This post is part of a series of guest posts on GPS by the graduate students in my Psychopathology course. As part of their work for the course, each student had to demonstrate mastery of the skill of “Educating the Public about Mental Health.” To that end, each student has to prepare three 1,000ish word posts on a particular class of mental disorders, with one of those focusing on changes made from the DSM-IV to the DSM-5.
The Basics of Premature Ejaculation by Ann O. Nonymous
Premature ejaculation is a type of sexual dysfunction. It is the frequent or repeated discharge of semen before, shortly after, or upon penetration. Premature ejaculation typically occurs with minimal stimulation, before the male wishes, and earlier than he expected. This dysfunction occurs when a male achieves an orgasm. It has been referred to as early ejaculation, rapid ejaculation, rapid climax, premature climax, and ejaculation praecox. There is not a clear definition for “premature,” but specialists at the International Society for Sexual Medicine supported a definition which stated, “ejaculation which always or nearly always occurs prior to or within one minute.” To understand premature ejaculation, one must have a good understanding of the typical ejaculation.
A typical ejaculation is the release of semen from the male reproduction system and usually occurs concurrently with an orgasm. The male orgasm includes stimulation, ejaculation and orgasm. There are two stages in the male ejaculation process. In the first stage, the genital tract contracts, and the prostate gland forces fluid into the upper region of the urethra. The fluid combines with fluid from the seminal ducts and seminal vesicles. During the orgasmic phase, the fluid from the prostate is constantly combined with the seminal fluid by the recurrent contractions of the prostate gland. At the beginning of ejaculation, the sphincter at the opening of the bladder closes, hindering the flow of seminal fluid from entering the bladder. Due to the closing of the sphincter, urine is also restricted from leaving the bladder and merging with the seminal fluid. The second stage of ejaculation involves the loosening of the urethral sphincter below the prostate to allow seminal fluid to enter into the urethral bulb and penile urethra. The muscles between the perineal region force the fluid down the penile urethra. A male’s body is only able to achieve a second orgasm after a waiting period, dependent on the specific male. Although this is a typical example of ejaculation, some men suffer from premature ejaculation.
Premature ejaculation is a widespread complaint in males. The specific cause of premature ejaculation is not known, but research suggests that the cause is a complicated interaction of psychological and biological factors. Evidence suggests that the ability to control and modulate sexual excitement is a learned behavior. If someone has learned to control or modulate sexual excitement incorrectly or inadequately, then he may be able to relearn how to control or modulate it. In some instances, a male may have established a pattern for ejaculation that will make it more difficult to change later in life, such as rushing to reach climax in hopes of not being discovered by others or feelings of guilt resulting in a rush to reach climax. Premature ejaculation is seldom a result of a physical or structural issue. Psychological problems can be a main cause of premature ejaculation.
Erectile dysfunction, anxiety, and relational problems are psychological factors that can play a part in premature ejaculation. Erectile dysfunction is a diagnosis for a male who is anxious about acquiring or preserving an erection, therefore, the male may form the pattern of rushing to ejaculate. Anxiety in a male can cause premature ejaculation in that the male has anxiety concerning performance or other related problems. Relational problems can also cause premature ejaculation. When a male has not had issues with premature ejaculation in the past with other sexual partners, then there is a high probability that interpersonal problems between the male and his current partner are playing a part in the dysfunction. There are also biological problems associated with premature ejaculation.
Biological factors influencing premature ejaculation include the following: unusual hormone levels, unusual levels of brain chemicals, unusual reflex activity of the ejaculation system, specific thyroid problems, inflammation or infection of the prostate or urethra, and inherited traits. The connection to neurological conditions, infections, and inflammation of the duct responsible for transporting urine and semen is rare in premature ejaculation. The cause of premature ejaculation is also rare in a male withdrawing from certain medication used to treat mental health problems, however, there has been an increasing number of diagnosis related to this cause. Also in rare cases, premature ejaculation is connected to physical symptoms, such as pain. Premature ejaculation may be a lifelong situation or may emerge later in life.
Symptoms with lifelong and acquired premature ejaculation are different. With lifelong premature ejaculation, a male has dealt with this dysfunction since his initial sexual experience. A male may experience psychological difficulties and intense anxiety about sexual experiences relating back to a traumatic experience in childhood. On the other hand, a male with acquired premature ejaculation has previously experienced successful sexual experiences with partners, but now has problems with premature ejaculation. A male may experience erectile dysfunction, performance anxiety, and psychotropic drug use with acquired premature ejaculation. Due to the variety of reasons possible for premature ejaculation, an in-depth assessment and tests are necessary for diagnosis.
In order to diagnosis premature ejaculation, a physician will typically inquire about the patient’s sex life. The physician will be interested in a health history and may conduct a physical exam. Typically, there are no abnormal physical or lab findings in this dysfunction. Most relevant information is provided through interviews with the male and his partner. Referrals to urologists who specialize in sexual dysfunctions or to mental health professionals are common in assisting in the process of making an official diagnosis. Blood tests may also be completed to assess male hormone levels and other biological areas that may affect ejaculation. After a diagnosis has been made, treatment for the dysfunction is the next step.
Treatment for premature ejaculation include sexual therapy, medications, and psychotherapy. Sexual therapy may involve having the male masturbate an hour or two prior to intercourse in order to delay ejaculation during sex or encouraging the male to avoid having sex and focus on other types of sexual play. Another technique in sexual therapy is the squeeze technique. This technique involves four steps and may be repeated as many times as needed. Medication may also be used, such as antidepressants and topical anesthetic creams. Antidepressants have a side effect of delayed orgasm, which may help premature ejaculation. Topical anesthetic creams decrease the sensation on the penis to help delay ejaculation. Psychotherapy is another option for treatment. Cognitive behavior therapy includes discussing relationships and experiences with a mental health provider. The sessions may help decrease performance anxiety and discover effective ways of coping with stress and resolving problems. With treatment, the prognosis is good.
In most instances, a male is able to learn to control ejaculation through education and implementing techniques taught to help premature ejaculation. In some instances, a 95% success rate in treating premature ejaculation has been documented. In situations where the dysfunction does not benefit from education and techniques, premature ejaculation may be connected to severe psychological or psychiatric conditions. In these cases, a male may benefit more from psychotherapy. That being said, all cases of premature ejaculation have options for treatment, whether the options are simple techniques or in-depth therapy with a mental health professional.