Premature Ejaculation

Marcus Waldinger and his associates usually divide Premature Ejaculation (PE) into two groups, which are known as 'lifelong' and 'acquired'. Now they've come up with a third type which they call 'natural variable', which covers men who are variable or inconsistent. Waldinger tells us that the new label will account between 20 and 40% of the population. He compares this with the percentage who have lifelong and acquired PE, which he estimates to be rather low at between 1% and 5% of the male population.

This new approach in definition puts back the emphasis onto the fact that men are generally dissatisfied with their performance, when they may be experiencing nothing more than the natural unpredictability of male sexual practice. If this is true, then it follows that most men who report having PE should not be seen as sick or treated with antidepressants, but should receive non-invasive psychological therapy like sexual psychotherapy or counseling.

But there is a problem with the psychological approach. There are very few scientific reports on the subject and those that exist tend to make generalizations from individual cases giving such explanations as 'castration anxiety' and 'hatred of women and so forth. These are not helpful in understanding either the etiology of premature ejaculation or how psychoanalysis can help in its perception and treatment.

It is not always easy to label the groups of sufferers. The categorization depends on 'intra-vaginal ejaculation latency time' (IELT), it's variation throughout life and the feelings of the man concerned. Men who have an IELT of less than one and a half minutes are usually defined as having lifelong PE or acquired PE but some men with lifelong PE can sometimes manage three minutes. If early ejaculation takes place every time, then lifelong PE is diagnosed. But those with considerable and inconsistency or variability are classed as 'normal variable'.

A new term called 'Premature like ejaculatory dysfunction' has been coined to describe those who self report PE even though they have a normal or even a long IELT. In a study by experienced clinicians, conducted over several locations in the United States subjects were defined as having PE or not according conventional definitions. The case revealed that out of those with PE, 48% were able to make at least two minutes, while 13% of men who said that they had PE managed between 5 and 25 minutes after penetration. This tells us that the conventional definition is unreliable. It shows many men who have normal and even long IELT still complain that they have premature ejaculation. It may be too soon to draw conclusions from this work, but it raises the question 'Is it good practice to define men as having PE if they can manage between 5 and 25 minutes of intercourse before ejaculating?'

Psychoanalysis was the favored treatment for premature ejaculation (PE) from 1920 until sometime in the 1960's. Marcel Waldinger has now suggested that it could return as the first choice treatment. He argues that the recent classification of three different types of premature ejaculation has generated a chance for a comeback of psychoanalytic investigation into the problem. The three types are 'lifelong PE' where the condition has existed during a man's sexually active life, acquired PE, which develops later and 'normal variable premature ejaculation', which is where the man's 'Intra-vaginal ejaculatory latency time' (IELT) varies considerably.

Waldinger also notes a parallel between the treatment of PE with topical anesthetic ointments of the 1940s and 1950s when psychoanalysis was at its height and the present use of antidepressants now that behavior therapy has become widespread as a treatment. Also in the 1940s, use of anesthetic ointments was off-label as the use of the antidepressants is off-label today. In addition, neither psychoanalysis nor behavioral therapy have been undergone any scientific research into their efficiency in treating PE.

Currently premature ejaculation is not seen as a condition that needs to be treated by psychoanalysis, but daily dosages of 'selective serotonin reuptake inhibitors' (SSRIs) or ad hoc treatment with tricyclic antidepressants such as clomipramine, or the use of local anesthetics. This approach may be questionable as the pharmacological approach comes from the perception of PE as a neurobiological condition. Also it does not take into account of the perception of PE by the man or his partner, nor does it consider the unconscious mental processes involved in the development and continuation of the condition. Waldinger suggest therefore that a psychoanalytic approach may be in order.

To do this, we must first consider the definition of PE which consists of the following symptoms:

1. Persistent, recurrent premature ejaculation with minimal stimulation before the person wishes it.

2 Dissatisfaction or interpersonal difficulty.

3 Not totally due to direct effects.

Waldinger has analyzed studies of 2004/2005 and discovered that this definition actually produces a high percentage of PE diagnoses which are false positives, due to the definition being over-weighted towards those men who complain about having PE and ignoring their IELT rating.

This tells us that the official definition does not account for the fact that there is a great variability in the time it takes men to ejaculate, and there is a similar variation in how long both partners want sex to last. This ambiguity, and the need to clarify exactly what is meant by PE, leads us try to establish a definition in quantitative form. The average IELT is about six and half minutes so if PE is defined as an IELT percentile below 2.5 that means that a man who ejaculates in less than a minute and a half has premature ejaculation. However, some would be happy with that and they would not be defined as having PE. But a man who has an IELT of over two minutes, but believes he has low control, can feel distress, and so it follows that mathematics cannot be the sole basis for diagnosis.

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