Definition, classification and etiology analysis of premature ejaculation

"I didn't even feel anything before he finished"-for men, ending sex too quickly is like a thorn in their side, causing fear, anxiety, and low self-esteem, making it a major problem. This condition of premature ejaculation is medically known as premature ejaculation (PE). In fact, PE is the most common male sexual dysfunction, affecting approximately 30% of men, or perhaps every man at some point in his life. However, very few people truly understand PE.

What is premature ejaculation?

Some scholars believe that, from a biological perspective, animals in nature can only reduce harm from predators by ejaculating quickly and shortening mating time as much as possible. From an evolutionary point of view, only males who can ejaculate in a short time have a higher chance of fertilizing females, enabling them to survive and reproduce in the fierce competition for survival. Conversely, males that need a longer time to ejaculate and mate are more likely to be attacked or killed by other males or other species during mating. Therefore, premature ejaculation is a result of survival of the fittest. The same applies to humans. In fact, premature ejaculation was rarely considered a disease in the past; on the contrary, it was once seen as a symbol of male physiological superiority. Only when society developed to a certain level and humans began to pursue sexual pleasure did premature ejaculation come to be considered a disease.

From its first reported appearance in 1887 until the first half of the 20th century, premature ejaculation was considered a specific psychological abnormality, also known as neurosis, and treated through psychoanalysis. Later, a German endocrinologist challenged this purely psychoanalytic theory, arguing that premature ejaculation was not a mental illness but a psychosomatic one, involving both biological and psychological factors, and using anesthetic ointments to delay ejaculation. In the mid-20th century, the clinical application of selective serotonin reuptake inhibitors (SSRIs) brought a breakthrough in the treatment of premature ejaculation, becoming a first-line treatment.

Ironically, despite its high incidence, premature ejaculation (PE) still lacks a universally accepted medical definition. Currently, several definitions are commonly used clinically: One widely accepted definition is based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-R) published by the American Psychiatric Association: "Persistent or recurrent ejaculation with minimal sexual stimulation, before, during, or shortly after penetration, earlier than desired (the physician considers various factors affecting the duration of sexual arousal, such as age, sexual partner, sexual environment, and frequency of intercourse), causing significant distress to the individual and strain in interpersonal relationships (between partners), and this is not due to withdrawal from a psychoactive substance (such as opium)." Another definition adopted by the International Society for Sexual Medicine (ISSM) is: "Premature ejaculation is a male sexual dysfunction characterized by ejaculation almost always or always before or within about one minute of penetration; lack of ability to delay ejaculation; resulting in negative personal consequences such as distress, anxiety, depression, and/or avoidance of sexual activity."

Although the definitions differ, they all include three common factors: a very short intravaginal ejaculation latency period (IELT), the male's inability to control ejaculation, and significant psychological stress and/or communication difficulties due to the short ejaculation time. Simply put, premature ejaculation refers to a man's lack of ejaculatory control, resulting in premature ejaculation before both partners have achieved sexual satisfaction. The key here is "ejaculation control." Theoretically, if the man can control ejaculation normally, extending the time until the moment of ejaculation, there is no premature ejaculation. Conversely, if the man's ejaculation control is insufficient, resulting in ejaculation before penetration or shortly after penetration, then premature ejaculation exists.

In clinical practice, premature ejaculation can be defined using two different methods: objective criteria and subjective feelings. Objective criteria are based on the actual duration of ejaculation (<1 minute) or the number of penile thrusts (<20 times). Subjective feelings refer to the situation where a man ejaculates before the time he or his partner expects, and such men often feel a decrease in ejaculatory control and/or this situation causes them distress, dissatisfaction, or difficulty in social interaction. Premature ejaculation can be diagnosed as long as either the objective criteria or the subjective feelings are present. However, it is important to note that, similar to the definition of erectile dysfunction, the prerequisite for a diagnosis of premature ejaculation is vaginal intercourse. If the duration is only short during masturbation, it is not appropriate to diagnose premature ejaculation.

How is premature ejaculation classified?

Premature ejaculation has traditionally been categorized into primary and secondary types. Primary premature ejaculation occurs during the first sexual encounter and is persistent; secondary premature ejaculation is characterized by a gradual or sudden onset, with normal ejaculation occurring before the onset, and is not as severe as primary premature ejaculation. Recently, scholars have added two new classifications: naturally occurring variant premature ejaculation and premature ejaculation-like ejaculatory dysfunction. These two types of "premature ejaculation" should not be considered true pathological symptoms.