Premature (Early) Ejaculation DSM-5 302.75 (F52.4)

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DSM-5 Category: Sexual Disorders

Introduction

Premature (Early) Ejaculation is classified as a sexual disorder in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition), diagnosis assigned to men who ejaculate prematurely during vaginal intercourse. Although premature ejaculation can occur during other sexual activity, it is only defined as a disorder in the case of vaginal intercourse, as a time duration for oral or manual stimulation has not been established. Premature or early ejaculation is defined as the man feels unable to control their orgasm, and climaxes in less than one minute after vaginal penetration; generally, this is not sufficient time for a woman to reach orgasm (American Psychiatric Association, 2013). This can result in sexual dissatisfaction or frustration for one or both partners, (Graziottin, & Althof, 2011), and self-esteem and self-image problems in the man. Many sources describe causality in terms of psychodynamic reasons such as anxiety or culturally or religiously rooted guilt about sex. Less frequently cited are causes that are more apparent: eagerness, inexperience (Lording, 2011). and penile hypersensitivity. Premature (Early) Ejaculation can become a conditioned response. Anxiety about climaxing too quickly and over focusing on the woman’s orgasm as the objective can perpetuate the sexual dysfunction. The definition of Premature (Early) ejaculation can be difficult to operationalize, as couples will have a range of preferences as to what constitutes adequate time at sexual intercourse (Hatzimouratidis, Amar, Eardley, Giuliano, Hatzichristou, Montorsi, Vardi, & Wespes, 2010). One way to define Premature (Early Ejaculation) is if sexual intercourse is unsatisfying to one partner, or “any ejaculation that happens before you both want it to” (Comfort, 1987). Unrealistic expectations regarding sexual endurance can be fueled by exposure to pornography. It is noted that three minutes is the average time from vaginal penetration to ejaculation (Brown University, n.d.).

Symptoms of Premature (Early) Ejaculation

According to the DSM-5, there are four criterions, and seven sub-features which are symptoms of Premature (Early) Ejaculation:

A. Consistently ejaculating within one minute or less of vaginal penetration.

B. Criterion A has persisted for at least six months, and has been experienced 75%-100% of the time.

C. Criterion A symptom results in clinically significant distress, sexual frustration, dissatisfaction or tension between partners.

D. This condition is not better accounted for by another non-sexual mental disorder, medication or illicit substance use, or medical condition.

The clinician can add the following specifiers:

  • Lifelong- Premature (Early) Ejaculation has been experienced since the first intercourse attempt.
  • Acquired- Premature (Early) Ejaculation has appeared after a period of sufficient orgasmic latency.
  • Generalized- Premature (Early) Ejaculation occurs with different partners and situations.
  • Situational- Premature (Early) Ejaculation only occurs with a specific partner and situation.

The severity of Premature (Early) Ejaculation can also be specified:

  • Mild, in which ejaculation occurs 30 -60 after vaginal penetration
  • Moderate, when ejaculation occurs 15-30 seconds after vaginal penetrations.
  • Severe, in which ejaculation occurs prior to penetration, upon penetration, or < 15 seconds after vaginal penetration (American Psychiatric Association, 2013).

Onset

The DSM-5 notes that Premature (Early) Ejaculation can begin with the onset of a male’s sexual experience, or later in life, after a period of normal sexual function (American Psychiatric Association, 2013).

Prevalence

According to the DSM-5, the prevalence of Premature (Early) Ejaculation is 1% to 3%

Among men in the US. (American Psychiatric Association, 2013). However, there are cultural differences apparent, as another source indicates a much higher prevalence among Greek men at 20%-30% (Hatzimouratidis, et al, 2010).

Risk Factors

The DSM-5 indicates that risk factors for Premature (Early) Ejaculation are anxiety disorders, specifically social anxiety (American Psychiatric Association, 2013). PTSD (Post-traumatic Stress Disorder) due to sexual trauma may also be a factor. Discomfort with sex or ones body from trauma, which is often overlooked in men, can produce anxiety and a need to complete the sex act as quickly as possible.

