Premature ejaculation

This article is about the medical condition. For the music group, see Premature Ejaculation (band).

Premature ejaculation (PE) is a male sexual dysfunction that occurs when a male expels semen (and most likely experiences orgasm) soon after beginning sexual activity, and with minimal penile stimulation. It has also been called early ejaculation, rapid ejaculation, rapid climax, premature climax and (historically) ejaculatio praecox. There is no uniform cut-off defining "premature", but a consensus of experts at the International Society for Sexual Medicine endorsed a definition of around one minute after penetration.^[1] The International Classification of Diseases (ICD-10) applies a cut-off of 15 seconds from the beginning of sexual intercourse.^[1]

Premature ejaculation
Specialty	Psychiatry, sexual medicine

Although men with premature ejaculation describe feeling that they have less control over ejaculating, it is not clear if that is true, and many or most average men also report that they wish they could last longer. In males, typical ejaculatory latency is approximately 4–8 minutes.^[2] The opposite condition is delayed ejaculation.^[3]

Men with PE often report emotional and relationship distress, and some avoid pursuing sexual relationships because of PE-related embarrassment.^[4] Compared with males, females consider PE less of a problem,^[5] but several studies show that the condition also causes female partners distress.^[4][6][7]

Cause

The causes of premature ejaculation are unclear. Many theories have been suggested, including that PE was the result of masturbating quickly during adolescence to avoid being caught, performance anxiety, passive-aggressive behavior or having too little sex; but there is little evidence to support any of these theories.^[2]

Several physiological mechanisms have been hypothesized to contribute to causing premature ejaculation, including serotonin receptors, a genetic predisposition, elevated penile sensitivity and nerve conduction atypicalities.^[8] Scientists have long suspected a genetic link to certain forms of premature ejaculation. However, studies have been inconclusive in isolating the gene responsible for lifelong PE.

The nucleus paragigantocellularis of the brain has been identified as having involvement in ejaculatory control.^[9] PE may be caused by prostatitis^[10] or as a medication side effect.

PE has been classified into four subtypes - lifelong, acquired, variable and subjective PE. The pathophysiology of lifelong PE is mediated by a complex interplay of central and peripheral serotonergic, dopaminergic, oxytocinergic, endocrinological, genetic and epigenetic factors. Acquired PE may occur due to psychological problems - such as sexual performance anxiety, and psychological or relationship problems - and/or co-morbidity, including erectile dysfunction, prostatitis and hyperthyroidism.^[11]

Mechanism

The physical process of ejaculation requires two actions: emission and expulsion. The emission is the first phase. It involves deposition of fluid from the ampullary vas deferens, seminal vesicles and prostate gland into the posterior urethra.^[12] The second phase is the expulsion phase. It involves closure of bladder neck, followed by the rhythmic contractions of the urethra by pelvic-perineal and bulbospongiosus muscle and intermittent relaxation of the external male urethral sphincter.^[13]

Sympathetic motor neurons control the emission phase of ejaculation reflex, and expulsion phase is executed by somatic and autonomic motor neurons. These motor neurons are located in the thoracolumbar and lumbosacral spinal cord and are activated in a coordinated manner when sufficient sensory input to reach the ejaculatory threshold has entered the central nervous system.^[14][15]

Intromission time

The 1948 Kinsey Report suggested that three-quarters of men ejaculate within two minutes of penetration in over half of their sexual encounters.^[16]

Current evidence supports an average intravaginal ejaculation latency time (IELT) of six and a half minutes in 18- to 30-year-olds.^[17][18] If the disorder is defined as an IELT percentile below 2.5, then premature ejaculation could be suggested by an IELT of less than about two minutes.^[19] Still, it is possible for some men with abnormally low IELTs to be satisfied with their performance and not report a lack of control.^[20] Likewise, those with higher IELTs may consider themselves premature ejaculators, and suffer from quality of life issues normally associated with premature ejaculation, and even benefit from non-pharmaceutical treatment.^[21]

Diagnosis

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines premature ejaculation as "A persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately 1 minute following vaginal penetration and before the person wishes it," with the additional requirements that the condition occurs for a duration longer than 6 months, causes clinically significant distress, and cannot be better explained by relationship distress, another mental disorder, or the use of medications.^[1] These factors are identified by talking with the person, not through any diagnostic test.^[1] The DSM-5 allows for specifiers whether the condition is lifelong or acquired, applying in general or only to certain situations, and severity based on the time under one minute, however these subtypes have been criticised as lacking validity due to insufficient evidence.^[22]

