PREMATURE EJACULATION

Premature Ejaculation

Premature Ejaculation

Introduction

Recent reports have sought to define premature ejaculation (PE) in terms of intravaginal ejaculatory latency time (IELT) and qualify the severity of the condition from 'none' to 'severe' in psychological terms . The definition has been based on well-constructed epidemiological and evidence-based principles in a group of men who have admitted that they have PE and who have agreed to use a stopwatch to measure their IELT.

For a man to seek help that requires confession of PE, and then measure this with a stopwatch during sexual intercourse would seem unusual, suggesting that he must be anxious about his performance, or his partner unsatisfied with their sexual activity, but assessment of anxiety levels is not included in published reports. (Waldinger, 2005)

Waldinger qualifies the 'disease' of PE using a medicalised standard of disease definition for lifelong PE, based on clinical research that indicates that some men ejaculate in less than 1 minute.

This raises 4 key questions about the construction of the disease and the deployment of a measure of time to somehow 'qualify' the condition. The key questions are:

1. How does measuring IELT stratify sexual experience?

2. Are the subjects who have agreed to participate in research 'normal' or are they a particularly anxious set of men?

3. To what extent does environment play its role in the complex causes of premature ejaculation?

4. What are acceptable expectations of normal sexual activity?

Background

This paper seeks to discuss these key questions and assumptions that underpin the qualification of PE, by examining the 'evidence' on which they have been constructed. PE is primarily determined in neurophysiological terms, describing a biological, sexual event. However in so doing, the diagnostic process marginalises complex networks of cultural meaning as well as the individual man's (and his partners') embodied and symbolic experience in the context of desire, intimacy and the performance of erotic interaction. Whilst of course, the person's actual experience of a phenomenon is unknown and essentially unknowable by others, it seems to us that a more effective deconstruction of PE must occur if we are to gain a more textured and sensitive appreciation of both the performativity of sex generally, and the implications of erotic dysfunction represented by premature ejaculation in particular. The aim of this paper is therefore to examine, with a more sociologically informed gaze the discourses related to PE and sexuality, and to reflect on the principles of evidence-based medicine, which may not be wholly appropriate for the management of this condition. (Waldinger, 2005)

Prevalence

The true prevalence of PE remains unknown, but has been variously cited as, highly prevalent and affecting 21% , 22-38% , 1%-75% and 75% of men.

These prevalence rates rely on three assumptions; firstly is that of an accurate measure of IELT, secondly, the man's veracity in reporting their IELT, and thirdly, the sample of men who are willing to participate in clinical studies, i.e. not all men who ejaculate early will seek treatment, therefore those who do may misrepresent the 'true' prevalence. (Waldinger, 2004)

Each of these assumptions tends to presume a universality of ...