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The Sensible Psychology Dictionary Psychiatric Diagnoses in Plain English

Premature ejaculation

DSM Classification

Premature ejaculation

Persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it. The clinician must take into account factors that affect duration of the excitement phase, such as age, novelty of the sexual partner or situation, and recent frequency of sexual activity.

Sensible Psychology Definition

When a man comes too soon

That’s it.

‘Coming too soon’ is a problem for millions of men

There is no ‘set time’ that indicates premature ejaculation has occurred. But it’s generally agreed that if a man climaxes before he has sufficiently pleasured his partner and before he and his partner would have liked, then the ejaculation was ‘premature’.

In this sense, premature ejaculation is a subjective evaluation and may mean climaxing within seconds of sexual stimulation (or occasionally even before any direct sexual stimulation).

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Sex can be an extremely focussing experience. This means that during sex we are much more open to ‘conditioning’. Our early sexual experiences, because of the novelty factor, can be especially intense. The more intense an experience is, the more likely we are to be imprinted with an emotional pattern for future response to that experience (this is also why a short-lived – but extreme – trauma can imprint flashbacks that continue for years).

So, for example, early sexual experiences may have been very hurried, perhaps due to fear of discovery by parents. In this way a pattern for ‘quick sex’ may have become unconsciously set in the man’s mind and body.

Premature ejaculation and performance anxiety

Premature ejaculation is a learned response and combines intense excitement with anxiety. Many men connect their sense of self worth and self esteem with their perceived ‘sexual performance’. They may feel under pressure either from themselves or from their partner to ‘perform longer’. This can result in so-called ‘performance anxiety’, which brings its own problems.

Premature ejaculation and the self fulfilling prophecy

When we don’t want something to happen, we fear it. The fear creates an expectation. The trouble is, expectation can make the thing we expect more likely to happen.

Placebo pills work because people expect them to work. You expect to cry at a sad movie, you expect to laugh at a comedian – and the expectation can play a greater role than people consciously realize in bringing about the response.

It’s the same with premature ejaculation (and impotence as well, of course). So the more a man fears premature ejaculation, the more his expectation becomes self fulfilling (although obviously not so fulfilling for his partner!).

Common treatment approaches

Antidepressants

Because the ‘anxiety’ element of premature ejaculation is well recognized, the focus of many treatments is the anxiety itself. So antidepressants may be prescribed in an attempt to reduce anxiety. Paradoxically, and most unfortunately in the circumstances, a common side effect of SSRIs is ‘orgasmic dysfunction’ (in both men and women).

The drug dapoxetine (not yet approved for use in the USA by the FDA) is an SSRI antidepressant developed specifically to treat premature ejaculation. (1)

Exercise

Physical exercises may be prescribed to strengthen the ‘PC’ (puboccocygeus) muscle.

Psychotherapy

Psychotherapy can help resolve emotional issues which may be implicated in premature ejaculation, such as sexual guilt or unconscious resentment against one’s partner. It does seem to be the case that premature ejaculation is more likely to occur during times of increased background stress in a man’s life.

The sensible psychology approach

Effective therapy for premature ejaculation should address both the sources of stress that may be contributing to sexual problems and the ‘pattern imprints’ that may be influencing sexual interactions.

Hypnosis is highly effective at altering the mind/body relationship during sex because it combines relaxation with an increased sense of self control and allows positive change to happen without incurring unpleasant side effects.(2)

Directly resolving the issue of premature ejaculation makes men happier and tends to have a beneficial ripple effect in other areas of their lives.

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Mark Tyrrell

About Mark Tyrrell

Psychology is my passion. I've been a psychotherapist trainer since 1998, specializing in brief, solution focused approaches. I now teach practitioners all over the world via our online courses.

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Notes:

  1. This drug is still awaiting approval and is not yet available. In trials 45% of men found it delayed ejaculation by up to a minute. Side effects include: dizziness, nausea, insomnia, headache and diarrhoea.
  2. See: Araoz D. ‘Hypnosis in human sexuality problems.’ Am J Clin Hypn. 2005;47(4):229-42.

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