The 2007 ICD-10 defined PE as ejaculating without control, and within around 15 seconds.^[1]

Treatments

Several treatments have been tested for treating premature ejaculation. A combination of medication and non-medication treatments is often the most effective method.^[23]

Self-treatment

Many men attempt to treat themselves for premature ejaculation by trying to distract themselves, such as by trying to focus their attention away from the sexual stimulation. There is little evidence to indicate that it is effective and it tends to detract from the sexual fulfilment of both partners. Other self-treatments include thrusting more slowly, withdrawing the penis altogether, purposefully ejaculating before sexual intercourse, and using more than one condom. Using more than one condom is not recommended as the friction will often lead to breakage. Some men report these to have been helpful.^[2]

A qualitative clinical trial, conducted by King's College London medical school teaching hospitals, compared use of the Prolong device and use of the Prolong device in combination cognitive behavioural therapy versus control group. Using the Climax Control Training program in 36 subjects (17 using the Prolong the device and 19 using the device in combination with cognitive behavioral therapy) it was found that PE symptoms were equally improved in both groups.^[24]

Sex therapy

Several techniques have been developed and applied by sex therapists, including Kegel exercises (to strengthen the muscles of the pelvic floor) and Masters and Johnson's "stop-start technique" (to desensitize the male's responses) and "squeeze technique" (to reduce excessive arousal).^[23]: 27

To treat premature ejaculation, Masters and Johnson developed the "squeeze technique", based on the Semans technique developed by James Semans in 1956.^[25] Men were instructed to pay close attention to their arousal pattern and learn to recognize how they felt shortly before their "point of no return", the moment ejaculation felt imminent and inevitable. Sensing it, they were to signal their partner, who squeezed the head of the penis between thumb and index finger, suppressing the ejaculatory reflex and allowing the male to last longer.^[26][27][28]

The squeeze technique worked, but many couples found it cumbersome. From the 1970s to the 1990s, sex therapists refined the Masters and Johnson approach, largely abandoning the squeeze technique and focused on a simpler and more effective technique called the "stop-start" technique. During intercourse, as the male gets the sensation of approaching climax, both partners stop moving and remain still until the male's feelings of ejaculatory inevitability subside, at which point, they are free to resume active intercourse.^{[26][29][30][31][32]}

The functional-sexological approach to treating premature ejaculation, as developed by François de Carufel & Gilles Trudel, offers a novel method focusing on sexual function improvement without interrupting sexual activity. This treatment, distinct from traditional behavioral techniques like the squeeze and stop-start methods, has demonstrated significant improvements in the duration of intercourse, sexual satisfaction, and overall sexual function. A pivotal study by De Carufel & Trudel (2006) showcases the effectiveness of this approach.^[33] Moreover, the Cochrane review on psychosocial interventions for premature ejaculation recognizes the De Carufel study as having a low risk of bias, highlighting its methodological robustness among psychosocial intervention studies.^[34] This acknowledgment points to the functional-sexological treatment as a promising avenue for individuals and couples grappling with premature ejaculation, suggesting a shift towards more contemporary and empirically supported treatments in the field.^[35]

Medications

Dapoxetine, a selective serotonin reuptake inhibitor (SSRI), has been approved for the treatment of premature ejaculation in several countries.^[36][37][38] Other SSRIs are used off-label to treat PE, including fluoxetine, paroxetine, citalopram, escitalopram and clomipramine.^[36] The opioid tramadol, an atypical oral analgesic is also used.^[36][39] Results have found PDE5 inhibitors to be effective in combination treatment with SSRIs.^[36] The full effects of these medications typically emerge after 2-3 weeks, with results indicating about ejaculatory delay varying between 6–20 times greater than before medication.^[36] Premature ejaculation can return upon discontinuation,^[36] and the side effects of these SSRIs can also include anorgasmia, erectile dysfunction, and diminished libido.^[36]

Topical anesthetics such as lidocaine and benzocaine that are applied to the tip and shaft of the penis have also been used. They are applied 10–15 minutes before sexual activity and have fewer potential side effects as compared to SSRIs.^[40] However, this is sometimes disliked due to the reduction of sensation in the penis as well as for the partner (due to the medication rubbing onto the partner).^[41] Another research was conducted in 21 men who were randomized (15 treatment, 6 placebo) and had complete follow-up data. Baseline mean ± standard deviation IELT was 74.3 ± 31.8 vs 84.9 ± 29.8 seconds among the treatment and placebo groups, respectively (p=0.39). After 2 months, men in the treatment group had significant improvement in IELT with a mean increase of 231.5 ± 166.9 seconds (95% confidence interval of 139-323 seconds) which was significantly greater than men on placebo (94.2 ± 67.1 seconds, p= 0.043). ^[42]

