As per a 2006 report, Premature Ejaculation/Rapid Ejaculation (PE/RE) is more prevalent than ED. Of the numerous definitions available, the International Classification of Disease defines PE/RE as the ‘inability to control ejaculation sufficiently for both partners to enjoy sexual interaction, when ejaculation occurs either before or very soon after the beginning of the intercourse (before or within 15 seconds) or when the ejaculation occurs in the absence of sufficient erection to make intercourse possible ‘.
PE/RE is categorized as primary and secondary. A man is known to suffer from primary PE/RE if the problem has been for lifelong. If the individual could previously control ejaculation sufficiently but has only recently developed this dysfunction, then he is known to suffer from secondary or acquired PE/RE.
PE/RE is the least studied of the male sexual dysfunctions. Of the number of men surveyed between the ages of 18 to 65, around 20% to 30% suffered from PE/RE but only a fraction of them sought treatment for the same. PE/RE not only affects the patients but also their sexual partner, most often than not negatively affecting the relationship and other aspects of life. Embarrassment, lack of knowledge and the stigma associated with suffering from sexual problems stop men from discussing it with their sexual partner or a physician.
The most common diagnosis of PE/RE is IELT (Intravaginal Ejaculatory Latency Time) defined as the time from vaginal penetration to the start of intravaginal ejaculation. The major drawback of this is that there is no agreed cutoff time. While some suggest it should be 1-minute others opine it to be 2 minutes based on the review and summary of published IELT data in men of PE/RE. However, one thing most agree is that control of ejaculation and satisfaction of sexual intercourse are the main measures of PE/RE.
PE/RE may be due to psychological or physiological problems or both. Psychological reasons maybe anxiety, interpersonal issues, early sexual experience, and ejaculatory control techniques. Physiological reasons maybe penile hypersensitivity, genetic predisposition, and serotonin receptor dysfunction. Unlike ED, there are no approved medications for PE/RE. Men may stay away from discussing this issue with their physician due to this very reason of non-availability of prescribed treatments. In a 2004 survey of 11,500 men spanning across the USA, Italy, and Germany, around 25% had PE/RE and less than 12% of the men who had self-reported PE/RE had sought treatment.
Non-approved pharmacological treatments include anti-depressants, topical anesthetics, and PDE-5 inhibitors. Psychological counseling and behavioral therapy are also used. In some cases, men suffering from PE/RE resort to self-treatment by applying de-sensitizing ointments to the penis, masturbating multiple times prior to intercourse, or by distracting themselves mentally during the sexual act.
The need of the hour is a standard definition and diagnostic criteria for PE/RE that are based on the characteristics and needs of the people suffering from this dysfunction. Medications specifically for PE/RE evaluated through large-scale clinical trials on men with PE/RE is needed. Most importantly patients with PE/RE must be encouraged to discuss the issue to improve diagnosis and reduce stigma.