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Revitalizing Psychiatry
Premature Ejaculation is the Most Common Sexual Problem for Men
Premature Ejaculation (PE) is the most common sexual problem for men [1]. Almost all men ejaculate
rapidly in their first-partner sexual experiences but with time are able to teach themselves how to achieve
control that is gratifying and satisfactory. However, ejaculatory control is elusive for many men, and their
sexual experience becomes defined by it. The figures vary by author, with the range being between 30%
and 75%. Obtaining an accurate figure of incidence is complicated by the lack of agreement as to
definition. Many men who have PE may develop a secondary erectile disorder such as erectile dysfunction
(ED), which can be thought of as a primary one.
American Psychiatric Association defines premature ejaculation as follows:
A. Persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after
penetration and before the person wishes it.
B. The disturbance (PE) causes marked distress or interpersonal difficulty.
As noted in A, ejaculation occurs before the individual wishes it. The individual has an awareness that
orgasm occurs suddenly and often takes him by surprise. The ability to decide when one wishes to
ejaculate is missed. This often (though not always) has an impact on the individual’s partner, resulting in
B; the relationship is burdened by the lack of ejaculatory control with spiraling consequences. The
individual feels a reinforced sense of shame, dread, humiliation, and inadequacy with painful
consequences. Sex is not seen as a shared activity to be embraced and viewed as a source of mutual
pleasure and enhancement; rather, it becomes an ordeal to be endured, with the outcome predetermined.
The partner initially may be confused and may feel responsible, but the more usual response in a partner
who has some sexual sophistication is to feel frustrated, impatient, and angry. This in turn is perceived by
the individual, which only intensifies his anxiety and distress and distorts even further the nature of the
sexual experience.
Possible Causes of Premature Ejaculation
There have been many attempts to explain the cause or causes of PE. These have included a belief that
unconscious conflicts are expressed by coming rapidly, that interpersonal struggles are manifested by
PE, that there is a biological difference in the certain reflexes, that there is a difference in the sensitivity of
the skin of the penis, and that PE actually represents the norm, given that animals have a very short
ejaculatory latency. (The fact that many primates ejaculate almost immediately after intromission
suggests the hypothesis that swift intercourse is a normal pattern and may have evolutionary survival
value. [2])
All too often men and their partners are quick to diagnose themselves in negative, self-blaming ways with
great suffering to both partners. Meaning may be ascribed to coming early that has no bearing on reality.
Premature ejaculation is only one of the many sexual symptoms around which the distress of an individual
or couple may be focused. A man with ejaculatory problems may be with a partner who has some
(unidentified) sexual constriction. If the partner has trouble with closeness or difficulty with arousal or
orgasm herself, the PE may mask those difficulties and provide the “obvious” problem that the couple
defines.
Dr. Derek C. Polonsky gives an excellent summary of PE [1], which he addresses to men with this problem:
1. This is a very common issue for men. Roughly 30% of men say that they are not satisfied with their
ability to control orgasm. Men are convinced that everyone else lasts just fine.
2. Often the focus becomes “am I going to last” – and there is a change away from enjoyment and
pleasure to one of business and performance, where one will be judged and criticized.
3. Men often think their problem is that they become too excited too quickly and that they need to distract
themselves in some way. (Think of a baseball game, do a mathematical calculation.) The issue is learning
to STAY at the high level of arousal; learning what you can do to keep a balance between coming and being
very aroused. (The best way to increase the capacity to sustain a high level of arousal without ejaculation
is to experience sexual intensity. The nervous system accommodates to stimulation by raising the
threshold for the ejaculatory reflex [3])
4. Many partners are convinced that the man is selfish – interested only in his getting off and not caring
about her being left high and dry. Frankly, most men feel shame and a sense of defeat rather than a self-
congratulatory high. In addition, for many men who come very soon, the subjective experience is that their
orgasm is not very intense.
5. Talking with your partner about your worries and learning something about your partner’s wishes and
worries will lessen considerably the pressure you feel around control.
6. The reverse holds true; that is, if you don’t talk about your concerns, and march forward trying to cover it
up, the pressure will only mount, and anxiety usually makes every aspect of sex more difficult and less
enjoyable.
7. It is important to know something about your partner’s sexual interests and needs. Guys often have the
idea that “real men” can thrust vigorously and continuously for long periods – the more rapid and longer,
the better for the woman. Most women will not confirm this perception.