Surgical treatments

Two different surgeries, both developed in South Korea, are available to permanently treat premature ejaculation: selective dorsal neurectomy (SDN)^[43] and glans penis augmentation using a hyaluronan gel.^[44][45] Circumcision has shown no effect on PE.^[46] The International Society for Sexual Medicine guidelines do not recommend either surgical treatment due to the risk of permanent loss of sexual function and insufficient reliable data^[46][47][22] and on the basis of violating the medical principle of non-maleficence as the surgery can lead to complications, of which some might not yet be known.^[46] The most common complication of surgery is the recurrence of PE, reported to occur in about 10% of surgeries.^[46] Other sources consider SDN as a safe and efficient treatment^[48] and these surgeries are popular in Asian countries.^[22][47]

Epidemiology

Premature ejaculation is a prevalent sexual dysfunction in males;^[49] however, because of the variability in time required to ejaculate and in partners' desired duration of sex, exact prevalence rates of PE are difficult to determine. In the "Sex in America" surveys (1999 and 2008), University of Chicago researchers found that between adolescence and age 59, approximately 30% of men reported having experienced PE at least once during the previous 12 months, whereas about 10 percent reported erectile dysfunction (ED).^[50] In males, although ED is the most prevalent sex problem after age 60, and may be more prevalent than PE overall according to some estimates,^[51] premature ejaculation remains a significant issue that, according to the survey, affects 28 percent of men age 65–74, and 22 percent of men age 75–85.^[50] Other studies report PE prevalence ranging from 3 percent to 41 percent of men over 18, but the great majority estimate a prevalence of 20 to 30 percent—making PE a very common sex problem.^{[4][10][49][52][22][53][54][55]}

There is a common misconception that younger men are more likely to develop premature ejaculation and that its frequency decreases with age.^[56][57] Prevalence studies have indicated, however, that rates of PE are relatively constant across age groups.^[8]

History

Naturalism

Male mammals ejaculate quickly during intercourse, prompting some biologists to speculate that rapid ejaculation had evolved into genetic makeup of human males to increase their chances of passing their genes.^[58][59]

Ejaculatory control issues have been documented for more than 1,500 years. The Kamasutra, the 4th century BCE Indian marriage handbook, declares that “if a male be long-timed, the female loves him the more, but if he be short timed, she is dissatisatisfied with him.”^[60][61]

Waldinger summarizes professional perspectives from early in the twentieth century.^[62]

Sex researcher Alfred Kinsey did not consider rapid ejaculation a problem, but viewed it as a sign of "masculine vigor" that could not always be cured.^[63] The belief that it should be considered a disease rather than a normal variation, has also been disputed by some modern researchers.^[64]

Medicalization

Further information: Medicalization of sexuality

In the 19th century, a symptom called spermatorrhoea invented by William Acton in 1857, meaning excessive or involuntary semen discharge, was developed and at the time used as a medical justification of celibacy.^[65][66] Spermatorrhoea was later sub-classified into other symptom clusters based partially on how it affected semen.^[66] Treatment for spermatorrhoea at the time included catheterisation, cauterisation, circumcision, and sticking needles through the perineum into the prostate.^[66] In the 19th and early 20th centuries, the cultural stigma towards researching sexuality which drove its unpopularity among doctors and in publications.^[65] The first recognition the symptoms described in spermatorrhoea as a disorder in itself is believed to be in 1883, termed ejaculatio praecox.^[66] The origin of the modern version of ejaculatio praecox, called premature ejaculation, is thought to of begun with Alfred Adler before major developments of psycohanalytic theory.^[67]

Through the mid 20th century, Sigmund Freud published widely accepted and virtually unchallenged theories that rapid ejaculation was due to neurosis, that penetrative sex was the only right way to achieve female orgasm, and that a man's erection was essential to female orgasm.^[68][69] It stated that males who ejaculate prematurely have unconscious hostility toward females, so they ejaculate rapidly, which satisfies them but frustrates their partners, who are unlikely to experience orgasm that quickly.^[70] Freudians claimed that premature ejaculation could be cured using psychoanalysis. But even years of psychoanalysis accomplished little, if anything, in curing premature ejaculation.^[70] In 1974, there was no evidence found to suggest that men with premature ejaculation harbor unusual hostility toward females. This so-called coital imperative has later been argued as a medically recognised disorder that did not actually serve the satisfaction of women but rather contributed to the pressure on and pathologisation of men in obtaining a so-called optimal time to ejaculation.^[69][71]

