The four types of premature ejaculation. Aetiology and treatment under discussion.

The four types of premature ejaculation. Aetiology and treatment under discussion.

Pemature ejaculation is probably the most controversial disease in the practice of Andrology. Premature ejaculation (PE) is the most common male sexual disorder, estimated to affect 30% of men and regardless of their age. “The actual percentage though may vary from study to study because of different evaluation modalities and a lack of a consensus on its definition. The stopwatch-measured intravaginal ejaculation latent time (IELT) seems to be one of the most objective parameters used to define PE, but loss of control during ejaculation with consequent interpersonal difficulties and distress is also an important criterion for diagnosis”.

The International Andrology Institute (IAI) states that in order for a patient to be classified as suffering from premature ejaculation he should exhibit the following symptoms:

  1. Ejaculation always or almost always occurs within one minute after penile penetration.
  2. Loss of control over ejaculation – Inability to delay ejaculation before or after penetration.
  3. Negative feelings, such as lack of confidence, which might lead to avoidance of sexual activity.

Premature Ejaculation is the most common reason why a man is led to see an Andrologist. Although PE’s aetiology has not yet been confirmed by doctors and researchers, the existence of four types of the disease has been stated by the majority of the studies. The ISSM recently adopted a new classification that Waldinger proposed in 2007 – in the updated guidelines, the new classification included two other variant types of PE: “natural variable PE” and “premature-like ejaculatory dysfunction”.

Therefore the four types of PE are the following: lifelong, acquired, normal variant and premature-like ejaculatory dysfunction. The difference between these types is critical since the causes and consequently the treatment change following each case’s epidemiology. As the authors of the study mention, “the presence of four different types of PE suggests different underlying pathogeneses and suggests that the treatment approach to these different types of PE should be individualized on the basis of symptoms and expectations”.

According to the study, conducted by the Division of Andrology and Female Urology, Department of Urology and Surgery, Chang Gung Memorial Hospital-Linkou, in Taiwan, biological and psychological factors can cause mostly PE disease.

Among the biological factors that can cause lifelong and acquired PE are hypersensitivity of the penis’s glans, disturbance of central serotonin neurotransmission, hyperthyroidism, and local irritation due to prostatitis.

As far as the psychological factors are concerned these can include anxiety, low self confidence and self esteem, an early unpleasant sexual incident or sexual abuse, problematic relationships between family members, difficulty or avoidance of making or maintaining long relationships.

Men with natural variable PE experience an early ejaculation occasionally or under specific conditions. Therefore their problem is easily treatable in comparison with the other types of PE. Lastly, men with premature-like ejaculatory dysfunction are imagining their early ejaculation or they are lacking the control of their ejaculation, but in fact their actual IELT lasts according to the normal duration time.

As far as the PE’s treatment is concerned the study concludes thatthe existence of four different types of PE indicates that management approaches should also be individualized. Psychotherapy, sex counseling, and behavioral therapies may be helpful for men with normal variant PE. Men with premature-like ejaculatory dysfunction should receive psychoeducation and sex counseling. Men with lifelong PE should receive pharmacotherapy. The treatment of men with acquired PE should be individualized on the basis of the underlying etiology and a patient’s expectations. Behavioral therapies have short-term efficacy, and the response can be augmented by pharmacotherapy.