Premature ejaculation (PE) is an ambiguous and poorly understood condition which can be difficult to manage for both the therapist and the client. In this article, I challenge some of the current theories and explore the options and opportunities for understanding PE.

What Exactly is Premature Ejaculation (PE)?

I criticize current definitions of premature ejaculation for their inconsistency and vagueness, flaws that render them overly prone to subjective interpretation. Scientific studies, because of their heterogeneity, tend to adversely affect both research and any information about the nature and prevalence of the complaint.

In 1980, the American Psychiatric Association published the DSM-III-TR, which attempted to define PE, albeit with a psychiatric bias and many other flaws. That definition has since been revised several times; the current, DSM-V (2013) resolved some of the earlier ambiguity.

I personally tend to be of the opinion that in general most of the cases of so-called PE are culturally conditioned and abetted by ignorance and misinformation, or a product of the man’s ego, or his presumption of his partner’s expectations.

That having been said, prevalence of authentic PE is probably one-tenth of that reported in the literature or about 3-4.5% rather than the whopping 30%. Part of the problem in the West is that practically everything is medicalized and, once medicalized, the pharmaceutical giants stand to reap huge profits.

This pernicious situation is further complicated by the self-interested proselytizing of fake experts marketing their snake-oil; a virtual non-problem is thus commodified and monetized in the jargon of the market.

For starters, I would like to propose a simple definition for the majority of “PE” as a perceived problem: If you ejaculate before you want to, and if that causes you any distress or a problem, it’s PE. If you simply cum quickly and it doesn’t bother or overly concern you, it’s not PE. Period.

Ask a urologist

Ask a urologist who knows something about PE and he’ll probably cite the so-called ‘2-minute rule.’ But the governing three requisites must also be present for PE to be diagnosed as a sexual disorder. These are:

  • Persistent or recurrent ejaculation before the man wants it; he is unable to delay ejaculation in nearly all instances;
  • The condition causes negative consequences, personal distress or relationship problems;
  • The condition is not directly caused by substances.

There are many contentious and ongoing criticisms of how PE is defined. The lack of time criteria in the definition results in misinterpretation by men as well as by caregivers, which paves the way to inconsistencies in communications and difficulty making direct comparisons in culturally heterogeneous groups. There is no consistent evidence that age, partner characteristics, or length of relationship has any effect on ejaculatory latency times (ELT) or the time from stimulation to ejaculation.

Another major criticism is the lack of criteria for how frequently or the period over which fast ejaculation must occur before it can be defined as a problem. For example, a man with frequent sexual activity who occasionally experiences rapid ejaculation may not be bothered at all; a man with infrequent sexual opportunity may be distressed by even a single experience of rapid ejaculation. Which man, if any, has PE? Unfortunately, the decision is made emotionally or based on unrealistic expectations.

The main difficulties with this definition are the method of measuring the latency time and how to define a normal or abnormal time. The concept of the ejaculatory latency time (ELT) was introduced in 1994, and is the time from stimulation to ejaculation.

This is useful in PE inquiries and may be either estimated by the man or his partner or timed directly. Because most men like to feel they are good performers, if he does tend to cum quickly, it may bother him; it may affect his self-perception, so there is a tendency for a man to overestimate his ELT. Again, such a casual definition is simply unacceptable.

PE a real problem

Is PE a real problem?

Our early ancestors probably wanted to ejaculate quickly to ensure their ability to reproduce with multiple partners and spread their genetic material; it also helps to avoid becoming a tiger snack. For the 21st-century man, however, erotosensuality not only allows him to fulfill his ‘masculine potential’ but also has important effects on his self-image and quality of life.

As males reach puberty and begin sexual activity, their time to ejaculation and their perceived ejaculation control or the ability to delay ejaculation change over time. In addition, ejaculation control and delay of ejaculation depend on the man, his partner, and the intimate situation. Rapid ejaculation doesn’t necessarily mean a lack of sensual pleasure; any perception of sexual dysfunction as PE or secondary to PE is heavily influenced by cultural and social factors.

We also know that social media, pornography, masturbation, cultural attitudes, and abstinence can all affect sexual function, including ELT. I therefore propose that it may not be prudent or even correct to define most PE as a pathology, or even as a disorder.

It may more appropriately be called an inconvenience. Moreover, we have to discern whether PE actually exists or whether it is the product of men having unrealistic concepts of sexual function or performance based on social conditioning, or wrong models, particularly that of pornography.