See also

• Anorgasmia
• Delayed ejaculation
• Edging (sexual practice)
• Pre-ejaculate
• Retrograde ejaculation
• Erectile dysfunction
• Blue balls
• Pull-out method
• Foreplay

References

1. Serefoglu, Ege Can; McMahon, Chris G.; Waldinger, Marcel D.; Althof, Stanley E.; Shindel, Alan; Adaikan, Ganesh; Becher, Edgardo F.; Dean, John; Giuliano, Francois; Hellstrom, Wayne J.G.; Giraldi, Annamaria; Glina, Sidney; Incrocci, Luca; Jannini, Emmanuele; McCabe, Marita; Parish, Sharon; Rowland, David; Segraves, Robert Taylor; Sharlip, Ira; Torres, Luiz Otavio (June 2014). "An evidence-based unified definition of lifelong and acquired premature ejaculation: report of the second international society for sexual medicine ad hoc committee for the definition of premature ejaculation". Sexual Medicine. 2 (2): 41–59. doi:10.1002/sm2.27. PMC 4184676. PMID 25356301.
2. Strassberg, D. S., & Perelman, M. A. (2009). Sexual dysfunctions. In P. H. Blaney & T. Millon (Eds.), Oxford textbook of psychopathology (2nd ed.), (pp. 399–430). NY: Oxford University Press.
3. Jern, Patrick; Santtila, Pekka; Witting, Katarina; Alanko, Katarina; Harlaar, Nicole; Johansson, Ada; von Der Pahlen, Bettina; Varjonen, Markus; Vikström, Nina; Ålgars, Monica; Sandnabba, Kenneth (2007). "Premature and delayed ejaculation: Genetic and environmental effects in a population-based sample of Finnish twins". The Journal of Sexual Medicine. 4 (6): 1739–1749. doi:10.1111/j.1743-6109.2007.00599.x. PMID 17888070.
4. Barnes T.; I. Eardley (2007). "Premature Ejaculation: The Scope of the Problem". Journal of Sex and Marital Therapy. 33 (3): 151–170. doi:10.1080/00926230601098472. PMID 17365515. S2CID 41366014.
5. Byers, E.S.; G. Grenier (2003). "Premature or Rapid Ejaculation: Heterosexual Couples' Perceptions of Men's Ejaculatory Behavior". Archives of Sexual Behavior. 32 (3): 261–70. doi:10.1023/A:1023417718557. PMID 12807298. S2CID 37472401.
6. Limoncin, E.; et al. (2013). "Premature Ejaculation Results in Female Sexual Distress: Standardization and Validation of a New Diagnostic Tool for Sexual Distress". Journal of Urology. 189 (5): 1830–5. doi:10.1016/j.juro.2012.11.007. hdl:11573/540121. PMID 23142691.
7. Graziottin, A.; S. Althof (2011). "What Does Premature Ejaculation Mean to the Man, the Woman, and the Couple?". Journal of Sexual Medicine. 8: 304–9. doi:10.1111/j.1743-6109.2011.02426.x. PMID 21967392.
8. Althof, S. E. (2007). "Treatment of rapid ejaculation: Psychotherapy, pharmacotherapy, and combined therapy", pp. 212–240 in S. R. Leiblum (Ed.), Principles and practice of sex therapy (4th ed.). NY: Guilford. ISBN 978-1593853495
9. Coolen LM, Olivier B, Peters HJ, Veening JG (1997). "Demonstration of ejaculation-induced neural activity in the male rat brain using 5-HT1A agonist 8-OH-DPAT". Physiol. Behav. 62 (4): 881–91. doi:10.1016/S0031-9384(97)00258-8. PMID 9284512. S2CID 35436289.
10. Althof, S.E.; et al. (2010). "International Society for Sexual Medicine's Guidelines for the Diagnosis and Treatment of Premature Ejaculation". Journal of Sexual Medicine. 7 (9): 2947–69. doi:10.1111/j.1743-6109.2010.01975.x. PMID 21050394.
11. (PDF). Archived from the original (PDF) on 2021-11-06. Retrieved 2021-12-21.{{cite web}}: CS1 maint: archived copy as title (link)
12. Böhlen D, Hugonnet CL, Mills RD, Weise ES, Schmid HP (2000). "Five meters of H(2)O: the pressure at the urinary bladder neck during human ejaculation". Prostate. 44 (4): 339–41. doi:10.1002/1097-0045(20000901)44:4<339::AID-PROS12>3.0.CO;2-Z. PMID 10951500. S2CID 26120815.
