Sexual Dysfunction - Premature Ejaculation


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Marcus Waldinger, using scientific data, divides premature ejaculation (PE) into two groups called 'lifelong' and 'acquired'.

Now he has proposed a third type to be called 'natural variable' which covers men who experience an inconsistent type of PE, not so much a disease of a failure but simply a normal variation in the man's ejaculatory control.

Dr Waldinger goes on to say that normal variable PE covers a high number of men (between 20 and 40% ) who think they are early ejaculators.

Compare this with the percentage of men who have lifelong and acquired PE, who are only between 1% and 5% of the male population, although these figures have never been thoroughly tested in detail.

This is a new step in defining PE as it draws attention to the fact that men are by and large dissatisfied with their sexual performance, when in truth they may be going through nothing more than the natural inconsistency of male sexual activity.

If Waldinger is right, and it looks like he is, then it looks like the majority of men who ask for treatment for PE should not be treated with medication for premature ejaculation such as off-label antidepressants, but they should be given non-invasive psychological therapy like sexual psychotherapy or counseling.

There is a problem in understanding the etiology of PE and how psychoanalysis can be useful in its understanding and treatment.

There are very few reports of psychoanalytic investigation into PE, and one of the problems of the very few accounts available is that they tend to extrapolate from individual cases to generalized explanations such as 'castration anxiety', 'hatred of women' and so on.

There are several groups and sub groups of sufferers from PE and the categorization depends on the individual's intra-vaginal ejaculation latency time (IELT), how it varies over time and the personal experience of the individual.

Lifelong and acquired PE

Men with lifelong PE or acquired PE usually have an IELT of less than one and  a half minutes. But there are some men with lifelong PE who can last three minutes or more. Also in cases of lifelong PE, early ejaculation occurs on each occasion but men with normal variable PE have considerable variability and inconsistency in their IELT.

Waldingeralso proposes a new designation 'premature like ejaculatory dysfunction' which explains the considerable number of men who say they have PE even though they have a regular or even a long IELT. In a recent study, conducted over several locations in the United States, men were classified as having PE or not according to recognized criteria.

Video - Premature Ejaculation

The study showed that 48% with PE could last at least two minutes, while 13% of men thought they had PE made 5 to 25 minutes. The study revealed that the old definitions were unreliable and even spurious. Many men who had normal and even long IELT still reported PE. So is good clinical judgment to class men as having PE if they can manage between 5 and 25 minutes of intercourse on a regular basis?

Marcel Waldinger has opened up an argument about the value of psychoanalysis as a cure for premature ejaculation (PE). Psychoanalysis was the old method before the Singing Sixties but no research was done to see how well it worked. Waldinger now says that the new classification of three different types of PE gives us the chance to revisit the old method.

Before I go on, the three classifications are 'lifelong' where the condition has been around since he started sex, 'acquired' which is something that develops and 'normal variable' which is when it comes about from time to time.

Waldinger also notices the similarity between the old fashioned use of topical anesthetic ointments when psychoanalysis was around, and the modern use of SSRI or tricyclic antidepressants, now that behavior therapy is the golden rule.

And in the Forties, the use of anesthetic ointments was off-label, just as antidepressants are off-label today. And another thing, neither psychoanalysis nor behavioral therapy have been looked at properly to see how well they work.

Video - premature ejaculation

Psychoanalysis for PE isn't done now. The modern is a daily dosage of 'selective serotonin reuptake inhibitors' or an as required dosage of tricyclic antidepressants such as clomipramine, or maybe using topical anesthetics. The pharmacological method of treating PE stems from the notion of it as being a neurobiological state.

But the use of pharmaceuticals is inadequate because it can't explain how PE is perceived either by the man his partner, and it tells us nothing about the unconscious mental processes involved. So Waldinger thinks that the psychoanalytic may be the right treatment after all.

Before we move on, let's look at the definition of PE. The current thinking says that PE is all these:

1 Persistent recurrent ejaculation with minimal sexual stimulation before the man wants it.

2 Noticeable concern or interpersonal problems.

3 Not totally due to direct effects.

Waldinger has looked at two studies dated 2004/2005 and discovered that this definition produces many PE diagnoses which turn out as false positives as the official definition gives more weight to the men who complain about having PE, and doesn't calculate their 'intra-vaginal ejaculatory latency time' (IELT).

So what this means is that the usual definition does not consider the great variability between men timings, nor does it include the variation in how long the partners want sex to last. This uncertainty tells us that  we need to know exactly what we mean by PE and then get a better definition.

The evidence is that, for the 18 to 30 year old group, the average IELT is about six and half minutes.

If we call PE an IELT percentile below 2.5 that means that a man who ejaculates in under a minute and a half has got it. But then, many men and their partners with an IELT of less than 1.5 minutes are satisfied with the situation and don't see it as a problem.

So they would not be classed as having PE. Now let's look at a man who has an IELT of two minutes, but thinks he has poor control, is upset about the situation, and has problems with his partner because of it. Even though he does not come within the conventional definition of PE, he can now be diagnosed with PE.

 

Updated

May 26 2016