Although you might question whether or not premature ejaculation is in fact a psychiatric condition, there is a definition present in the
DSM IV manual of the American Psychiatric Association.
This is a manual which lists all mental health disorders in both children and adults, describing not only the symptoms, but the statistics, prevalence, prognosis and causes of these conditions. You might also question whether or not a psychiatric manual is a good place for a definition of premature ejaculation, a condition which is much more the preserve of psychologists and sexual therapists than psychiatrists, but such is the nature of medicine –wishing to medicalize what may well be natural conditions in human existence.
The highly criticized DSM IV definition has been quoted widely in all kinds of places across the Internet. It is as follows:
Premature ejaculation, also known as rapid or early ejaculation, is defined as the persistent or recurrent onset of orgasm and ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it. (This DSM definition also states that the condition must also cause marked distress or interpersonal difficulty.)
As you can see, in this definition, the criteria for defining male sexual performance is premature ejaculation are multifactorial, with concepts of personal distress, interpersonal difficulty, latency, and control over ejaculation or coming into the definition. That in itself, because many of these criteria are subjective, presents huge difficulty in formalizing a scientific definition of what is in some ways an impressionistic diagnosis.
Moreover, a lot of research in the past few years has demonstrated that many of these criteria are not supported by empirical scientific evidence. For example, many men who ejaculate quickly experience intercourse as profoundly satisfying and rewarding, and have no issues of shame or guilt around their rapid ejaculation. It would be interesting to know if this also applied to men with delayed ejaculation.
In many cases this lack of emotional distress is shared by the partner, either because intercourse is not important to her, or because the partner ensures that she reaches orgasm through oral or manual stimulation before intercourse begins.
Video – premature ejaculation
Subjective control over ejaculation is both variable from one sexual event to another, and between types of sexual events. So if a man begins intercourse when he’s not particularly aroused, he’s likely to be able to continue thrusting vaginally quite some time – rather longer than he would if he were highly aroused when he penetrated his partner.
Also, there is definitely a large influence around the man’s intention in sexual “performance”. When a man intends to make sex last longer, he takes the trouble to notice the warning signs that his ejaculation is about to occur, and he tends to take action to intervene and prevent it happening. By contrast, if he’s not interested in controlling his ejaculation he is likely to ignore these warning signs and simply surrender to the physical pleasure of orgasm and ejaculation. To complicate matters even further, many women would definitely like intercourse to last longer, but never say as much, or at least never admit as much to their partner, since they have accepted the compromise of orgasm through manual stimulation before intercourse begins.
There can be many reasons why woman accept such a compromise, but the most frequent of them is to maintain the harmony of the relationship.
So once again it’s clear that defining premature ejaculation is not a simple matter: when we move away from the simplistic time based observations of Alfred Kinsey and the unjustifiable assumptions of Masters and Johnson about female orgasmic capacity, to a definition that encompasses partner satisfaction, the waters become muddied even more. How then, can these difficulties to be resolved?
One approach would be to simply define PE on the basis of objective, identifiable factors such as duration of intercourse, leaving out any issues of partner satisfaction or dissatisfaction. In a way this makes sense, because it’s objective and measurable. However, an emerging body of evidence seems to suggest that when a man perceives he has little or no control over his ejaculation he really does experience a degree of stress, which certainly supports the DSM IV approach around the diagnosis and definition of premature ejaculation, an approach which clearly links PE to a negative emotional outcome for the man and woman concerned. Such negative outcomes are an essential part of the diagnostic criteria for many conditions, such as depression, hypertension, and even osteoporosis.
Masters and Johnson
Masters and Johnson, or more exactly Dr William H Masters and Virginia E Johnson, have often been described as pioneering sex researchers. What was different about their approach was that they were uninhibited in investigating human sexuality, and in regarding it as a normal aspect of our existence.
This fundamental shift in approach from previous decades allowed them to explore human sexual dysfunction, to diagnose sexual dysfunction, and to treat it, in a much more effective way than had previously been the case. Another difference in their approach was to take people into a residential setting, and give them training and education on how to overcome sexual dysfunctions and problems over a short period of time in an intense sequence of consultations.
They began their research at Washington University, and continued it at the independent foundation known as the Reproductive Biology Research Foundation in 1964, later known as the Masters and Johnson Institute from 1978 onwards. Their work is now documented by the Kinsey Institute. (See Kinsey’s definition of premature ejaculation here.)
A brief history of their research work is instructive in understanding how they could investigate premature ejaculation and come to what was effectively the first formal definition of premature ejaculation that had been attempted. They began by recording laboratory data on both the anatomy and physiology of men and women during sexual stimulation.
Using the sexually uninhibited approach referred to above, they watched over 10,000 cycles of human sexual response, and as a result were able to define previously unknown aspects of sexual arousal such as the exact way in which woman’s vagina lubricated prior to intercourse and during sexual arousal.
They also investigated the nature of human orgasm, demonstrating similarity between clitorally and vaginally produced orgasms, and demonstrating the capacity of women to have multiple orgasms. This work dispelled a great number of long-standing preconceptions about human sexuality.
Their best-known books were Human Sexual Response and Human Sexual Inadequacy, published in 1966 and 1970. (The partnership began actually in 1957, when Masters hired Virginia Johnson as a research assistant.)
Although Kinsey predated them in publishing work on human sexuality (specifically in his Kinsey reports of Sexual Behavior In The Human Male in 1948, and Sexual Behavior In The Human Female in 1953), Kinsey’s work had mostly been reportage of the frequency with which certain sexual behaviors were found in the human population.
Masters and Johnson were actually interested in studying the function and form of human sexual response, using such previously unknown techniques as observation and measurement of masturbation and sexual intercourse as it took place in the laboratory.
This produced physiological data, but it also enabled them to present both sexual behavior and sexual dysfunction, including premature ejaculation, in a way that emphasized the fact that it was both a healthy and a natural part of human existence, and formed an essential part of the pleasure and intimacy of sexual relationships.
In this framework, it seems completely natural they would have undertaken the investigation of sexual dysfunctions like premature ejaculation, since this can be extremely disruptive to both the sexual aspects of a relationship, and to the relationship in a wider setting, outside the bedroom, as were.
It’s also clear that the observational work which they carried out would have been extremely useful in helping to define premature ejaculation, although in retrospect we can see that their definition was certainly framed within the limitations of thinking at the time. More exactly, the belief that most women could reach orgasm during sexual intercourse as a result of the man’s thrusting alone appears to have framed their thinking around the definition of premature ejaculation.
They defined premature ejaculation as a man’s inability to delay ejaculation for long enough so that the woman could achieve orgasm during intercourse 50% of the time.
The presumption that a woman could reach orgasm during intercourse as a matter of routine underlies this definition, and seriously weakens it. What we can say with certainty is that a number of women could reach orgasm if their man could delay ejaculation and continue thrusting vigorously for long enough, although it’s necessary for a woman to be highly aroused before intercourse starts, and for her to be very familiar with the process of reaching orgasm through vaginal stimulation, for this to happen.