Emanuele A. Jannini - Premature Ejaculation: From Etiology to Diagnosis and Treatment
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Premature ejaculation (PE) is a common male sexual complaint, with a self-reported prevalence of 20 30% in observational studies. Over the past 10 20 years, our understanding of PE has evolved from the initial premise that it is a psychological disorder to the current recognition of an underlying biological and probably genetic predisposition in many cases. This new understanding has been accompanied by novel approaches to the assessment and treatment of patients with PE.
Premature Ejaculationis the first truly contemporary reference volume on the subject. It covers a broad range of aspects relevant to PE, including past and current definitions of the condition, the etiology of PE, its epidemiology, the impact of PE on both the patient and his partner, and the treatment of PE using pharmacotherapy and/or psychotherapy/cognitive behavioral therapy. The book is well illustrated and referenced, and the primary focus throughout is on evidence-based medicine.
This timely and authoritative volume will be of great value to sexual health physicians, andrologists, endocrinologists, urologists, psychiatrists, sexologists, psychologists, and other interested healthcare professionals.
Premature Ejaculationis the first truly contemporary reference volume on the subject. It covers a broad range of aspects relevant to PE, including past and current definitions of the condition, the etiology of PE, its epidemiology, the impact of PE on both the patient and his partner, and the treatment of PE using pharmacotherapy and/or psychotherapy/cognitive behavioral therapy. The book is well illustrated and referenced, and the primary focus throughout is on evidence-based medicine.
This timely and authoritative volume will be of great value to sexual health physicians, andrologists, endocrinologists, urologists, psychiatrists, sexologists, psychologists, and other interested healthcare professionals.
Emanuele A. Jannini: author's other books
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Emanuele A. Jannini
RIMTH MD
John Knotts
Dr Medhavi Agarwal
Abrams Hank
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Emmanuele A. Jannini , Chris G. McMahon and Marcel D. Waldinger (eds.) Premature Ejaculation 2013 From Etiology to Diagnosis and Treatment 10.1007/978-88-470-2646-9_1 Springer-Verlag Italia 2013
1. Introduction
Chris G. McMahon 1
(1)
Australian Centre for Sexual Health, Berry Road Medical Centre, Suite 2-4, 1a Berry Road, St Leonards, NSW, 2065, Australia
Chris G. McMahon
Email:
Abstract
This textbook explores the conundrum of premature ejaculation and in doing so attempts to demystify the epidemiology, pathogenesis and etiology, dimensions, diagnosis, and management of this common sexual complaint.
As long as man has breathed, his fascination, pursuit and quest for the perfect sexual experience have remained one of his principal raisons dtre . After thousands of years, millions of words and pictures, and billions of attempts, he still often finds the goal largely unobtainable. Until recently, our understanding of premature ejaculation (PE) was an eclectic mix and homogenization of ancient historical and culturally diverse influences. In many ancient cultures and times, there were many references to the importance of ejaculation and the art of love and sexuality.
The Bible states that semen was intended to be deposited only in vaginas and mainly for the purpose of procreation. Men were told: Be fruitful, and multiply and replenish the earth (Genesis 2). The punishment for not obeying Gods Law was death, as Onan was to discover to his peril. Onans father, Judah, forced him to marry his brothers widow Tamar, whom he did not love. Onan discovered that during coitus he could not ejaculate into Tamar: he spilled it [semen] on the ground, and the thing which he did displeased the Lord: wherefore He slew him (Genesis 38).
The Indian god Shiva, who has the power to destroy and create, is often represented with an erect phallus, a symbol of power and fertility. Because Shiva always holds back his seed, the lingam (penis) remains erect, as a potential creator [].
The Kama Sutra was written between the first and fourth centuries AD by Mallanaga, a bachelor belonging to the Vatsyayana sect. It is best described as the lifestyle book of its era which was devoted to personal discipline and offered a range of knowledge that the reader may acquire, to find (and keep) a partner. It gave suggestions on many subjects, from how to freshen the breath by chewing betel leaves to a range of sexual positions that seems often to be addressed to a contortionist []. Although initially published in Britain in 1876, it was considered by Victorian England to be far too lewd and was not officially available until 1963.