13. Master VA, Turek PJ (2001). "Ejaculatory physiology and dysfunction". Urol. Clin. North Am. 28 (2): 363–75, x. doi:10.1016/S0094-0143(05)70145-2. PMID 11402588.
14. deGroat WC, Booth AM (1980). "Physiology of male sexual function". Ann. Intern. Med. 92 (2 Pt 2): 329–31. doi:10.7326/0003-4819-92-2-329. PMID 7356224.
15. Truitt WA, Coolen LM (2002). "Identification of a potential ejaculation generator in the spinal cord". Science. 297 (5586): 1566–9. Bibcode:2002Sci...297.1566T. doi:10.1126/science.1073885. PMID 12202834. S2CID 29708727.
16. Kinsey, Alfred (1948), Sexual Behavior in the Human Male, Philadelphia: W. B. Saunders Co
17. . Archived from the original on 2017-07-08. Retrieved 2007-10-21.{{cite web}}: CS1 maint: bot: original URL status unknown (link)
18. Waldinger MD, Quinn P, Dilleen M, Mundayat R, Schweitzer DH, Boolell M (2005). "A multinational population survey of intravaginal ejaculation latency time". The Journal of Sexual Medicine. 2 (4): 492–7. doi:10.1111/j.1743-6109.2005.00070.x. PMID 16422843.
19. Waldinger MD, Zwinderman AH, Olivier B, Schweitzer DH (2005). "Proposal for a definition of lifelong premature ejaculation based on epidemiological stopwatch data". The Journal of Sexual Medicine. 2 (4): 498–507. doi:10.1111/j.1743-6109.2005.00069.x. PMID 16422844.
20. Brock, Gerald B.; Bénard, Francois; Casey, Richard; Elliott, Stacy L.; Gajewski, Jerzy B.; Lee, Jay C. (2009). "Canadian Male Sexual Health Council Survey to Assess Prevalence and Treatment of Premature Ejaculation in Canada". The Journal of Sexual Medicine. 6 (8): 2115–2123. doi:10.1111/j.1743-6109.2009.01362.x. PMID 19572961. Nevertheless, it is well accepted that men with IELTs below 1.5 minutes may be "happy" with their performance and do not report a lack of control, and therefore, do not suffer from PE.
21. Shindel, Alan W.; Althof, Stanley E.; Carrier, Serge; Chou, Roger; McMahon, Chris G.; Mulhall, John P.; Paduch, Darius A.; Pastuszak, Alexander W.; Rowland, David; Tapscott, Ashley H.; Sharlip, Ira D. (2022). "Disorders of Ejaculation: An AUA/SMSNA Guideline". Journal of Urology. 207 (3): 504–512. doi:10.1097/JU.0000000000002392. ISSN 0022-5347. PMID 34961344. S2CID 245511620. Waldinger et al. conceptualized two provisional diagnoses that may be applicable in the context of men who have concerns about PE but do not meet specific criteria for either lifelong or acquired PE. Natural variable PE is defined as occasional short ELT that occurs irregularly and inconsistently and over which the man feels diminished sense of control. This condition is typically minimally or non-disruptive of overall sexual satisfaction and does not occur with a frequency that poses serious impediment for the patient. Subjective PE (SPE, also known as PE-like dysfunction) is defined as subjective concern or preoccupation about short ELT that is within population norms.24 Data on management of these provisional conditions is limited; for the time being education and/or psychosexual therapy, rather than pharmacotherapy, are favored as the treatments of choice for Natural variable PE and SPE.
22. Serefoglu E.C.; T.R. Saitz (2012). "New Insights on Premature Ejaculation: A Review of Definition, Classification Prevalence, and Treatment". Asian Journal of Andrology. 14 (6): 822–9. doi:10.1038/aja.2012.108. PMC 3720102. PMID 23064688.
23. Hatzimouratidis, K.; Giuliano, F.; Moncada, I.; Muneer, A.; Salonia, A.; Verze, P.; Parnham, A.; Serefoglu, E.C. (2017). (PDF). European Association of Urology. Archived from the original (PDF) on 16 March 2018.
