Coming too soon. When a new patient discloses that he suffers from premature ejaculation, his doctor may feel a little jolt of pleasure. This is the pleasure of knowing that, almost certainly, something can be done to treat the man and that in a few months he will be enjoying a much more gratifying sex life.

More than 90 per cent of men with this condition can be cured within an average of fourteen weeks. But before the advent of modem sex therapy, most premature ejaculation (PE) sufferers were burdened with their problem for life.

All healthy men begin as premature ejaculators. By their late teens most have learnt some control, but it is estimated that about 10 per cent never do. It is a natural impulse which men have to unlearn.

In evolutionary terms, rapid ejaculation made perfect sense. Sixty thousand years ago, men were dead by the age of twenty-two and life was dangerous. Out there in the wilds they didn’t want their backs turned for too long. The longer it took, the more vulnerable they were. Women became fertile at around the age of fourteen, and because 80 per of babies died, the men had to ensure the women were constantly pregnant. Basically, the men who were most successful were quick.

Nowadays, there is a perception that the men who are most successful are slow. Before the 1900s there was virtually nothing in medical literature about PE being a problem. It is only since the rise of the women’s movement in the seventies that it has become an issue.

At about the age of seventeen or eighteen, most young men discover ejaculatory control. One week they have no control and the next they have it. For the others it is more of a struggle, but by the age of twenty, about 90 per cent can exert a degree of voluntary control. Some men who suffer from PE compensate by climaxing twice. The second time is usually slower, however. This remedy is not available to all men because, with age, the ability to regain an erection quickly is lost.

By the age of fifteen, a male can gain a second erection within five minutes, a third within ten minutes and a fourth within twenty minutes. The interval doubles up each time. By the time he is twenty-five, he has to wait twenty minutes for his second erection and forty minutes for the next. By the age of forty-five, this initial interval has expanded to more than two hours, and by the time he reaches seventy he might have to wait eighteen hours before he can get a second erection. These are averages, and of course, there are enormous individual variations.

For a long time, PE was defined in terms of number of thrusts the man could deliver or the number of seconds he could last. But this was found unworkable as no one could put an exact time or thrust limit on what constituted normal ejaculatory control. A new definition states that ‘the essential feature of PE is that the man lacks adequate voluntary ejaculatory control with the result that he climaxes involuntarily before he wishes to’. This definition has been adopted by the World Health Organization.

In her book PE. How To Overcome Premature Ejaculation the late Dr Helen Singer Kaplan notes that some men accept they climax rapidly and this does not impact on their sexual pleasure. But, more often than not, it is a source of distress.

‘In our society, men often measure their self-worth by the hardness of their erection and by their “staying power”. Men who have poor control, especially if they are unsure of themselves in other ways, may end up with a general sense of inadequacy and failure and may develop additional sexual difficulties.’

Men with PE may become anxious about their performance and begin feeling noticeably stressed in anticipation of intercourse. It is physically impossible for a man to maintain an erection if he is stressed. During such periods, the body releases its ‘emergency’ hormones (adrenalin and noradrenaline which cause immediate detumescence.

Ninety-nine per cent of PE has a psychological cause, although it may also result from illness or as a side effect of medication. PE that occurs in later years can sometimes be the first sign of more serious problems, such as diabetes or a neurological disease like multiple sclerosis. Urethritis may also be a cause.

In general, men who suffer from PE are no more neurotic than men who don’t. The only difference is that they are too quick. Apart from possible deeper psychological issues, the immediate cause of PE is always a lack of sexual sensory awareness. PE sufferers never develop a normal sense of what their genitals feel like when they are highly excited and about to climax. Dealing with this sensory deficit is the key to the cure.

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