Dr. Hyacinth Peninnah Paljor

In my previous health tip, featured here last time, I talked about what actually is Premature Ejaculation (PE) or early ejaculation, what is its actual condition and how is it defined. Today I will share some statistics, diagnosis, variants and causes of PE.

Statistics of PE:

1. You are not alone!  PE is a common sexual complaint.
2. Estimates vary, but as many as 30-40% men across the world experience PE at some point in their lives. 
3. In US alone, about 60%-70% of people 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 PE are as follows:

1. In almost 75-100% sexual activities, the experience of ejaculation occurs within one minute of vaginal penetration.
2. The problem of PE has persisted for at least six months
3. The symptoms cause significant mental stress to the person
4. It occurred due to a nonsexual mental disorder, a medical disease, effects of a drug or medication, etc.

Severity of PE:

The severity of PE or early ejaculation is broadly defined as follows:

1. Mild: Occurring within 30 seconds to one minute
2. Moderate: Occurring within 15-30 seconds
3. Severe: Occurring even before sexual activity, at the start of it, or within 15 seconds of vaginal penetration

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 occurs again and again. In such case, pregnancy will not be possible unless artificial insemination is used. 

Types and characteristics of P.E.

PE can be Chronic or Acquired

Chronic (lifelong) PE is when the person has been experiencing it since he became sexually active (i.e., post puberty). Usually it is seen that PE starts occurring from the beginning of sexual activity, probably the first sexual intercourse or even on masturbation, when the discharge occurs early.

Acquired (recent) PE means that the condition began in an individual who previously experienced an acceptable level of ejaculatory control and had successful sexual escapades but only recently (couple of weeks to months) has developed the tendency to ejaculate early. 

What causes P.E?

Not a particular cause is responsible for causing PE.  However, the causes of PE can be divided into two broad sub-heads, which are psychological and biological cause:

Psychological causes:

PE is believed to be a psychological problem and does not represent any known defect in the brain or nervous system. Psychological causes behind PE may include a certain pattern that is hard to change as result 
of your previous sexual experiences. They may arise from following:

1. Atmosphere at Work or school
2. Relationships with peer groups
3. General attitude toward sex
4. Any bad feelings about sex that relates to one or more bad experiences encountered
5. Erectile dysfunction  
6. Performance anxiety, where men want to show a good performance of sexual act with the female partner.

Type of the relationship/sexual engagement (e.g., married/unmarried/live in relationship)

Sexual attitude or interest of the female partner

Early sexual experiences, like development of habit of reaching climax soon for pleasure or ejaculating quickly because of fear of being discovered by others 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. 

Last but not least, a situation 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. 

Biological causes of PE:

Many scientists have questioned whether PE is purely psychological. A number of investigators have found differences in nervous stimulations and hormonal differences in men who experience PE as compared 
to individuals who do not.  Some believe that some men have hyper-excitability or oversensitivity in their genitalia, which is again not proven.  So, among the biological causes of PE, the most common are:

1. Abnormal functioning of the ejaculatory system
2. Thyroid problems
3. Infection or inflammation of the urethra or prostate
4. Nerve damage occurring due to trauma or surgery (a very rare cause)
5. Abnormal levels of hormones and/or neurotransmitters (which are chemicals present in the brain)
6. Higher, free and total testosterone levels have been demonstrated in men with PE than in men without premature ejaculation. Recent article in a Chinese andrology journal showed that semen from men  with PE contained significantly less acid phosphatase and alpha-glucosidase than the counterparts 
7. Another study found that many men with PE have low serum prolactin levels.

Somehow these biochemical markers play only a partial role in contributing to PE. Further research is needed. Abnormal functioning of the ejaculatory system. Further, if you need to know non-medical methods of controlling PE read - 'All You Need to Know About Premature Ejaculation 3'.

If you wish to discuss any specific problem, you can consult a sexologist and ask a free question.