Premature Ejaculation is a complex condition that puzzled scientists for more than a hundred years. The first major scientific work on premature ejaculation, Über Ejaculatio Praecox by Karl Abraham, dates back to 1917. However, in the 40s, a German endocrinologist named Bernhard Schapiro realized that what we call premature ejaculation isn’t a single medical condition, but two. So, he proposed to split the disorder into two subtypes.
What Really is Premature Ejaculation?
Premature ejaculation is a condition where the man climax and ejaculate too quick during intercourse. But how fast is too fast? Over the years, specialists proposed different time criteria. Nowadays, the one minute mark is accepted as the official benchmark by the International Society for Sexual Medicine (ISSM).
Shapiro realized that while some men always ejaculate faster than a minute; others have a regular ejaculatory control until a certain point in life where they suffer from a gradual or sudden loss of control. Therefore, he assumed that the actual causes and risk factors of a premature ejaculation could be different depending on when the condition developed. Shapiro used the terms primary and secondary premature ejaculation to distinguish both types. However, nowadays, the accepted terminologies are lifelong and acquired premature ejaculation.
Lifelong Premature Ejaculation (Lifelong PE)
Lifelong premature ejaculation is the condition where a man has always suffered from rapid ejaculation. If, since the first time you’ve masturbated, you never felt any control over your ejaculation, you might experience lifelong PE. The exact criteria established by the ISSM to be considered a lifelong premature ejaculator are:
- During vaginal penetration, your ejaculation must always, or nearly always, occurs within one minute.
- You aren’t able to prolong the time you last before orgasming
- Your premature ejaculation causes you distress, bother or frustration
Suspected Causes of Lifelong Premature Ejaculation
Since the 90s, premature ejaculation research has focused on the neurobiological aspect. Some researchers such as Marcel D. Waldinger advanced that lifelong premature ejaculation is caused by some neurological factors such as a diminished serotonin level. Indeed, some antidepressant drugs that increase the level of serotonin in the brain (such as SSRIs) increase both the ejaculation latency time and the ejaculation control. Waldinger also suspected genetic factors to be responsible for this neurologic imbalance. Therefore, lifelong premature ejaculation could be an hereditary disorder.
Acquired Premature Ejaculation (Acquired PE)
Acquired premature ejaculation is the condition where a man experience a gradual or sudden loss of control over his ejaculation. Just like lifelong PE, the loss of control has to cause frustration or distress. However, the time criteria isn’t as rigid. While lifelong PE benchmark is set at 1 minute, the ISSM proposed a reduction under the 3 minutes mark for Acquired PE. In fact, the time limit is less important for this premature ejaculation subtype since it’s the reduction of the control and latency time that define the condition.
Suspected Causes of Acquired Premature Ejaculation
While neurobiological causes are the main suspect for lifelong PE, acquired premature ejaculation has a more diversified list of potential causes. Experts are still discussing all the different risk factors. Yet, we know that some medical condition (like chronic prostatitis) could trigger it. Other suspected risk factors include psychological or relational issues, such as anxiety disorders or other sexual dysfunction such as erectile dysfunction.
Other Type of Premature Ejaculation
Since a lot of men who don’t fit into those two categories still complain about a lack of control over their ejaculation, some specialists proposed two other subtypes of premature ejaculation: variable and subjective premature ejaculation.
Variable Premature Ejaculation (Variable PE)
Variable PE consists of men who sometimes ejaculate within the 1-minute mark, but other time they can last longer. Officially, they do not suffer from premature ejaculation since variable PE isn’t considered a sexual dysfunction but just a regular variation of a healthy sexual response. Variable premature ejaculators may simply lack control over their arousal. Where lifelong and acquired premature ejaculators can look at medical treatment to increase their ejaculatory contol, men who suffer from variable PE should consider sex therapy exercises to gain a better arousal control.
Subjective Premature Ejaculation (Subjective PE)
The last form of premature ejaculation is called subjective PE. A man who suffers from subjective PE is a man who’s dissatisfied with his ejaculation control even if he’s within the average. This means that he has a typical sexual response and his dissatisfaction comes from unrealistic expectations. The solution to a subjective premature ejaculation is often to reestablish normal apprehension about how long a man should last.
If you are unsatisfied with your ejaculation control, the first thing you should do is to determine which type of premature ejaculation you might have. Lifelong and acquired PE are sexual dysfunction with possible medical implication. If you think you might suffer from one of them, your first move should be to talk to a doctor. Only a physician can screen for medical causes. A doctor can also refer you to specific treatments for your condition. Indeed, the first line treatment recommended by the Internation Society for Sexual Medicine for lifelong PE consists of prescribed medication.
However, if you fit under the variable or subjective PE definition, sex therapy is probably more suited for you. Some simple exercises can help you gain a more satisfactory control of your arousal. Those arousal management techniques will lead to a better ejaculation control. Also, sex therapy can help reframe your expectations about how long sex should be. After all, when a man is suffering from subjective PE, his real problem is about his preconceptions, not his sexual response.
- Lifelong premature ejaculation: from authority-based to evidence-based medicine. | BJU int.
- Premature ejaculation and serotonergic antidepressants-induced delayed ejaculation: the involvement of the serotonergic system | Behav Brain Res
- Causes of Premature Ejaculation | Premature Ejaculation Help
- Changing paradigms from a historical DSM-III and DSM-IV view toward an evidence-based definition of premature ejaculation. Part II–proposals for DSM-V and ICD-11 | J Sex Med
Definition of Premature Ejaculation (PE) | ISSM