Premature Ejaculation

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While ED is typically a dysfunction of older males, Premature Ejaculation (PE) most frequently occurs in younger men. PE is the persistent or recurrent ejaculation during sexual activity that is associated with minimal stimulation and individual or couple dissatisfaction with duration (ApA, 2000). At the present time, there are no objective criteria for determining the duration of sexual activity that constitutes premature ejaculation. Perhaps it is easier to describe what is not premature ejaculation: Both partners agree that the quality of their sexual activities is not negatively impacted by efforts to postpone ejaculation (LoPic-colo, 1994). Prevalence estimates for PE derived from community samples indicate a rate of disorder between 36 and 38% (Spector & Carey, 1990).

Definitive data on the etiology of premature ejaculation does not currently exist. Sociobiologists have theorized that it offers an evolutionary advantage and has been built into the human organism (Hong, 1984). However, this theory does not effectively deal with the large variability in duration of intercourse that has been observed both across and within species. Another theory proposed by Kaplan (1974) postulates that men with premature ejaculation are not able to accurately perceive their own level of sexual arousal and thus do not engage in any self-control procedures to avoid rapid ejaculation. One laboratory analogue indicates, however, that men with premature ejaculation were better able to perceive their own levels of sexual arousal when compared to controls (Spiess, Geer, & O'Donohue, 1984).

Rowland, Cooper, and Slob (1996) found that men who experience PE can be differentiated from functional men and men with ED by both a heightened response to vibro-tactile penile stimulation and an increase in negative emotion, such as shame and embarrassment, during sexually arousing activities. This evidence supports a psychophysi-ological model of PE in which a vulnerability of the penile reflex and intensified negative cognitions and affect combine to create problems with ejaculation latency (Strassberg, Kelly, Carroll, & Kircher, 1987). Finally, it has been proposed that premature ejaculation is related to low frequency of sexual activity (Kinsey, Pomeroy, & Martin, 1948). While some research has indicated that sensory thresholds in the penis are lowered by infrequent sexual activity and that premature ejaculation patients do have a low rate of sexual activity (e.g., Spiess et al., 1984), it is possible that premature ejaculation causes low rates of sex, rather than causality being in the opposite direction, as this disorder makes sex an unpleasant failure experience.

The standard treatment for PE involves the pause procedure developed by Semans (1956) and modified into the pause and squeeze technique by Masters and Johnson (1970). .Although there has not been a controlled experimental study of the relative effectiveness of the pause procedure versus the pause and squeeze technique, both appear to be effective. Success rates of 90% to 98% "cure" have been reported, and this success has been demonstrated in group and individual treatment as well as in self-help programs (Kilmann & Auerbach, 1979).

More recently, psychopharmacological treatment of PE has been the subject of research. According to Rosen et al. (1999), several uncontrolled studies of SSRI treatment of PE have indicated that pharmacological treatment may be efficacious. Waldinger, Hengeveld, and Zwinderman (1994) found that low doses of clomipramine significantly improved ejaculatory latency and improved sexual satisfaction in men with PE. Similar results have been found for paroxetine, fluoxetine, and setraline (Rosen et al., 1999). While SSRI treatment for PE seems provocative, it is important to remember that serotonergic drugs have well-known deleterious effects on sexual arousal and physicians and clinicians should question whether reducing levels of sexual arousal is a desirable method for lengthening ejac-

ulatory latencies. SSRI treatment of PE is temporary, with latency effects disappearing after treatment is discontinued (Waldinger et al., 1994).

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5 Secrets to Lasting Longer In The Bedroom

5 Secrets to Lasting Longer In The Bedroom

How to increase your staying power to extend your pleasure-and hers. There are many techniques, exercises and even devices, aids, and drugs to help you last longer in the bedroom. However, in most cases, the main reason most guys don't last long is due to what's going on in their minds, not their bodies.

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