Some aspects of premature ejaculation causes and treatment

Men who come quickly during intercourse, in other words men who have short IELT (that's the intra-vagina all ejaculatory latency time, more commonly known as the interval between penetration and ejaculation) may be experiencing this problem because they either have psychological issues which cause them to ejaculate quickly or because they have some kind of neurobiological difference to other men.

It's extremely unlikely my opinion that it's anything to do with neurobiology, because the reality is that premature ejaculation is so common as to be normal.

On the other hand, many researchers have observed that men with lifelong premature ejaculation actually display normal emotional profiles and show no evidence of being psychologically disturbed.

I think for me the answer lies in the fact that men can be anxious about sex, whilst having a normal emotional profile in the rest of their lives.

We mustn't forget, either, the fact that premature ejaculation is such a subjective matter: some men who have lifelong PE aren't the least bit bothered about it but simply can't control the delay in reaching orgasm for more than a minute or two.

There are certainly plenty of places where you can get advice on all aspects of relationships, including the emotional and the sexual. This is good on the emotional side of relationships.

Other men who repeatedly complain of ejaculating quickly have been shown to have an excellent intra-vaginal ejaculatory latency time.

Therefore we might conclude that some men have psychological issues which affect their judgment about their sexual performance: this is quite normal in men when you consider the issues that penis size generates.

The other explanation for a faulty perception of time between penetration ejaculation is the partner's expectations and aspirations, perhaps being higher than the man's, or possibly even unrealistic.

It was for this reason that the category "premature like ejaculatory dysfunction" was developed: this is a condition which is characterized by an incorrect belief around the man's sexual capacity, often involving a conviction that what is a perfectly normal time for intercourse is actually too brief.

There is a serious misjudgment made here, where the man is judging himself against a standard which he sees as typical of all men: clearly this is a psychological condition not totally dissimilar from some kind of body dysmorphic disorder, although it may also be caused by social and sexual issues within the relationship.

The appropriate treatment for men like this is counseling, simple information provision, or deeper psychotherapy.

To formalize the symptoms of premature ejaculation and decide why it is happening to you you could try and analyze premature-like ejaculatory dysfunction.

This can be defined as having four aspects:

  • one, a perception of his own rapid ejaculation most of the time when a man is making love;
  • two, persistent worrying about the consequences of the man's supposed lack of control over his ejaculation;
  • three, a simply mistaken belief that the man's intra-vagina ejaculatory latency time is below normal;
  • four, no psychological dysfunction that would provide any kind of alternative diagnosis.

The last factor is particularly important, because Waldinger supports the view that so-called lifelong PE, involving a time between penetration ejaculation of 1 to 2 minutes, is based in neurobiological issues from which psychological and relationship problems then develop.

He bases this is in large part on the fact that drug treatment with SSRIs, in particular in the early days of this work, with clomipramine, has become standard practice for this condition.

Nonetheless, it has to be said that it's not entirely clear how the profile of men with lifelong PE fits into the category of premature ejaculatory dysfunction.

Furthermore, it is manifestly obvious to any therapist who has worked with these men that they have often successfully implemented coping strategies that help them to manage sex involving only a short time of intravaginal thrusting.

It's also equally evident, unfortunately, that there are many men and women who have not adjusted to this situation, and continue to experience fundamental interpersonal problems because of it.


For this reason it may be helpful for men in the situation to know that so-called cure for premature ejaculation was announced few years ago.

This was a compound known as PSD 502, the codename for topical spray consisting of two common anesthetics - lidocaine and prilocaine.

What's different about these two anesthetics in comparison to the ones that have been used for many years in controlling premature ejaculation is that they are delivered in a metered dose aerosol formulation, which is claimed to be safe and effective.

Not only that but it's administered only a short time before intercourse begins, and doesn't need to be washed off as it is absorbed into the skin.

In the past, anesthetics contained in ointments that were spread on the glans had to be washed off half an hour after application and before intercourse so they didn't transfer to the partner's vagina.