24. Ventus, Daniel; Gunst, Annika; Arver, Stefan; Dhejne, Cecilia; Öberg, Katarina G.; Zamore-Söderström, Elin; Kärnä, Antti; Jern, Patrick (2020-07-01). "Vibrator-Assisted Start–Stop Exercises Improve Premature Ejaculation Symptoms: A Randomized Controlled Trial". Archives of Sexual Behavior. 49 (5): 1559–1573. doi:10.1007/s10508-019-01520-0. ISSN 1573-2800. PMC 7300103. PMID 31741252.
25. Kaplan (1974), pp. 298–299
26. Castleman, M. (2004). Great Sex. Rodale, Inc. pp. 136–138. ISBN 978-1594869914.
27. Masters, W.; V. Johnson (1970), Human Sexual Inadequacy, Little Brown & Company
28. Belliveau, F.; L. Richter (1970). Understanding Human Sexual Inadequacy. Hodder and Stoughton.
29. Kaplan (1989), pp. 48–58
30. Metz, M.; B. McCarthy (2003). Coping With Premature Ejaculation. New Harbinger Publications. pp. 123–128. ISBN 9781572243408.
31. Silverberg, S. (2010) [1978]. Lasting Longer: The Treatment Program for Premature Ejaculation. Physicians Medical Press. pp. 44–57.
32. Birch. R.W. (2007). A Short Book About Lasting Longer. PEC Publishing. pp. 27–38. ISBN 978-1449523237.
33. De Carufel, F., & Trudel, G. (2006). Effects of a new functional-sexological treatment for premature ejaculation. Journal of Sex & Marital Therapy, 32(2), 97-114.
34. Cochrane Database of Systematic Reviews. (2011). Psychosocial interventions for premature ejaculation. Cochrane Database of Systematic Reviews.
35. Hartmann, Uwe (2007). "Re: Effects of a New Functional-Sexological Treatment for Premature Ejaculation". European Urology. 52 (4): 1259–1261. doi:10.1016/j.eururo.2007.07.021. PMID 17933037.
36. Crowdis, Marissa; Nazir, Saad (2022), "Premature Ejaculation", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 31536307, retrieved 2022-07-19
37. Hutchinson, K; Cruickshank, K; Wylie, K (May 1, 2012). "A benefit-risk assessment of dapoxetine in the treatment of premature ejaculation". Drug Safety. 35 (5): 359–72. doi:10.2165/11598150-000000000-00000. PMID 22452563. S2CID 35249748.
38. McMahon, CG; Althof, SE, Kaufman, JM, Buvat, J, Levine, SB, Aquilina, JW, Tesfaye, F, Rothman, M, Rivas, DA, Porst, H (February 2011). "Efficacy and safety of dapoxetine for the treatment of premature ejaculation: integrated analysis of results from five phase 3 trials". The Journal of Sexual Medicine. 8 (2): 524–39. doi:10.1111/j.1743-6109.2010.02097.x. PMID 21059176.{{cite journal}}: CS1 maint: multiple names: authors list (link)
39. Wong, BL; Malde, S (Jan 2013). "The use of tramadol "on-demand" for premature ejaculation: a systematic review". Urology. 81 (1): 98–103. doi:10.1016/j.urology.2012.08.037. PMID 23102445.
40. Shabsigh, Ridwan; Kaminetsky, Jed; Yang, Michael; Perelman, Michael (April 2017). "Pd69-02 Double-Blind, Randomized Controlled Trial of Topical 4% Benzocaine Wipes for Management of Premature Ejaculation: Interim Analysis". Journal of Urology. 197 (4S). doi:10.1016/j.juro.2017.02.3143. ISSN 0022-5347. S2CID 78743713.
41. MacCarty E.J.; Dinsmore W.W. (2010). "Premature Ejaculation: Treatment Update". International Journal of STD & AIDS. 21 (2): 77–81. doi:10.1258/ijsa.2009.009434. PMID 20089991. S2CID 5431867.
42. Shabsigh, Ridwan; Kaminetsky, Jed; Yang, Michael; Perelman, Michael (April 2017). "Pd69-02 Double-Blind, Randomized Controlled Trial of Topical 4% Benzocaine Wipes for Management of Premature Ejaculation: Interim Analysis". Journal of Urology. 197 (4S). doi:10.1016/j.juro.2017.02.3143. ISSN 0022-5347. S2CID 78743713.
