Premature Ejaculation - What Is The Right Way To Diagnose It?

As many as 30-40 % men across the world including India experience problem of PE at some time of life. In Part 1, we learnt about the condition called Premature Ejaculation (PE). In this 2nd part, let’s understand about it’s diagnosis & types of PE - why and how it happens.

How to Diagnose PE:
The specific criteria for premature (early) ejaculation are as follows:

1. In almost 75-100% sexual activity, the experience of ejaculation occurring during sexual intercourse within 1 minute after vaginal penetration and before the individual wishes it.
2. The problem has persisted for at least 6 months and is a cause of mental stress to the person.
3. The dysfunction cannot be better explained by any other nonsexual mental disorder, any medical disease, the effects of a drug or medication, etc

Severity of PE:
The severity of premature (early) ejaculation is broadly defined as follows:

1. Mild (occurring within approximately 30 seconds to 1 minute of vaginal penetration)
2. Moderate (occurring within approximately 15-30 seconds of vaginal penetration)
3. Severe (occurring even before sexual activity, at the start of sexual activity, or within approximately 15 seconds of vaginal penetration). In such cases, conception will not be possible unless artificial insemination is used.

Types and Characteristics of P.E. :
Premature ejaculation can be Chronic (lifelong) or Acquired (recent).

Chronic PE: With chronic (lifelong) premature ejaculation, the person has been experiencing premature ejaculation since he became sexually active (ie, post-puberty).
Acquired PE: Acquired (recent) premature ejaculation means that the condition began in an individual who previously experienced an acceptable level of ejaculatory control and only recently has developed PE.

What are the causes?

The causes of PE can be divided into two broad sub-heads, which are psychological or biological cause:

1. Psychological Causes: Premature ejaculation is believed to be a psychological problem and does not represent any known organic/physical disease involving the male reproductive organs or any known defect in the brain or nervous system. It is usually due to a pattern that is hard to change and is a result of your previous sexual experiences. One of the most common reason is childhood habit of reaching climax/ ejaculation quickly because of fear of discovery when masturbating or during early sexual experiences with a female partner. This pattern of rapid attainment of sexual release is difficult to change in later stage of life (in marriage or long-term relationships). Other reasons are situations in which one may have hurried climax/ ejaculation in order to hide any problem or feelings of guilt that make you rush through sexual encounters. Also, psychological causes include anxiety and relationship issues which can also result from deep anxiety about sex that relates to bad experiences encountered by the patient during development (eg: incest, sexual assault, conflict with parents, etc ).

2. Biological Causes: A number of researchers have found differences in nervous stimulations and hormonal differences in men who experience premature ejaculation compared with individuals who do not. Some believe that some men have hyper-excitability or oversensitivity of their genitalia. Abnormal functioning of the ejaculatory system can be attributed to:

• Thyroid problems; infection or inflammation of the urethra or prostate.
• Nerve damage occurring due to trauma or surgery (a very rare cause).
• Abnormal levels of hormones and/or neurotransmitters (chemicals present in the brain)
• Higher free and total testosterone levels or varied other biochemical markers