I get asked all the time about premature ejaculation (PE). The concept of PE is problematic in a number of ways. Firstly, its ill-defined. Some clinical descriptions don't specify the time it takes for an ejaculation to be considered premature. Others specify an intravaginal ejaculation latency time of 15 seconds, or 30 seconds or 1 minute. Others don't recognize differences between lifelong and acquired PE (D'cruz & Andrade, 2020).
Most studies exploring the prevalence of PE have been criticized for relying on patient self-reports or poorly validated definitions of PE, suggesting their reported rates to be inaccurate (El-Hamd et al., 2019). This reliance on subjective indicators (e.g. ejaculation-related distress) has raised concerns that prevalence estimates are inflated, resulting in over-diagnosis in normally-functioning men (Segraves, 2010).
For example, 20–70% of the general population report having PE, but only 4–5% of men can actually be clinically diagnosed with PE according to the International Society of Sexual Medicine definition (Althof et al., 2014). Thus a conversation needs to be had about the existence of PE.
Defining PE as a pathological condition may not necessarily be correct. Mammals ejaculate quickly to enhance their ability to procreate. A similar phenomenon could be true in humans, as pointed out by Hong (1984) in his theory, "Survival of the Fastest."
PE is not necessarily always associated with lack of sexual enjoyment, and the perception of a sexual dysfunction may be heavily influenced by social factors, such as social media, cultural attitudes, and abstinence (Waldinger et al., 2005).
These concepts challenge whether PE truly exists or whether it has arisen as a result of men having unrealistic concepts of sexual function which are based on social conditioning, especially the use of pornography.
PE is a multimillion-dollar industry. Therefore the pharmaceutical industry must be challenged about their incentive to overpathologize and overmedicalise PE.
Language is powerful. If you tell yourself that you have PE, you're creating a sexual script for you to follow. Write a new script.
