Premature Ejaculation

The inability to control ejaculation to the extent sufficient for both partners to receive satisfaction from sexual intercourse.

– premature ejaculation due to diseases of the male genital organs;
– premature ejaculation due to organic brain damage.

Absolute acceleration of ejaculation

Diagnostic criteria: the duration of sexual intercourse is less than one minute (less than 20 frictions) against the background of regular sex life.

Relative acceleration of ejaculation

Diagnostic criteria: the duration of sexual intercourse within the physiological norm (from 1 to 3 minutes).

However, this duration of sexual intercourse is not enough to get an orgasmic discharge from a partner.

Acceleration of ejaculation, unspecified

– Premature ejaculation without further clarification (BDU).

Accelerated ejaculation is one of the most frequent sexual problems of men. W. Masters and B. Johnson (1983) believe that at least 15–20% of Americans have difficulty trying to control rapid ejaculation, but not all of them seek help from specialists. Thus, according to the NHSLS survey (1994), 30% of men reported that they had an orgasm too soon. In a survey of K. Starke and V. Friedrich (1987) of 78% of men under the age of 30 who could indicate the average duration of sexual intercourse, 7% had it up to 1 minute, 23% had it up to 3 minutes, 40% – 4 – 10 minutes, in 7% – more than 10 minutes, in 1% – ejaculation was absent.
It should be recognized that today among researchers there is no generally accepted definition of premature ejaculation. So, G. Kelly (2000) notes that the boundaries between norm and pathology are not absolute here and are largely culturally determined. He gives such an example. If a man from East Bay (Melanesia) ejaculates more than 30 seconds after the penis is inserted into the vagina, the locals consider such sexual intercourse to be excessively long, which is perceived as a deviation from the norm.

Along with the approach presented in the adapted ICD-10, there are other interpretations of accelerated ejaculation. For example, Luo Piccolo (1978), based on statistical data from a survey of 1,000 married couples, believes that treatment is indicated for men who have sexual intercourse for less than 4 minutes. In 1970, W. Masters and W. Johnson expressed the opinion that if a man ejaculates before the partner has time to reach orgasm in at least 50% of cases of sexual intercourse between them, he suffers from premature ejaculation. However, later Masters and Johnson (1991) themselves recognized such a definition as unsuccessful. In particular, it is not applicable to situations where a woman rarely experienced an orgasm or never had it during coitus. X. Kaplan (1974, 1987) connects with the concept of premature ejaculation the absence of arbitrary control over the ejaculatory reflex. She believes that normally a man is able to learn to endure a high degree of sexual arousal for a long time without the occurrence of reflex ejaculation. However, most experts believe that complete arbitrary control over ejaculation is the exception rather than the rule, therefore, it is very problematic to associate it with the norm (S. Kratochvil, 1982; W. Masters, V. Johnson, 1983, etc.). Recently, the point of view has spread that sex disorders should include cases where, usually with minimal sexual stimulation, ejaculation in a man repeatedly occurs earlier than his partner has time to get satisfaction from coitus and if he is so unable to control the process of ejaculation, that one or both partners are starting to treat it as a problem.

The diagnostic criteria for premature ejaculation, according to the American Psychiatric Association (APA), are as follows:

a) ejaculation occurs with minimal sexual stimulation before, during or immediately after penetration, before the partners would like;
b) violation of ejaculation leads to problems in communication with the sexual partner;
c) premature ejaculation is not associated with the direct action of drugs (for example, the effect of opioid withdrawal).

It should be noted that men often experience feelings of frustration and lack of self-confidence due to their inability to control the onset of ejaculation, but since the orgasm still gives them pleasure, they may not have sufficient motivation to go to the doctor for this problem (M. Metz et al., 1997). Their partners, who are just beginning to come into sexual arousal when the man is already ejaculating and the sexual act ends, suffer the most. Persistent problems with premature ejaculation can cause conflicts between sexual partners and lead to other sexual disorders. Women who experience frustration, frustration and physical discomfort due to frequent sexual frustrations can lose interest in sex and stop experiencing agitation from it (G. Kelly, 2000). In some cases, attempts by men to consciously control their sexual arousal, to prevent rapid ejaculation, distract him from intercourse so much that it leads to loss of erection. Any difficulties in the occurrence and maintenance of an erection on the background of a conflict relationship with a partner are easily fixed by neurotic mechanisms, leading to the emergence of anxious expectation of sexual failure, that is, secondary psychogenic erectile dysfunction.

According to some estimates, 35–40% of men who received treatment for sexual disorders mainly complained of premature ejaculation (G. Kaplan, B. Sadoc, 1996).

There is no doubt that, other things being equal, the ability of a man to sufficiently regulate the duration of sexual intercourse allows him to better adapt to his partner and ensure sexual stimulation that satisfies her. In addition, with longer duration of sexual intercourse, the man himself, as a rule, experiences brighter and more intense orgasmic experiences.

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