Overview
Premature ejaculation, a disorder only found in men, is characterised by the ejaculation within a minute of stimulation. It happens without the personโs desire to ejaculate. Stimulation may mean penetrative sex, oral sex or through masturbation. In some cases, ejaculation may be before stimulation too.
Initially the causes of this disorder were considered from a psychoanalytical point of view where the male had unconscious conflicts with the women which was considered to be the cause of the disorder.
However, there was no evidence found for the theory. Behavioural approaches considered Premature Ejaculation to be a learnt behaviour. Some psychologists even suggested that it may be caused due to psychosomatic approaches.
However, there wasnโt enough evidence supporting any of the theories. Some psychiatrists started treating Premature Ejaculation with serotonergic drugs which showed quite an effect and delay in ejaculation. This motivated researchers to look into neurobiological causes of the disorder.
Current views on the cause of Premature Ejaculation suggest neurobiological causes for the disorder. Rapid ejaculation is related to maladaptive function of the 5HT2C receptors in certain brain regions.
It is the receptor which binds serotonin in certain brain regions. Hence, it is treated as a neurobiological disease.
It is often seen to affect menโs self esteem, a lack of sense of control, and adverse consequences for partner relationships.
It may also cause personal distress in the sexual partner and decreased sexual satisfaction in the sexual partner. Ejaculation prior to penetration may be associated with difficulties in conception.
Common Signs and Symptoms
The main symptom of this disorder is ejaculating within the first minute of stimulation which may be due to penetrative sex or other forms of stimulation.
This causes issues with self esteem and problems in partnered relationships causing imminent distress to the person.
Risk Factors
DSM-5 notes several risk factors for Premature Ejaculation. Temperamental factors associated with the disorder include anxiety and depressive disorders.
Neurobiological factors associated with the disorder include dopamine transporter gene polymorphism or serotonin transporter gene polymorphism. Thyroid disease, prostatitis and drug withdrawal is also associated with Premature Ejaculation.
Diagnosis
For the purpose of research, Stopwatch Assessment of Ejaculatory Latency may be used. However, use of such an assessment is not recommended for the sake of diagnosis and treatment. Generally, self report latency is considered.
A physical exam is mandatory and a detailed clinical interview is needed before diagnosis.
To be diagnosed with Premature Ejaculation, following criteria must be met:
- For the past 6 months, there should be recurrent(almost all) occurrences of ejaculation within a minute of stimulation and without the person desiring it to be so.
- This pattern causes distress to the person.
Clinicians are required to mention if the condition is life long or acquired. It may be mild, moderate and severe in degree.
Treatment
Pharmacological treatment is usually recommended for the treatment of Premature Ejaculation. Mostly, Serotonin Reuptake Inhibitors (SSRIs) and Tricyclic Antidepressants (TCA) are given.
Dapoxetine, paroxetine, sertraline, fluoxetine, citalopram are often administered in monitored doses. Efficacy rates of these medicines are quite high.
Several studies of pharmacological treatments with behavioural treatment were conducted. It is seen to be quite helpful in circumstances where PE is acquired.
Surgery and use of Topical Anesthetics are other options for the treatment of PE. However, their efficacy is still low and more research is warranted.
Differential Diagnosis
1. Substance/medication-induced sexual dysfunction: When problems with premature ejaculation are due to substance use, intoxication, or withdrawal, substance/ medication-induced sexual dysfunction should be diagnosed.
2. Ejaculatory concerns that do not meet diagnostic criteria: It is necessary to identify males with normal ejaculatory timings who desire longer ejaculatory latencies and males who have episodic premature (early) ejaculation. Neither of these situations would lead to a diagnosis of premature (early) ejaculation.
Comorbidity
Premature (early) ejaculation may be associated with erectile problems, anxiety disorders and prostatitis, thyroid disease, or drug withdrawal.
Specialists
Psychologists, psychiatrists, sex therapists are often referred to for treatment.