So if this aerosol spray really works it could indeed represent a revolution in treatment of premature ejaculation, although one of the critical factors for me in assessing suitability for this use in this way is whether or not it leaves the man able to experience sexual pleasure, and more importantly, whether or not it gives him any sensation of irritation.

The manufacturers claim that it is an agent that selectively desensitizes skin of the penis, only affecting the non-keratinized skin, in other words the inner lining foreskin and surface of the glans penis.

They claim also that it doesn't affect the feeling ejaculation and orgasm this is a claim which I haven't yet been able to test but I will report back on it as soon as possible.

Regardless of that point, one clear advantage is that it's only applied 5 min before sex, so in some ways it actually suits a schedule of sex on demand, and that is quite revolutionary in these treatments.

Men who report back to me about the use of condoms containing anesthetic lotion have reported that in general these don't work at all, so it'll be interesting to see how this new product compares.

Certainly in a case study reported in the International Society of Sexual Medicine, 300 men who were tested with an ejaculatory latency time of two minutes or less were divided into two groups, one using a placebo spray and one using PSD 502. You can read about Stud 100 here, too.

Both groups had an average of only 36 seconds before ejaculation after penetration.

The researchers claim the group who use PSD 502 spray managed to achieve a time between penetration and ejaculation of 4 minutes while the placebo group only improved to 1 minute.

This is certainly a dramatic improvement if borne out by experience in a domestic situation.

As always, the ability to follow the instructions exactly about how to use and apply the medication will be critical in determining what results a man gets.

Nonetheless the study seem to revealed that the product was well tolerated by both the man and his sexual partner, and there were no reports of particularly serious or unpleasant side-effects, just minor irritation in some cases.

Dr Ira D sharlip, of the American Urological Association said that because premature ejaculation, most common male sexual dysfunction is, occurring in his estimation about 20 to 30% of men.

Although in my estimation that is really 75% of men, the prospect of any aerosol spray that had the potential to become an effective treatment of premature during ejaculation was long overdue. Clueless medication could be a success if it lives up to its claims.

But Then Again, Is Genetics The Cause Of PE?

Meanwhile, and perhaps regrettably, research by Dr Marcel Waldinger continues to demonstrate the possibility of a genetic influence on premature ejaculation.

One could argue that ultimately everything is determined genetically, but in the Journal of Sexual Medicine, Waldinger quite explicitly suggests that the speed of ejaculation is a genetically determined characteristic male sexual behavior.

He studied 89 Dutch men who claim to have experienced premature ejaculation ever since they became sexually active.

Men who started to experience this sexual dysfunction later in life were excluded, since clearly there was a social or environmental factor at work to produce PE in those men.

(One might ask why are similar social factors could not have been active in the men who had experienced PE since the time they became sexually active: this seems to me a very important and pertinent question for this study.)

A control group of 92 men was used for comparison purposes.

The experiments were conducted in the man's home during sex with their partners, during which the female partners were asked to record the time from penetration to ejaculation using a stopwatch when they had sex.

Again, this seems to me to be rather flawed experimental procedure, but it is the best data that we have.

The experimenters organized the results into a series of bands, delineated by time to ejaculation.

They discovered that men who ejaculated rapidly had much less serotonin, one of the substances linked to transmission of nerve impulses across the gaps between nerve cells.

Serotonin is one of the things that is linked to sexual activity and libido in both men and women, so it's not unreasonable to conclude that there is a link between premature ejaculation and low levels of serotonin.

However, to then extrapolate to the assumption that the difference in activity in serotonin levels is due to a genetic cause seems a big step.

Waldinger and his associates have claimed that the 5-HTTLPR gene is the one responsible for the brain level and activity of serotonin, and that it occurs in three variants known as LL, SL, and SS.

Apparently men with the LL variation ejaculate much more rapidly, in fact twice as fast as men with the SS and LL gene variants.

Although the research is not conclusive, it is interesting that as long ago as 1998 Waldinger predicted that both the speed of ejaculation and primary form of ejaculation would be determined genetically.

For those of us working in the field, however, it is difficult not to believe that therapy and counseling, in particular addressing relationship issues between the partners that raise the man's level of anxiety, does continue to have a major role to play.

Updated November 14, 2018

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