8. Practice and frequency are absolutely crucial. Almost all men will have less control over when they
come if they have not had an orgasm for a while.
Treatment approaches
Treatment approaches now include and integrating of individual and couple dynamics, cognitive and
behavioral approaches, and more recently the introduction of various medications [1]. To remove the
pressure it is essential for the man to be able to please his partner in a variety of ways. Dr. J. Hong
cleverly emphasized the human approach to pleasure giving: The tender touch, the passionate caress, the
gentle rub, the titillating probe, and all those other infinite maneuvers that humans, as the most
sophisticate bipedal primate, are best equipped to do, can be much more satisfying to women than simply
a longer time span between intromission and ejaculation. [2]
Often, the therapist has to provide support and practical guidance with establishing a relationship with a
partner, offer suggestions for how to “script” the sexuality, and literally “walk” the individual through the
process. The “script” that many men follow is one that is tailor-made for increasing anxiety and isolation
and almost guarantees that the ejaculatory control will be poor. It is often based on the unrealistic
portrayal of sexuality in movies, where there is a seamless progression through intensifying states of
sexual arousal and breathless nonverbal passion, usually with the male directing the pace and at all times
knowing exactly what will please his partner. It is a daunting task for the man with poor ejaculatory
control to manage on his own. The therapist can provide a model for slowing things down, for getting to
know and trust a new partner, and for telling the partner early on that he has concerns about his sexual
performance. In the absence of changing the script, the more usual pattern is for the man to feel alone
with his struggle to “hold off” and for his partner to feel confused about what has happened. When the
partner has had sexual experiences that were different, she might be able to recognize the issue as
residing with her partner. But often the woman may wonder about her own abilities and feel she has
somehow failed to be a good sexual partner, and the spiral of self-doubt and anxiety begins for both.
References:
1. Polonsky, D. C., Premature Ejaculation. In Principles and Practice of Sex Therapy. Third Edition, New
York, The Guilford Press, 2000
2. Hong, J. Survival of the fastest: On the origins of premature ejaculation. Journal of Sex Research, 1984,
Vol. 20, 109-112
3. Levine, S. B. Helping men to control ejaculation: Sexual life – A clinician’s guide, 1992, New York: Plenum
Premature Ejaculation (PE) is the most common sexual problem for men [1]. Almost all men ejaculate
rapidly in their first-partner sexual experiences but with time are able to teach themselves how to achieve
control that is gratifying and satisfactory. However, ejaculatory control is elusive for many men, and their
sexual experience becomes defined by it. The figures vary by author, with the range being between 30%
and 75%. Obtaining an accurate figure of incidence is complicated by the lack of agreement as to
definition. Many men who have PE may develop a secondary erectile disorder such as erectile dysfunction
(ED), which can be thought of as a primary one.
American Psychiatric Association defines premature ejaculation as follows:
A. Persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after
penetration and before the person wishes it.
B. The disturbance (PE) causes marked distress or interpersonal difficulty.
As noted in A, ejaculation occurs before the individual wishes it. The individual has an awareness that
orgasm occurs suddenly and often takes him by surprise. The ability to decide when one wishes to
ejaculate is missed. This often (though not always) has an impact on the individual’s partner, resulting in
B; the relationship is burdened by the lack of ejaculatory control with spiraling consequences. The
individual feels a reinforced sense of shame, dread, humiliation, and inadequacy with painful
consequences. Sex is not seen as a shared activity to be embraced and viewed as a source of mutual
pleasure and enhancement; rather, it becomes an ordeal to be endured, with the outcome predetermined.
The partner initially may be confused and may feel responsible, but the more usual response in a partner
who has some sexual sophistication is to feel frustrated, impatient, and angry. This in turn is perceived by
the individual, which only intensifies his anxiety and distress and distorts even further the nature of the
sexual experience.
Possible Causes of Premature Ejaculation
There have been many attempts to explain the cause or causes of PE. These have included a belief that
unconscious conflicts are expressed by coming rapidly, that interpersonal struggles are manifested by
PE, that there is a biological difference in the certain reflexes, that there is a difference in the sensitivity of
the skin of the penis, and that PE actually represents the norm, given that animals have a very short
ejaculatory latency. (The fact that many primates ejaculate almost immediately after intromission
suggests the hypothesis that swift intercourse is a normal pattern and may have evolutionary survival
value. [2])
All too often men and their partners are quick to diagnose themselves in negative, self-blaming ways with
great suffering to both partners. Meaning may be ascribed to coming early that has no bearing on reality.
