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The term premature ejaculation is not well defined in medical circles and is sometimes considered to be more of a marketing tool than
a medical condition. By widely advertising Premature Ejaculation / Erectile Dysfunction as a problem, an industry has been created to solve what in the
past might not have been a great concern. The psychological effects of Premature Ejaculation and Erectile Dysfunction have also been
considered similar to the effects on young women of the thin model paradigm.
Most men experience premature ejaculation at least once in their lives. Often adolescents and young men experience premature
ejaculation during their first sexual arousal encounters, but eventually learn ejaculatory control. Because there is great variability
in both how long it takes men to ejaculate and how long both partners want sex to last, researchers have begun to form a quantitative
definition of premature ejaculation. Current evidence supports an average intravaginal ejaculation latency time of six and a half
minutes in 18-30 year olds. If the disorder is defined as an IELT percentile below 2.5, then premature ejaculation could be suggested
by an IELT of less than about one and a half minutes. Nevertheless, it is well accepted that men with IELTs below 1.5 minutes could
be "happy" with their performance and do not report a lack of control and therefore do not suffer from Premature Ejaculation. On the
other hand, a man with 2 minutes IELT may have the perception of poor control over his ejaculation, distressed about his condition,
has interpersonal difficulties and therefore be diagnosed with Premature Ejaculation.
Psychological factors commonly contribute to premature ejaculation. While men sometimes underestimate the relationships between
sexual arousal performance and emotional well-being, premature ejaculation can be caused by temporary depression, stress over
financial matters, unrealistic expectations about performance, a history of sexual intercourse, or an overall lack of confidence.
Interpersonal dynamics strongly contribute to sexual arousal function, and premature ejaculation can be caused by a lack of
communication between partners, hurt feelings, or unresolved conflicts that interfere with the ability to achieve emotional
intimacy. Neurological prematureejaculation can also lead to other forms of erectile dysfunction, or intensify the existing problem,
by creating performance anxiety. In a less pathological context, prematureejaculation could also be simply caused by sexual arousal.
The physical process of ejaculation requires two sequential actions: emission and expulsion.
It is believed that the neurotransmitter serotonin (5HT) plays a central role in modulating ejaculation. Several animal studies have
demonstrated its inhibitory effect on ejaculation. Therefore, it is perceived that low level of serotonin in the synaptic cleft in
these specific areas in the brain could cause premature ejaculation. This theory is further supported by the proven effectiveness of
selective serotonin reuptake inhibitors (SSRIs), which increase serotonin level in the synapse, in treating
Premature Ejaculation.
Premature ejaculation should be distinguished from erectile dysfunction related to the development of a general medical condition.
Some individuals with erectile dysfunction may omit their usual strategies for delaying orgasm. Others require prolonged noncoital
stimulation to develop a degree of erection sufficient for intromission. In such individuals, sexual arousal may be so high that
ejaculation occurs immediately. Occasional problems with premature ejaculation that are not persistent or recurrent or are not
accompanied by marked distress or interpersonal difficulty do not qualify for the diagnosis of premature ejaculation. The clinician
should also take into account the individual's age, overall sexual arousal experience, recent sexual intercourse, and the novelty of
the partner. When problems with premature ejaculation are due exclusively to substance use (e.g., opioid withdrawal), a
substance-induced erectile dysfunction can be diagnosed.