The Science of Premature Ejaculation & How to Cure It
Premature Ejaculation: From Ancient Greece to Modern Times
It needs to go down in history as the worst sexual encounter of all time.
You may have heard of Romulus and Remus, the mythical brothers who, legend has it, founded the city of Rome. But did you know that the ancient city of Athens had its own foundational myth?
It did.
And buckle up…
It’s a doozy.
In the 1800s, a small fragment of a tragedy written by Euripides in the 5th century BCE was found. It tells the mythical story of the founding of Athens. When classicists translated the work, it tells the story of the first King of Athens, Erichtonius, who was the product of premature ejaculation.
The Greek god of fire, Hephaestus, fell madly in love with Athena, the goddess. Athena came to him trying to score some weapons off him, and he turned into a total creeper. He pursued Athena and tried to copulate with her, but she ran.
He got close enough to her to try and grab her in his embrace, but, in a surge of sexual excitement, ejaculated right then and there…it landed on her leg.
Gross, I know.
The ancient Greeks were wild.
Athena wiped his issue off her leg (with a piece of wool, understandably) and tossed it onto the ground where it came into contact with Gaea, the goddess of the Earth.
And, εὕρηκα!
Just like that, Eirchtonius was conceived.
This is the first known mention of premature ejaculation in literary history.
While most instances of premature ejaculation are much less dramatic (and far less rape-y) it’s still a painful experience for men all over the world. It’s also one that’s far more common than most of us are willing to acknowledge.
What is Premature Ejaculation?
Premature ejaculation is one of the most common sexual health concerns for men. It is a condition in which a man ejaculates sooner than he or his partner wishes during sexual activity. Premature ejaculation can occur at any time, but it is most common during vaginal intercourse.
Premature ejaculation is a sensitive subject.
It’s so sensitive, it goes underdiagnosed far too often. Men feel deeply ashamed when they experience PE, thus they’re hesitant to bring it up to their doctor. Nonetheless, studies suggest that PE affects up to 30% of men worldwide, making it an extremely common condition. Some reviews even suggest that up to 75% of men suffer from the condition.
Why such a wide variance? Because premature ejaculation has been something that’s rather difficult to define.
In the 1950s, researchers Masters and Johnson defined it as “the inability of a male to control ejaculation sufficiently to satisfy his female partner in more than 50% of coital episodes, provided that she is not anorgasmic.”
Today, our definitions are a bit more precise (and forgiving). The DSM-5 defines premature ejaculation once the following three criteria are met:
Ejaculation occurs during partnered sexual activity within approximately 1 minute following vaginal penetration and before the individual wishes it, during all or almost all sexual activity (75% to 100% of the time)
Symptoms must persist for at minimum 6 months and cause clinically significant distress to the individual
The dysfunction is not explainable by a nonsexual mental disorder, medical conditions, the effects of a drug or medication, or severe relationship distress, or other significant stressors
Furthermore, ED is branched into three categories of severity:
Mild (occurs within approximately 30 seconds to 1 minute of penetration)
Moderate (occurs within approximately 15 to 30 seconds of penetration)
Severe (occurs before sexual activity, like old Hephaestus; at the start of sexual activity, or within approximately 15 seconds of penetration).
What Causes Premature Ejaculation?
There are many possible causes of premature ejaculation, including anxiety, stress, and hormonal problems. It can also be caused by a variety of physical factors, such as age, poor sexual fitness, and low testosterone levels.
It may also be due to physical problems, such as an over-sensitive penis.
Wait, what?
You read that right. There’s such a thing as an oversensitive penis, called penile hypersensitivity.
One study concluded:
Our study showed that patients with lifelong PE might have a hypersensitivity profile in terms of peripheral sensory thresholds. Penile hypersensitivity appeared to be a factor contributing to short intravaginal ejaculation latencies in the sample of lifelong PE men. Finally, the penile vibratory threshold is a valid measurement tool for predicting the severity of PE.
But fear not…whatever the cause, we’re going to explore some options available to people for PE, whether it’s intermittent or lifelong.
Treatments for PE
There are several ways to cure premature ejaculation. Lifestyle changes include reducing stress levels and improving your overall sexual fitness. If those measures don’t work, the most common medications used to treat premature ejaculation are antidepressants, anticonvulsants, and testosterone replacement therapy, depending on what the cause is.
There are four categories of PE:
Lifelong — present since first sexual experience
Acquired — present after a period of normal sexual functioning
Generalized — not limited to situations, partners, or sexual activities
Situational — only happens with certain types of sex, partners, or situations
Lifelong PE is usually treated with antidepressant drugs. These cases include oversensitive men and men with anxiety problems that haven’t gone away.
Acquired PE typically happens in men with an underlying cause, such as newly acquired mental illness, stress, or other external factors. If those external factors can be addressed, and the issue goes away, all is well.
If not, antidepressant drugs are the best treatment available.