Premature ejaculation is only one of the many sexual symptoms around which the distress of an individual
or couple may be focused. A man with ejaculatory problems may be with a partner who has some
(unidentified) sexual constriction. If the partner has trouble with closeness or difficulty with arousal or
orgasm herself, the PE may mask those difficulties and provide the “obvious” problem that the couple
defines.
Dr. Derek C. Polonsky gives an excellent summary of PE [1], which he addresses to men with this problem:
1. This is a very common issue for men. Roughly 30% of men say that they are not satisfied with their
ability to control orgasm. Men are convinced that everyone else lasts just fine.
2. Often the focus becomes “am I going to last” – and there is a change away from enjoyment and
pleasure to one of business and performance, where one will be judged and criticized.
3. Men often think their problem is that they become too excited too quickly and that they need to distract
themselves in some way. (Think of a baseball game, do a mathematical calculation.) The issue is learning
to STAY at the high level of arousal; learning what you can do to keep a balance between coming and being
very aroused. (The best way to increase the capacity to sustain a high level of arousal without ejaculation
is to experience sexual intensity. The nervous system accommodates to stimulation by raising the
threshold for the ejaculatory reflex [3])
4. Many partners are convinced that the man is selfish – interested only in his getting off and not caring
about her being left high and dry. Frankly, most men feel shame and a sense of defeat rather than a self-
congratulatory high. In addition, for many men who come very soon, the subjective experience is that their
orgasm is not very intense.
5. Talking with your partner about your worries and learning something about your partner’s wishes and
worries will lessen considerably the pressure you feel around control.
6. The reverse holds true; that is, if you don’t talk about your concerns, and march forward trying to cover it
up, the pressure will only mount, and anxiety usually makes every aspect of sex more difficult and less
enjoyable.
7. It is important to know something about your partner’s sexual interests and needs. Guys often have the
idea that “real men” can thrust vigorously and continuously for long periods – the more rapid and longer,
the better for the woman. Most women will not confirm this perception.
8. Practice and frequency are absolutely crucial. Almost all men will have less control over when they
come if they have not had an orgasm for a while.
Treatment approaches
Treatment approaches now include and integrating of individual and couple dynamics, cognitive and
behavioral approaches, and more recently the introduction of various medications [1]. To remove the
pressure it is essential for the man to be able to please his partner in a variety of ways. Dr. J. Hong
cleverly emphasized the human approach to pleasure giving: The tender touch, the passionate caress, the
gentle rub, the titillating probe, and all those other infinite maneuvers that humans, as the most
sophisticate bipedal primate, are best equipped to do, can be much more satisfying to women than simply
a longer time span between intromission and ejaculation. [2]
Often, the therapist has to provide support and practical guidance with establishing a relationship with a
partner, offer suggestions for how to “script” the sexuality, and literally “walk” the individual through the
process. The “script” that many men follow is one that is tailor-made for increasing anxiety and isolation
and almost guarantees that the ejaculatory control will be poor. It is often based on the unrealistic
portrayal of sexuality in movies, where there is a seamless progression through intensifying states of
sexual arousal and breathless nonverbal passion, usually with the male directing the pace and at all times
knowing exactly what will please his partner. It is a daunting task for the man with poor ejaculatory
control to manage on his own. The therapist can provide a model for slowing things down, for getting to
know and trust a new partner, and for telling the partner early on that he has concerns about his sexual
performance. In the absence of changing the script, the more usual pattern is for the man to feel alone
with his struggle to “hold off” and for his partner to feel confused about what has happened. When the
partner has had sexual experiences that were different, she might be able to recognize the issue as
residing with her partner. But often the woman may wonder about her own abilities and feel she has
somehow failed to be a good sexual partner, and the spiral of self-doubt and anxiety begins for both.
References:
1. Polonsky, D. C., Premature Ejaculation. In Principles and Practice of Sex Therapy. Third Edition, New
York, The Guilford Press, 2000
2. Hong, J. Survival of the fastest: On the origins of premature ejaculation. Journal of Sex Research, 1984,
Vol. 20, 109-112
3. Levine, S. B. Helping men to control ejaculation: Sexual life – A clinician’s guide, 1992, New York: Plenum
Premature Ejaculation