43. Zhang, G.-X.; Yu, L.-P.; Bai, W.-J.; Wang, X.-F. (2012). "Selective resection of dorsal nerves of penis for premature ejaculation". International Journal of Andrology. 35 (6): 873–879. doi:10.1111/j.1365-2605.2012.01296.x. PMID 22882515.
44. Kim, J. J.; Kwak, T. I.; Jeon, B. G.; Cheon, J.; Moon, D. G. (2004). "Effects of glans penis augmentation using hyaluronic acid gel for premature ejaculation". International Journal of Impotence Research. 16 (6): 547–51. doi:10.1038/sj.ijir.3901226. PMID 15057258. S2CID 205677292.
45. Kwak, T. I.; Jin, M. H.; Kim, J. J.; Moon, D. G. (2008). "Long-term effects of glans penis augmentation using injectable hyaluronic acid gel for premature ejaculation". International Journal of Impotence Research. 20 (4): 425–428. doi:10.1038/ijir.2008.26. PMID 18548080. S2CID 32849162.
46. Anaissie, James; Yafi, Faysal A.; Hellstrom, Wayne J. G. (2016). "Surgery is not indicated for the treatment of premature ejaculation". Translational Andrology and Urology. 5 (4): 607–612. doi:10.21037/tau.2016.03.10. PMC 5001994. PMID 27652232.
47. Moon, Du Geon (2016). "Is there a place for surgical treatment of premature ejaculation?". Translational Andrology and Urology. 5 (4): 502–507. doi:10.21037/tau.2016.05.06. PMC 5002006. PMID 27652223.
48. Yang, D. Y.; Ko, K.; Lee, W. K.; Park, H. J.; Lee, S. W.; Moon, K. H.; Kim, S. W.; Kim, S. W.; Cho, K. S.; Moon Du, G.; Min, K.; Yang, S. K.; Son, H.; Park, K. (2013). "Urologist's Practice Patterns Including Surgical Treatment in the Management of Premature Ejaculation: A Korean Nationwide Survey". The World Journal of Men's Health. 31 (3): 226–31. doi:10.5534/wjmh.2013.31.3.226. PMC 3888892. PMID 24459656.
49. "Premature ejaculation". Mayo Clinic.com. Retrieved 2007-03-02.
50. Laumann, E.O.; et al. (1999). "Sexual Dysfunction in the United States: Prevalence and Predictors". Journal of the American Medical Association. 281 (6): 537–44. doi:10.1001/jama.281.6.537. PMID 10022110.
51. Schouten BW, Bohnen AM, Groeneveld FP, Dohle GR, Thomas S, Bosch JL (July 2010). "Next Men's Clinic Erectile dysfunction in the community: trends over time in incidence, prevalence, GP consultation and medication use—the Krimpen study: trends in ED". J Sex Med. 7 (7): 2547–53. doi:10.1111/j.1743-6109.2010.01849.x. PMID 20497307.
52. Mathers, M.J.; et al. (2013). "Premature Ejaculation in Urological Routine Practice". Aktuelle Urologie. 44 (1): 33–9. doi:10.1055/s-0032-1331727. PMID 23381878. S2CID 198315452.
53. Tang, W.S.; E.M. Khoo (2011). "Prevalence and Correlates of Premature Ejaculation in a Primary Care Setting: A Preliminary Cross-Sectional Study". Journal of Sexual Medicine. 8 (7): 2071–8. doi:10.1111/j.1743-6109.2011.02280.x. PMID 21492404.
54. Porst, H.; et al. (2007). "The Premature Ejaculation Prevalence and Attitudes (PEPA) Survey: Prevalence, Co-morbidities, and Professional Help-Seeking". European Urology. 51 (3): 816–824. doi:10.1016/j.eururo.2006.07.004. PMID 16934919.
55. Rowland, D.; et al. (204). "Self-Reported Premature Ejaculation and Aspects of Sexual Functioning and Satisfaction". Journal of Sexual Medicine. 1 (2): 225–32. doi:10.1111/j.1743-6109.2004.04033.x. PMID 16429622.
56. Pearson, Catherine (2023-10-15). "8 Sex Myths That Experts Wish Would Go Away". The New York Times. ISSN 0362-4331. Retrieved 2024-03-11.
57. Kalejaiye, Odunayo; Almekaty, Khaled; Blecher, Gideon; Minhas, Suks (2017-12-04). "Premature ejaculation: challenging new and the old concepts". F1000Research. 6 (6:2084): 2084. doi:10.12688/f1000research.12150.1. PMC 5717471. PMID 29259775.
