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There are many definitions of premature ejaculation (PE). Some say it's when a man can't prolong intercourse long enough for his wife to climax. Does this mean a man who can last half an hour is premature if his wife does not climax? Does it mean the man who never lasts two minutes is not premature if his wife usually climaxes? (Both such couples exist.) The usual medical definition is a man who ejaculates less than two minutes after entering the vagina; but the reality is three minutes is not enough time for the vast majority of women to reach climax. The best definition we have found deals not with the woman's climax, or how long intercourse lasts, but with the man's ability to control his ejaculation most of the time, climaxing only when he chooses. Admittedly this is a subjective measure that cannot be quantified for use in studies, but it is a good real world standard.
How many men deal with PE? We’ve seen estimates as low as 2% and as high at 70%! Some of these are high because they ask if men have ever experienced PE. A variety of relation issues, as well as not having had sex in a long time, affect how long a man can last, so such a question is of little use. The best studies put the number of men who can’t last two minutes at 11% to 14%. The number of men who don’t have real control is higher than this – possibly as high as one third of all men.
Originally, it was thought that rapid ejaculation was the result of mental issues such as anxiety, fear, anger, or embarrassment. Based on this, treatment was to deal with the mind via psychoanalysis. In 1970, Masters and Johnson said PE was a result of self-learned behaviours: rapid masturbation or hurried sex resulting from fear of discovery. This theory resulted in trying to cure PE by behaviour modification – retraining a man to make sex last longer.
While all the things listed above may be factors in some cases of PE, there is growing research-based understanding that some men are "hard wired" to ejaculate quickly during intercourse (most men can last much longer during masturbation and other sex acts – intercourse is different). Studies of twins have suggested heredity is involved, studies of penile sensitivity have found that men with PE have greater sensitivity than those without, and several studies have found certain genes to be more common in men with PE. This new understanding of PE has brought about the search for ways to treat PE with medication, and studies of medications have further supported the idea that PE is not “all in the head” by showing that the placebo effect is very weak for PE.
PE is divided into two categories. If a man has always climaxed rapidly during intercourse, he has primary or lifelong PE. If he started to have problems after a period of good control, he has secondary or acquired PE. Secondary PE is far more likely to have a psychological component. Secondary PE is also common in men who develop erectile difficulty, with almost half of such men reporting PE. Anxiety about losing an erection causes men to speed up so they can climax “before it’s too late”. In this case, the solution is to deal with the ED so the man can take his time.
Rapid ejaculation is very much a couple issue. It clearly affects the man and the woman, their sex life, and their marriage as a whole. It is also unlikely that a man will be able to succeed in changing without the loving support and help of his wife. Women should understand that most men find PE shameful; he feels like he is not really a man, and he does not want anyone else, even a doctor or counsellor, to know of the condition. It's common for a man to refuse to seek help because of his embarrassment. In such a situation, the wife should lovingly but firmly communicate to her husband that she will not accept him ruining their sex life because of fear or pride.
We will begin with ways for a couple to train the man to have control of when he ejaculates, then suggest other alternatives for those who find this does not work. Studies of men with primary PE find that 80% ejaculate after less than half a minute of intercourse, with the rest averaging two minutes or less. A man who regularly lasts three or more minutes probably does not have a predisposition to ejaculate quickly, and as such can likely learn to last longer. Men who always climax in less than a minute can try to learn to last longer, but most in this group will be unable to make a change. Don’t beat up on yourself (or your husband) if you can’t learn to last longer – genetics may be against you. There are other ways to deal with PE.
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