Is premature ejaculation really a medical condition?

If you’re in a room with 20 random blokes, it’s likely six or seven of them are worried about and unsatisfied with their ability to control their ejaculation during partnered sex.

In other words, these fellas, who account for around 30% of the male population (it is the most common sexual complaint presented by men), are, at least in their own opinion, suffering from a clinically diagnosable sexual dysfunction: premature ejaculation.

But most of these blokes actually function more or less like most guys do if ejaculatory function is measured by any observable parameter: during penetrative intercourse, fewer than 2% will actually reach climax within a very short time (a minute or less) on a regular basis.

So it’s a question of how you want to define “premature”, (or “early”, or “rapid”) ejaculation, something that is vigorously debated among scientists and clinicians today.

Measuring up

The diagnostic criteria doctors follow (such as the American Psychiatric Association’s DSM-IV, or the World Health Organisation’s ICD-10) do not specify a time frame in which ejaculation should occur.

But that looks certain to change in forthcoming updates of these diagnostic manuals, with many scientists calling for a cut-off based on ejaculation latency time (during penetrative sex) to separate the “functional” from the “dysfunctional”.

Even so, the question lingers: how fast is too fast, and on what grounds do we draw the line between function and dysfunction?

On a proximate level of explanation, this is an easy one: if you’re very quick, chances are your partner won’t be satisfied. This, in turn, could conceivably result in poor confidence, low self-esteem and less overall sexual satisfaction for all involved.

But there’s no evidence the sensation of orgasm in itself would be any less enjoyable because it occurs quickly – and neither is there any evidence that sperm quality would be any better (or worse) as a function of ejaculation latency time.

It seems recreational, not procreational, sex is where this problem needs addressing. But then, a dysfunction, sexual or otherwise, should be disruptive of the function’s purpose – so what is, ultimately, the purpose of the male ejaculation? Most people would surely argue the grand, ultimate purpose of ejaculation is to fertilise a female’s egg, thus creating offspring.

So if that’s the deal, shouldn’t ejaculation be considered “premature” only in the event that it occurs before penetration can even take place, something extremely few men experience with any regularity?

Learning from swingers

The blokes among our closest relatives in nature – the primates – will generally not copulate any longer than necessary to achieve ejaculation.

Most chimpanzees will have this task done and dusted in less than ten seconds. From the Darwinist point of view, there’s a very good reason for this: most male chimps will never become alpha males, and the alpha male has first pick of all females in the group – only when he’s done will he allow other males to approach the resident ladies.

Males further down the pecking order, who fail to appreciate this reality and attempt to go all Don Juan before their turn, are likely – if apprehended – to be reminded in no uncertain terms of the wrongness of their doings.

If a non-alpha male is to stand any chance of having his own offspring, he better be very quick when the window of opportunity presents itself.

This is a neat example of evolutionary adaptation: males who ejaculate very quickly increase their chances of conceiving offspring, so genes that contribute to this kind of swift shooting will increase in the population.

Sooner rather than later, most males will possess this ability if it has a genetic component. And that is, ultimately, the very opposite of dysfunction.

Doing it for kicks

This biological underdog advantage observed in apes and monkeys, while philosophically and biologically neat, offers little consolation to men who are genuinely concerned about their own ejaculatory function; men who as a result of these concerns experience difficulties in their relationships and daily lives.

After all, partnered sex is more often than not a recreational activity these days, at least in our part of the world.

Shouldn’t we aim to treat the concerns of men rather than focusing efforts on increasing values on readily measurable objective parameters such as ejaculation latency time?

A cynic would point out it may actually be the dissatisfaction of the man’s sexual partner that requires treatment: if sexual partners of men would universally prefer them to ejaculate as quickly as possible, would we still consider quickly occurring ejaculation a dysfunction?

Illnesses with diagnostic criteria that ultimately depend on some other person’s preferences, even if it is only partly (e.g. you only have a diagnosable cold if you carry a virus and sneeze often enough for me to find you bothersome), are scarce in the medical handbooks.

Nonetheless, many men are troubled by their ejaculatory function, and that’s presumably because one of their favourite leisure-time activities is at risk of being ruined, or at least accompanied with anxiety and general unrest in the build-up.

If it’s not broken …

Today, “premature” ejaculation is often treated with drugs that interfere with the brain’s serotonin metabolism; drugs that were originally intended for treatment of mood disorders.

One of these compounds, dapoxetine, has actually been developed especially to treat premature ejaculation and is available today in several countries in Europe, with many other countries (including Australia) expected to follow suit in the near future.

What we may have done is to slap a “dysfunction” tag on what is likely a perfectly normal variation in the function of a neurobiological mechanism – variation that may actually have been genuinely advantageous in not too distant history!

While it should obviously be perceived as a good thing that there’s an available pharmaceutical treatment alternative, that, for the record, has been well received by many men, many others also report unpleasant side effects (nausea, dizziness and reduced sexual desire being the most common), whereas these drugs appear completely ineffective for others still.

Fast love

So, how fast is within the boundaries of “normal”, you ask?

Well, on average, about eight minutes, according to a large-scale population survey involving 491 men from five countries.

But the variation is anything between a few seconds and 45 minutes.

For anyone fond of statistics, the standard deviation (from the mean of eight minutes) is slightly greater than a whopping seven minutes.

How fast is too fast, then? It depends on your intention. If it’s to make a baby, anything above zero seconds of penetration stands a decent chance of doing the trick, given everything else is working out as it should.

If it’s to bring pleasure to your partner, how many minutes does he or she need? If it’s to feel better about yourself, well, anything above a minute and you’re safe within one standard deviation from the average Joe.

In reality, you’ll probably gain little from knowing this, or from the pointless exercise that is quantifying your performance by calculating minutes and seconds.

If you experience a problem, there probably isn’t anything medically wrong with you. Talk to your partner. And if it still doesn’t work out, there’s always the option to try the medication.

Patrick Jern, Post-doctoral researcher, Department of Psychology and Logopedics, Åbo Akademi University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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