186 Premature Ejaculation (302.75)

DSM-IV-TR criteria

• A. Persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it. The clinician must take into account factors that affect duration of the excitement phase, such as age, novelty of the sexual partner or situation, and recent frequency of sexual activity.
• B. The disturbance causes marked distress or interpersonal difficulty.
• C. The premature ejaculation is not due exclusively to the direct effects of a substance (e.g., withdrawal from opioids).
• Specify type:
  • Lifelong Type
  • Acquired Type
• Specify type:
  • Generalized Type
  • Situational Type
• Specify:
  • Due to Psychological Factors
  • Due to Combined Factors

Associated Features

• Premature Ejaculation can be categorized as one of two types – Primary PE and Secondary PE. Primary PE refers to the type that has been present in an individual since becoming sexually functional. Secondary PE refers to the type that is acquired later in life in individuals who have had normal levels of sexual function. Both forms of PE are categorized as psychological conditions, as physiological factors such as organic diseases and brain lesions cannot be implicated.
• Individuals suffering from Premature Ejaculation display symptoms included but not limited to abdominal pain, involuntary movements of the eyes, accentuated fall in systolic pressure, and urinary problems.

Child vs. adult presentation

Premature ejaculation can happen at any point during a man’s life but is more common in young men aged 18-30. It may also occur in conjunction with secondary impotence in men aged 45-65.

Gender and cultural differences in presentation

• Premature Ejaculation is limited to the male sex, though its effects can pose problems for both sexes..
• Research shows that only men suffer from this disorder and it is common. Although all races can have premature ejaculation, there is some evidence that it occurs more in African Americans than in Hispanic and white men. In an analysis by Laumann et al (1999), they found that premature ejaculation occurred more among African American men (34%) and white men (29%) than in Hispanic men (27%).
• Rates are relatively uniform around the world except in the Middle East, where the rate is approximately 12.4%

Epidemiology

• This disorder affects 25%-40% of men in the U.S.
• According to the NHSLS, PE affects approximately 30% of men aged 18 to 59, making it the most prevalent male sexual dysfunction.

Etiology

There is no clear cause for premature ejaculation. It is believed that some psychological factors such as anxiety, guilt, or depression may be causing premature ejaculation. It may also be caused by medical conditions, such as hormonal problems, history of injuries, or side effect from certain medications. It has been suggested that PE may have conferred males an evolutionary advantage; males who were able to ejaculate faster would have been able, potentially, to impregnate females more efficiently. The cultural shift of sexual activity to a more recreational function has largely eliminated whatever potential benefits PE may have conferred evolutionarily.

Empirically supported treatments

• Treatments are focused on gradually training and improving mental habituation to sex and physical development of stimulation control.
• In clinical cases, various medications are being tested to help slow down the speed of the arousal response.
• Serotonergic medications, such as SSRIs, can delay ejaculation. Clinical trials indicate that Paroxetine gives the largest increase in intravaginal ejaculation latency time.
• Clomipramine often helps with serious cases that are related to the central nervous system (as opposed to psychological factors). Tramadol has also been shown to be effective in delaying ejaculation.
• The stop-start method requires the men to provide direct feedback to his partner for when the ejaculatory urge nears. At this point, sexual stimulation stops, allowing for his arousal to subside before stimulation is resumed. The efficacy of the stop-squeeze technique is approximately 60%.
• The squeeze technique is where the woman teases her partner to erection and prior to his ejaculation, she squeezes the tip of the penis, which temporarily prevents ejaculation. This process is repeated three or four times in a 15-20 minute session before the man purposely ejaculates.