therapist should enquire about the following:
- Erectile dysfunction
- Performance anxiety ( it is seen very commonly in men i.e., they want to show a good performance in the sexual act with the female partner)
ü Psychotropic drug use or alcohol consumption
ü Previous & Current relationship
ü Nonsexual aspect of the current relationship ( comfort level & trust factors)
ü Level of involvement of the sexual partner during sexual acts
ü Sexual response of partner
ü Stamina or fitness level for prolonged intercourse
WHAT CAUSES P.E.?
Not a single particular cause is responsible for causing premature ejaculation. It can either occur when you indulge in sexual activity with a new partner or if it’s been too long since the previous ejaculation.
However, the causes of premature ejaculation can be divided into two broad sub-heads, which are psychological or biological cause:
Premature ejaculation is believed to be a psychological problem and does not represent any known organic / physical disease involving the male reproductive organs or any known defect in the brain or nervous system.
Psychological causes behind premature ejaculation may include the development of a certain pattern that is hard to change and is a result of your previous sexual experiences.
One of them most common reason is childhood habit of reaching climax / ejaculation quickly because of fear of discovery when masturbating as teenagers or during early sexual experiences with female partner. This pattern of rapid attainment of sexual release is difficult to change in later stage of life during marriage or long-term relationships.
Other reason is situations in which you may have hurried climax / ejaculation in order to hide your problem from your female partner; or feelings of guilt that make you rush through sexual encounters.
Other psychological causes include anxiety and relationship issues which can also result from deep anxiety about sex that relates to bad experiences encountered by the patient during development (e.g. incest, sexual assault, conflict with parents, etc.)
Biological causes of premature ejaculation:
Many scientists have questioned whether premature ejaculation is purely psychological. A number of investigators have found differences in nervous stimulations and hormonal differences in men who experience premature ejaculation compared with individuals who do not.
Some believe that some men have hyper-excitability or over-sensitivity of their genitalia, which is again not proven.
- Abnormal functioning of the ejaculatory system
- Thyroid problems
- Infection or inflammation of the urethra or prostate
- Nerve damage occurring due to trauma or surgery (a very rare cause)
- Abnormal levels of hormones and/or neurotransmitters (which are chemicals present in the brain) have been many times said to be responsible for PE like
- Testosterone is thought to play a role in the ejaculatory reflex. Higher free and total testosterone levels have been demonstrated in men with premature ejaculation than in men without premature ejaculation
- Recent article in a Chinese andrology journal showed that semen from men withpremature ejaculation contained significantly less acid phosphatase and alpha-glucosidase than did the semen of control subjects.
- Another study found that many men with premature ejaculation have low serum prolactin levels
Somehow these biochemical markers may contribute to premature ejaculation, organic and psychological associations (eg, anxiety) suggest that these biochemical markers play only a partial role. Further research is needed.
In part 3 and 4, we will discuss how to approach the men / couple suffering from premature ejaculation to resolve this problem.
The therapy includes wide spectrum of approach including counselling, behavioural methods, exercises, techniques and medical remedies both modern as well as alternative medicines.