58. Wright, Karen (June 1, 1992). "Evolution of the Orgasm". Discover Magazine.
59. Carufel, Francois de (2016). Premature Ejaculation: Theory, Evaluation and Therapeutic Treatment. Taylor & Francis. p. 6. ISBN 9781317280750.
60. Astbury-Ward, Edna (2002). "From Kama Sutra to dot.com: The history, myths and management of premature ejaculation". Sexual and Relationship Therapy. 17 (4): 368. doi:10.1080/1468199021000017218. ISSN 1468-1994. S2CID 146305025.
61. Gajjala, Sukumar Reddy; Khalidi, Azheel (2014). "Premature ejaculation: A review". Indian Journal of Sexually Transmitted Diseases and AIDS. 35 (2): 92–95. doi:10.4103/0253-7184.142391. ISSN 2589-0557. PMC 4553859. PMID 26396440.
62. Waldinger, Marcel D. (2013). "History of Premature Ejaculation". Premature Ejaculation. pp. 5–24. doi:10.1007/978-88-470-2646-9_2. ISBN 978-88-470-2645-2.
63. Kaplan (1974), p. 292
64. Puppo, Vincenzo; Puppo, Giulia (2016). "Comprehensive review of the anatomy and physiology of male ejaculation: Premature ejaculation is not a disease". Clinical Anatomy. 29 (1): 111–119. doi:10.1002/ca.22655. PMID 26457680. S2CID 9213013.
65. Hart, Graham; Wellings, Kaye (2002-04-13). "Sexual behaviour and its medicalisation: in sickness and in health". BMJ. 324 (7342): 896–900. doi:10.1136/bmj.324.7342.896. ISSN 0959-8138. PMC 1122837. PMID 11950742.
66. Grunt-Mejer, Katarzyna (2022-07-03). "The history of the medicalisation of rapid ejaculation—A reflection of the rising importance of female pleasure in a phallocentric world". Psychology & Sexuality. 13 (3): 565–582. doi:10.1080/19419899.2021.1888312. ISSN 1941-9899. S2CID 233924065.
67. Grunt-Mejer, Katarzyna (2022-07-03). "The history of the medicalisation of rapid ejaculation—A reflection of the rising importance of female pleasure in a phallocentric world". Psychology & Sexuality. 13 (3): 565–582. doi:10.1080/19419899.2021.1888312. ISSN 1941-9899. S2CID 233924065.
68. Kaplan, Helen Singer (1989). How to overcome premature ejaculation (2nd ed.). New York: Brunner/Mazel. p. 295. ISBN 9780876305423. OCLC 1008628084.
69. Grunt-Mejer, Katarzyna (2022-07-03). "The history of the medicalisation of rapid ejaculation—A reflection of the rising importance of female pleasure in a phallocentric world". Psychology & Sexuality. 13 (3): 565–582. doi:10.1080/19419899.2021.1888312. ISSN 1941-9899. S2CID 233924065.
70. Kaplan, Helen Singer (1974). The new sex therapy: active treatment of sexual dysfunctions. New York: Brunner/Mazel. p. 28. ISBN 9780876300831. OCLC 1015728698.
71. Stegenga, Jacob (2021-12-02). "Medicalization of Sexual Desire". European Journal of Analytic Philosophy. 17 (2): 5–34. doi:10.31820/ejap.17.3.4. ISSN 1849-0514.

Cited sources

• Kaplan, Helen S. (1974). The New Sex Therapy. Psychology Press. ISBN 9780876300831.
• Kaplan, Helen S. (1989). How to Overcome Premature Ejaculation. Routledge. ISBN 9780876305423.

Further reading

• Hamblin, James (2012). "When Is Ejaculation 'Premature,' and When Should a Penis Be Made Numb?". The Atlantic. Retrieved 6 March 2017. According to [Dr. John Mulhall], when we talk casually about premature ejaculation ... we're usually talking about what the medical community would consider 'premature-ejaculatory-like syndrome,' or simply 'rapid ejaculation.' ... Mulhall says it comes down to whether the guy lasts long enough. If his partner is made wholly replete in 90 seconds, then a man who lasts 95 seconds can be fine. But if another guy lasts 15 minutes, and that's not cutting it, then it's a problem and can be considered rapid.  

External links