Comorbidity

The DSM-5 indicates that Premature (Early) Ejaculation may be comorbid with erectile dysfunction (American Psychiatric Association, 2013).

Treatment for Premature (Early) Ejaculation

The DSM-5 does not specify treatment options for Premature (Early) Ejaculation (American Psychiatric Association, 2013). Premature (Early) Ejaculation is diagnosed by self report, both by the man and preferably his partner (Drogo Montague, Jarow, Broderick, Dmochowski, Heaton, Lue. Nehra, & Sharlip, n.d.) Treatment options include psychosexual education, where specific sexual techniques to delay ejaculation are presented, such as the stop- and-go method of intercourse, where thrusting is stopped when the man feels ejaculation is imminent, or the squeeze method, where pressure is applied behind the glans until the urge to ejaculate passes (Brown University, n.d.). There are pharmacological treatment options, such as SSRI’s (Selective Serotonin Re-uptake Inhibitors), which frequently have the side effect of delaying orgasm. A topical anesthetic such as 7.5% benzocaine can reduce penile sensitivity and delay ejaculation (Brown University, n.d.).

A concrete, conventional view of sex can place performance pressure on a man, and create other problems such as erectile dysfunction. Instead of focusing exclusively on intercourse, sexual techniques other than intercourse can be used by couples if the man has Premature (Early) Ejaculation. Digital stimulation, oral copulation, and full-body massage are alternatives for a man to pleasure a woman, or bring her to climax, before or after ejaculation. Premature (Early) Ejaculation also does not have to mean the sexual encounter is concluded, but that an interlude can take place, Given the higher prevalence of Premature ( Early) Ejaculation among younger, less sexually experienced men, and that younger men have a briefer orgasmic latency period, intercourse can be attempted again after a rest period (Comfort, 1987). The alternative sexual techniques can also be employed following the male climax to satisfy his partner.

Impact on Functioning

The DSM-5 notes that Premature (Early) Ejaculation has the potential to have a significant impact on an intimate relationship, reduced self esteem, It can result in sexual frustration for both partners, and difficulties with conception (American Psychiatric Association, 2013). Premature (Early) Ejaculation can result in Injured self-image, doubts about one's masculinity or sexual prowess, or feelings of inadequacy.

References

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders.(5th Edition). Washington, DC.

Brown University ( n.d.). Premature Ejaculation. Brown University Health Education. Retrieved March 1, 2014, from http://brown.edu/Student_Services/Health_Services/Health_Education/mens_health/premature_ejaculation.php

Comfort, A. (1987). The Joy of Sex: A Gourmet Guide to Lovemaking. Chapter 6: Problems. Pocket Books: NY.

Drogo K., Montague, D.K., Jarow, J., Broderick, G.A., Dmochowski, R.R., Heaton, J.P.W., Lue, T.F., Nehra, A., and Sharlip, I.D. (n.d.) Guideline on the Pharmacologic Management of Premature Ejaculation. American Urological Association. Retrieved March 12, 2014 from https://www.auanet.org/education/guidelines/prematureejaculation.cfm

Graziottin, A., and Althof, S. (2011). What Does Premature Ejaculation Mean to the Man, the Woman, and the Couple? The Journal of Sexual Medicine. (8), Issue Supplement s4. 304–309. Special Issue: A Practical Approach to Premature Ejaculation. DOI: 10.1111/j.1743-6109.2011.02426.x

Hatzimouratidis, K., Amar, E., Eardley, I, Giuliano, F., Hatzichristou, D., Montorsi, F., Vardi, Y., and Wespes E. (2010). Guidelines on Male Sexual Dysfunction: Erectile Dysfunction and Premature Ejaculation. Retrieved March 12, 2014 from http://www.uroweb.org/fileadmin/tx_eauguidelines/2010/Trans/2010_Guidelines_on_Male_Sexual_Dysfunction.pdf

Lording, D. (2011). Andrology Australia. Premature Ejaculation Retrieved March 12, 2014 from https://www.andrologyaustralia.org/wp-content/uploads/Factsheet_PremEjac_2011.pdf


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