ALTHOUGH ERECTILE dysfunction or impotence has received a lot of publicity and media attention, there is in fact a far more common and pervasive male sexual dysfunction which, in many respects, is more difficult to treat.
I refer, of course, to premature ejaculation (PE) which is said to affect 40 per cent of men. Despite its high prevalence, there is no universally agreed upon definition of PE. When it occurs however, men and their sexual partners are aware of its presence and the sexual frustration it causes. One of the better definitions of PE is that it is "persistent or recurrent ejaculation with minimal sexual stimulation before, upon or shortly after penetration and before it is wished by the man or his partner".
Premature ejaculation can be a cause of significant distress and frustration and can lead to other psychosexual problems, depression, and marital/relational conflict. At its very worse it may result in secondary impotence and even infertility.
The definition above includes the element "persistence" which emphasises that for the problem to exist it must be present over a long period. "Minimal sexual stimulation", emphasises the 'hair-trigger' nature of the problem, and the "before, upon or shortly after", emphasises that there are varying degrees of severity. The key element in the definition, however, is the phrase "before it is wished by the man or his partner". This emphasises that the main difference between those who don't have this problem and those who do, is one of being able to exercise some degree of control over the timing of ejaculation. Premature ejaculation may therefore be thought of essentially as an inability to exercise voluntary control over the timing of ejaculation.
Premature ejaculation may be primary or secondary. Primary PE refers to a situation where the man has never had any ejaculatory control and has therefore had PE all his sexual life. Secondary PE refers to a period of PE which follows normal ejaculatory control. Primary PE is much more common and is thought to be a learnt behaviour caused by anxiety over being caught during early sexual experiences such as frequent rapid masturbation or clandestine sexual liaisons such that they had to be terminated quickly. With several such repeated episodes a pattern of ejaculating quickly was established which became habitual and was then difficult to unlearn. Secondary PE may be due to inflammatory conditions affecting the genitourinary tract such as prostatitis or urethritis.
There may be occasions when men with normal ejaculatory control experience uncontrolled ejaculation. This usually occurs when there has been no sexual release for some time or where there is heightened sexual tension or anxiety. Examples include a man who has been away from his partner for some time, or a man about to have his first sexual rendezvous with a new lover or a man involved in a new illicit liaison. The PE may be situational in that a man may not have the problem with his regular partner but may experience it with a new lover.
Premature ejaculation is a problem because at the very least it causes sexual frustration in the female partner and qualitatively less satisfying orgasms in the man. The former may result in the man having feelings of inadequacy, poor self-esteem and depression which may have secondary effects on the relationship. This may manifest as avoidance of sexual activity, performance anxiety resulting in secondary erectile dysfunction (impotence), relational/marital conflict and emotional withdrawal to name a few.
A supportive, understanding and loving partner who tactfully encourages the man to seek professional help may do a lot to minimise the potential negative repercussions on the relationship. Criticism and ridicule, on the other hand, are guaranteed to lead to withdrawal, avoidance, anger and resentment which will impact negatively on the relationship.
(Next week: Exploring treatment options for PE)
- Dr. William D. Aiken, consultant urologist, University
Hospital of the West Indies.