Generalized and situational are frequently treated with reassurance (from peers, from partners, etc.), education, and behavioral therapy.
Topical Anesthetics
These are old-school remedies that come in the form of numbing creams and sprays that are applied to the penis before sex. While they’ve largely been displaced by the high effectiveness of SSRIs, they were the original remedy.
Think: the lidocaine they use on your gums at the dentist, but for your penis.
This method has a lot of problems, including applying too much of the cream/spray and women becoming numb as well, rendering it more difficult for her to reach climax.
And, let’s face it, for a lot of people, digging out a spray and applying it to the penis, then waiting 5 to 10 minutes for it to take effect, can kill the mood.
Antidepressants: SSRIs
Studies have shown, antidepressants are very effective treatments for premature ejaculation. In one study, two antidepressants were compared to placebo in treating premature ejaculation. The results showed that approximately 70% of men who received antidepressants experienced a significant improvement in their Premature Ejaculation Index (PEI) score.
Study authors note:
In the fluoxetine group, 8 (30.8%) patients cured, improvement in 11 (42.3%) and failure in 7 (26.9%). In the sertraline group, 12 (38.7%) patients cured, improvement in 10 (32.3%) and failure in 9 (29%). Side effects in group I were nausea in 3, headache in 1 and insomnia in 2 (total 6 patients, 23%). In group II, we observed nausea in 2 and mouth dryness in 6 (total 8 patients, 25.8%). No patients were excluded from the study due to side effects.
Additionally, antidepressant use was associated with decreased anxiety and improved self-esteem.
Another study compared the effectiveness of various SSRIs in comparison with placebo, and the results speak for themselves. Over time, the IELT (intravaginal ejaculatory latency time) rose for those taking SSRIs, but not for others.
Sertraline (Zoloft) and Fluoxetine (Prozac) seem to be the most effective drugs we have to help men last longer in bed.
SSRIs are drugs you have to take daily, but a Dutch study found that most men prefer this, over a drug you have to remember to take before sexual activity begins (or an anesthetic numbing cream).
Phosphodiesterase type 5 inhibitors
Like most drugs with a profound benefit for sexual health (Viagra), PDE5 inhibitors were discovered as a treatment accidentally. PDE5 inhibitors are usually prescribed to men with Erectile Dysfunction, but some research has suggested that in those men, it can help with PE, too.
A small Chinese study from 2003 showed that PDE5 inhibitors helped men with both PE and ED to have more staying power. Study authors note:
Forty-five patients of PE complicated by ED received flexible doses of sildenafil from 50 to 100 mg for 1 to 3 months. Intravaginal ejaculatory latency time (IELT) and sexual satisfaction ratio (SSR) of partner were recorded to evaluate the effect of PE treatment, as well as the general efficacy and satisfaction of ED treatment. And the difference of IIEF-5 before and after the treatment were compared.
Twenty-seven patients had their PE improved and the effective rate was 60%. Forty patients reported the improvement in erection and the percentage of erectile improvement was 88.88%. All the 27 patients with improvement of PE achieved effective erection through the administration of 50 mg sildenafil and the satisfaction rate reached 81.48%.
These can also be handy for the very small subset of men for whom SSRIs and topical creams have failed.
These come with quite a bit more side effects than SSRIs do, so SSRIs are almost always the first line of defense.
Testosterone Replacement Therapy
Testosterone replacement therapy is also useful in treating PE. But don’t get ahead of me guys, it’s typically the last thing prescribed after other things have been tried, and it’s only prescribed to men with underlying hormone issues.
One study found a 4.8-fold increase in the duration of sex in men treated for testosterone deficiency with testosterone replacement therapy, compared with a 1.8-fold increase for those taking Dapoxetine (a PDE5 inhibitor):
In regard to treatment results, recipients of testosterone replacement demonstrated a 4.8-fold increase in mean intravaginal ejaculation latency time, while dapoxetine recipients had a 1.8-fold increase. Our findings demonstrate that testosterone replacement may be a promising treatment for those with secondary PE in the presence of testosterone deficiency.
Conclusions
Whatever the cause, premature ejaculation can be frustrating and embarrassing for men. Treatment for premature ejaculation typically involves counseling and/or medications. However, many men find that treatment works best when combined with lifestyle changes.
What’s most important is that we men start discussing this issue more openly, and I mean beyond just telling each other jokes. We need to be candid about our sexual problems, if anything, to let others know they aren’t alone. And we shouldn’t have any shame, especially considering how common this issue is.
It’s also comparatively easy to remedy. There’s no need to live our lives in the miserable dark of shame.
The sexual lives of our dreams often exist right outside our comfort zones.
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Three books I recommend checking out:
Tell Me What You Want: The Science of Sexual Desire and How It Can Help You Improve Your Sex Life
Sex at Dawn: How We Mate, Why We Stray, and What It Means for Modern Relationships
A Billion Wicked Thoughts: What the Internet Tells Us About Sexual Relationships
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