Premature Ejaculation

Premature ejaculation (PE) is a highly prevalent condition; based on data from the National Health and Social Life Survey, this condition affects 21% of men between 18 and 59 years of age in the USA. This disorder is classified into two categories: primary PE, which is present from the time a male first becomes sexually active and secondary PE, which is acquired later in life.

Etiology and Priligy Australia

The specific cause of PE is not known. A number of etiologies have been proposed, including a variety of psychological and organic causes. Dunn and colleagues performed a cross-sectional population survey in 1999 and found that anxiety was strongly associated with the presence of PE.

While the authors acknowledge that the direction of this and other associations from their study need to be clarified, their results suggest that psychological factors such as anxiety could possibly  have a causative role in sexual problems such as PE. In contrast to psychosexual causes, organic causes have also been postulated to cause PE. Waldinger et al. proposed that PE is a neurobiological disorder due to serotonergic hypoactivity.

Studies of male rats have shown that serotonin (5-hydroxytryptamine or 5-HT), and various serotonin receptors, play a role in the process of ejaculation. Activation of 5-HT1B and 5-HT2c receptors delays ejaculation, while activation of 5-HT1a receptors facilitates ejaculation. Some authors have related decreased central serotonergic activity (increased 5-HT1a sensitivity or decreased 5-HT2c sensitivity) to PE.


One of the first definitions for PE was offered by Masters and Johnson, who described it as the inability of the male partner to delay ejaculation long enough for the female partner to achieve orgasm 50% of the time. The Diagnostic and Statistical Manual of Mental Disorders, revised version 4 (DSM-IV-TR) highlights the individual and interpersonal distress caused by male climax earlier than desired by the male. Key aspects of the DSM-IV-TR definition include:

  1. Reduced control over ejaculation;
  2. A decrease in the patient’s and/or partner’s satisfaction with sexual intercourse;
  3. Distress or bother in the patient and/or partner regarding the PE.

This DSM-IV-TR definition has been widely utilized clinically, and the Premature Ejaculation Diagnostic Tool (PEDT) is a five-item questionnaire developed specifically to apply the DSM-IV-TR criteria for PE. In 2006, Waldinger and Schweitzer reported on the limitations of the DSM-IV criteria for PE diagnosis, noting that it resulted in a low, positive predictive value. Symonds et al. subsequently published a manuscript arguing the opposite, stating the PEDT is a reliable and valid PE diagnostic tool.

Many investigators favor the use of intravaginal ejaculation latency time (IELT) to diagnose PE. IELT is defined as the time from vaginal intromission to the onset of ejaculation. Canadian pharmacy viagra – cheap erectile dysfunction sildenafil medications Canada.

Advantages include that IELT is, at least in theory, a reproducible, objective measure. However, a 2005 manuscript by Patrick et al. highlighted some of the limitations of IELT. The authors assessed 207 men with PE and 1,380 men with-out PE. At the time of the first study visit, subjects were asked to estimate their own IELT.

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