Part Two of the Kama Sutra deals exclusively with sexual intercourse and considers different lengths of time to ejaculation as having various merits. The author believed that The first time of union the passion of the man is intense, but on subsequent union the reverse of this is true . He observed that, if a male be long - timed, the female loves him the more, but if he be short timed, she is dissatisfied with him . He concludes that males when engaged in coition, cease of themselves after emission and are satisfied, but it is not so with females . This is a clear reference to the fact that PE causes bother, frustration, and relationship friction.
Chinese sexology can be traced back many dynasties. The Tang Dynasty (618907 AD) was considered to be sexually free, and during this period sex was positively encouraged as the means to good health. Early Taoist philosophers saw frequent and long-lasting sex as promoting balance between the Yin (negative, dark, feminine) and Yang (positive, bright, masculine). Sex was considered the very essence of nature and harmony. It was also thought that to ejaculate (chi) made the man weak for the next sexual encounter. Delaying or suppressing ejaculation was felt to be beneficial, and a disciplined approach to delaying ejaculation became popular. In the Ming Dynasty (13681644), attitudes to sex became more restricted, and by the Quing Dynasty (16441911), sexuality was repressed and regulated [].
In sixteenth century Tunisia, Sheikh Nefzawi, adviser to the Grand Vizier of Tunis, wrote a book on the art of love called The Perfumed Garden , the Islamic version of the Kama Sutra . He makes specific reference to PE, but offers no remedy for the problem. When the mutual operation is performed, a lively combat ensues between the two actors who frolic and kiss and intertwine. Man in the pride of his strength, works like a pestle, and the woman, with lascivious undulations, comes artfully to his aid. Soon all too soon the ejaculation comes!
Erotic life flourished at all levels of society in ancient Egypt []. This may have had the effect of reducing anxiety and possibly delaying ejaculation, although there is no specific mention of PE.
Recent neurobiological, clinical, epidemiological, and observational research has provided new insights into the neuroanatomy and neurobiology of ejaculation and the dimensions, epidemiology, psychosocial and relational effects, and pathophysiology of premature ejaculation by both clinicians and the pharmaceutical industry []. Our understanding of PE has evolved from the initial premise that PE was a psychosexual disorder to a new understanding. We now believe that ejaculatory latency is a genetically determined biological variable and that some men are born with a genetic propensity to ejaculate rapidly. In parallel with this new understanding, the way we classify, define, evaluate, diagnose, and treat PE has undergone a paradigm change.
The first contemporary multivariate evidence-based definition of lifelong PE was developed in 2008 by a panel of international experts, and characterizes lifelong PE as ejaculation which always or nearly always occurs prior to or within about one minute of vaginal penetration, the inability to delay ejaculation on all or nearly all vaginal penetrations, and the presence of negative personal consequences, such as distress, bother, frustration and/or the avoidance of sexual intimacy. This definition is limited to heterosexual men engaging in vaginal intercourse. There is insufficient published evidence to propose an evidenced-based definition of acquired PE.
The PE treatment paradigm, previously limited to behavioral psychotherapy, has now expanded to include drug treatment [].
This textbook explores the conundrum of premature ejaculation and in doing so attempts to demystify the epidemiology, pathogenesis and etiology, dimensions, diagnosis, and management of this common sexual complaint.
References
Mattelaer JJ (2000) The phallus in art and culture. Historical committee of the European association of urology, Amsterdam
Gupta M (1999) An alternative combined approach to the treatment of premature ejaculation in Asian men. J Sex Marital Ther 14:7177 CrossRef
Bhatia MS, Malik SC (1991) Dhat syndromea useful diagnostic entity in Indian culture. Br J Psychiatry 159:691695 PubMed CrossRef
Burton R, Arbuthnot FF (1963) Translation: kama sutra. Berkley Publishing Group, New York
Sommer B, Harvey H (2000) Sex, law and society in late imperial China. Stanford University Press, San Francisco
Shokeir AA, Hussein MI (1999) The urology of pharaonic Egypt. BJU Int 84(7):755761 PubMed CrossRef
Von Baeyer HC (2000) The lotus effect. The Sciences 40:95106
Manniche L (2001) Sacred luxuries, fragrance, aromatherapy and cosmetics in ancient Egypt. Cornell University Press, New York; Opus Publishing, London
Metz ME et al (1997) Premature ejaculation: a psychophysiological review. J Sex Marital Ther 23(1):323 PubMed CrossRef
Symonds T et al (2003) How does premature ejaculation impact a mans life? J Sex Marital Ther 29(5):361370 PubMed CrossRef
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