Furthermore, real or subjective PE is a multimillion-dollar industry and we must challenge the male enhancements, the sex-therapy, and the pharmaceutical industries as to whether medicalizing a man’s perception of PE benefits him or whether he would be best served with counseling or training in physical ejaculation control methods.

How many men have PE?

Physiology of Ejaculation

PE is estimated in the medical literature to affect 20–40% of the general population; though in reality, only 4–5% may satisfy the currently accepted clinical definition. In the studies there is huge variability in the reported prevalence owing to the various definitions of PE used and the inquiry methods, which include questionnaires, self-reports, and several expert panel definitions.

Quite apart from the variability in prevalence, there is one variable that is consistently low: the proportion of men seeking treatment for PE. This may reflect anxiety and the perceived stigma attached to the condition.

Physiology of Ejaculation

Ejaculation is a normal part of male sexual function and consists of two coordinated neurological reflexes: emission and ejection.

Orgasm is a phenomenon different from ejaculation but generally occurs simultaneously with ejaculation. Emission involves contractions of the seminal vesicles and prostate and expulsion of a mixture of sperm and seminal fluid into the urethra.

This is mediated by the sympathetic nervous system (T10–L2)[1]. Ejection involves the pulsatile contractions of the bulbocavernosus and pelvic floor muscles with relaxation of the external urinary sphincter, and ejecting of semen from the penis. Somatic nerves (S2–4) mediate ejection and involves the sympathetic nervous system with limited voluntary control.[2]

These reflexes are stimulated by sensory input from nerve endings in the glans of the penis, which are relayed via the spinal cord to the brain. The pathway involves a variety of central and secondary neurons.

The parasympathetic system is the other ‘involuntary’ nervous component that is involved in the erectile response, but has less involvement in ejaculation.[3]

Dopamine and serotonin are essential neurotransmitters; dopamine promotes seminal emission and ejaculation, while serotonin is inhibitory serving to delay ejaculation. There is a notion that PE is due to hyposensitivity or hypersensitivity of some receptors, or both. Some studies have documented the role of oxytocin and, although not well established, it has been found to have a stimulatory effect on ejaculation in animal models and reduces ejaculatory latency times.

What about hormones? The influence of hormones is less clear. Some animal models have suggested that cerebral dopamine and serotonin may interact with the hypothalamic-pituitary-thyroid axis. Hyperthyroid rats had shorter times to first ejaculation compared with controls.

A small study by Carani et al. found a significant correlation between PE and hyperthyroid men, which fell dramatically, from 50 to 15%, following treatment. This would support a possible role for the thyroid hormones in ejaculation. However, other studies have suggested that there is a role only in acquired PE and this is a rare cause.

In conclusion, before we start self-diagnosing PE and creating a monster, I recommend that any man complaining of PE first determine whether the underlying problem is more psycho-emotional, social, or imaginary. For starters, I recommend considering some of the factors I list in Appendix I, which can be viewed/downloaded from my site using this link: Non-Medical PE.

I am very fond of self-assessments and questionnaires for getting information. In the case of PE, I have adopted and adapted the so-called PE Index questionnaire. You can view and download the Index from my site by clicking this link: Premature Ejaculation Index.

Finally, I would be remiss if I were not to pitch the benefits of my Homoerotic Tantra:Mascul-IN-Touch℠ and Mascul-IN-Timacy℠ programs and the opportunities to learn about ejaculatory control techniques (ECTs). ECTs are not only an integral part of the ritual practices I teach, they are also very helpful in any erotosensory/intimate situation where a man might want to delay ejaculation. The ECTs are also very beneficial in strengthening the male genitourinary region, enhancing the strength of erections, and enhancing ejaculatory control and power.

©2020/2021. Homoerotic Tantra:Mascul-IN-Touch℠ and H.W. Vadney MDiv. (Daka Karuṇā (करुणा) T.). All rights Reserved. This document is considered proprietary and confidential. Permission to publish this article is granted provided attribution is recognized without prejudice to the author’s rights. Homoerotic Tantra:Mascul-IN-Touch℠, Homoerotic Tantra:Mascul-IN-Timacy℠, and Daka Karuna are alteregos of H.W. Vadney MDiv. Homoerotic Tantra℠, Mascul-IN-Touch℠, and Homoerotic Tantra:Mascul-IN-Touch℠, Hesion℠, and Mascul-IN-Timacy℠ are proprietary service marks claimed by H.W. Vadney MDiv.