Assessment Methods of Premature Ejaculation

What Is Premature Ejaculation?

Rapid or premature ejaculation is characterized as ejaculation occurring without voluntary control and with minimal sexual stimulation.

What Are the Symptoms of Premature Ejaculation?

The main symptom of premature ejaculation is the failure to delay ejaculation for more than one minute after penetration or masturbation.

Premature ejaculation can be classified as:

• Lifelong or Primary: Lifelong premature ejaculation occurs all of the time, starting from your first sexual encounter.

• Acquired or Secondary: Acquired premature ejaculation develops after previous sexual experiences without ejaculatory problems.

How to Assess Premature Ejaculation?

Two different dimensions diagnose premature ejaculation:

• Ejaculatory Latency.

• Voluntary Control.

According to the ICD-10 (International Statistical Classification of Diseases and Related Health Problems) classification system, ejaculation must occur ' within 15 seconds of the beginning of intercourse,' while DSM-IV is equivocal on duration, stating that ejaculation occurs with minimal sexual stimulation before or shortly after penetration.

ICD-10 does not mention voluntary control, while DSM-IV explains that ejaculation occurs 'before the person wishes.' Both classification systems require the man to be distressed for at least six months. Both require the clinician to judge the independence of this condition from other mental, behavioral, or physiological disorders. The 15 seconds duration may make many men complain that it is absurd.

It is required to associate distress felt by men regarding this condition. Those who oppose defining rapid ejaculation in quantitative terms argue that the salient parameter should be voluntary control.

What Is the Theory That Is Related to Premature Ejaculation?

The prevailing opinions regarding the cause of rapid ejaculation have typically assumed that the dysfunction was either psychological or learned, depending upon the theorists' assumptions about how the mind operates. Some believe that a lowered ejaculatory latency stems from:

• Anxiety.

• General hostility toward women.

• Interpersonal conflicts with a particular partner.

• Conditioning patterned on furtive masturbation practices.

• Early hurried sexual experiences with prostitutes.

• Hasty lovemaking in the backseat of a car.

Once established, performance anxiety was thought to maintain the rapid ejaculatory pattern.

Anxiety Is Not a Singular Concept:

• Anxiety may refer to a phobic response such as being fearful of the dark wet unseen vagina.

• It may also refer to effect, such as conflict resolution, where two contradictory urges are at play; for example, the man is angry at his partner but feels guilty about directly expressing his hostility.

• Anxiety may refer as well to a preoccupation with sexual failure and poor performance. As the man contemplates another sexual experience, his anxiety leads to an avoidance of any future sexual opportunity.

It was suggested that this performance anxiety has two discrete dimensions: a cognitive component where the man watches himself, thus removing himself from awareness of his arousal level, and an emotional component consisting of fear of failure.

Separating rapid ejaculation into lifelong and acquired groups may prove helpful in clarifying the etiology of the dysfunction. A subgroup of lifelong rapid ejaculators may have a biological vulnerability, while those with acquired symptoms may not. The development of rapid ejaculation requires an examination of recent psychosocial stressors, medication, or surgery. It is often a consequence of erectile failure. Men develop performance anxiety regarding erectile reliability and rush intercourse, thinking they have limited time to 'complete the act.' With these thoughts, this additional dysfunction appears, and men become even more anxious about sexual interactions.

What Are the Assessments Done for Premature Ejaculation?

• Rapid ejaculation is best assessed along both dimensions of ejaculatory latency following vaginal penetration and degree of voluntary control. Questions are asked about how long it takes the man to reach orgasm under the following circumstances: masturbation, partner hand and/or mouth stimulation, and intercourse.

• For instance, some men have inordinately high expectations, that they should be able to last 45 minutes, and falsely label themselves as rapid ejaculators. Education often reverses this misattribution. The man's level of sexual experience is reviewed, as is the duration of his current relationship.

• Young inexperienced men routinely ejaculate quickly, while men anxious to please new partners often encounter transient problems. Factors that improve and worsen performance are noted, such as coital positions. Next, the man's degree of voluntary control is examined, and it is noted which factors improve or worsen, such as distraction.

• The clinician reviews whether the dysfunction occurs under all circumstances or only with specific partners. If this is an acquired disorder, it is important to ascertain the life events that are temporally related to the onset of the problem, such as the mother-in-law coming to live with the family. It is also necessary to gauge whether rapid ejaculation is the primary problem or is secondary to erectile dysfunction, in other words, whether it occurred after the man began having difficulty achieving an erection.

• The quality of the non-sexual relationship is also studied, with particular attention to the partner's response to the dysfunction and her level of expectation. Finally, it is worthwhile enquiring about the partner's sexual functioning because sometimes rapid ejaculation disguises a partner's dysfunction. Therefore, it is considered as an adaptive response to the partner's sexual aversion.

• Organic factors are seldom implicated; however, trauma to the sympathetic nervous system during surgery for aortic aneurysm, pelvic fracture, prostatitis, and urethritis can induce rapid ejaculation. Additionally, drug withdrawal from narcotics or Trifluoperazine has been associated with this symptom.

• Serum levels of follicle-stimulating hormone, prolactin, luteinizing hormone, total and free testosterone, thyroid-stimulating hormone, free triiodothyronine, and thyroxine were measured to diagnose premature ejaculation. Usually, these levels will be lower in men with premature ejaculation, according to the premature ejaculation diagnostic tool. But, still, the relationship between these findings has to be determined by more extensive studies.

What Are the Risk Factors Associated With Premature Ejaculation?

Various factors can increase the risk of premature ejaculation, including:

• Erectile Dysfunction: Men might be at increased risk of premature ejaculation if he occasionally or regularly has trouble getting or maintaining an erection. Fear of losing the erection can also cause one to consciously or unconsciously hasten through sexual experience.

• Stress: Emotional or mental stress in any area of a men's life can also play a role in premature ejaculation, limiting their ability to relax and focus during sexual contact.

Conclusion

Since premature ejaculation is recognized as a disorder caused by psychogenic and biological etiologies, it is important to assess patients with potential causes. An assessment of premature ejaculation should be made to know the possible cause and to prescribe an appropriate treatment. Various treatment options are being developed, but there are no licensed medications to treat premature ejaculation. Treatment is not always necessary for premature ejaculation. But if required, it may include psychological counseling for both the man and his partner and medications to prevent premature ejaculation. When the cause is multifactorial, a combination of treatments may be required, with the value of psychotherapy.