Intrusive Partners - Elusive Mates by Betchen Stephen J.;

Author:Betchen, Stephen J.;
Language: eng
Format: epub
Publisher: Taylor & Francis Group

Premature Ejaculation

Premature ejaculation (PE) has been found to be the most commonly reported male sexual disorder (Laumann, Gagnon, Michael, & Michaels, 1994). In a review of the research, Simons and Carey (2001) claimed that estimates of the disorder ranged from 4 to 31% and as high as 77%, depending on the setting (e.g., sexuality clinic) in which it was reported. Masters and Johnson (1970) referred to a man as a premature ejaculator if he could delay ejaculation long enough for his partner to reach orgasm 50% of the time. Several sex therapists, however, have found this definition troublesome because most women do not achieve orgasms without clitoral stimulation (Kaplan, 1974, 1989; Polonsky, 2000; Reinisch, 1990; Zilbergeld, 1992). These therapists seem to agree that a man suffers from PE if he cannot voluntarily exert enough control over his ejaculatory reflex to enjoy a high degree of sexual arousal during intercourse. Kaplan (1974) believed this is the case, regardless of whether the male ejaculates “after two thrusts or five, whether it occurs before the female reaches orgasm or not” (p. 290). Reinisch (1990) added that the couple “shouldn’t be watching a clock or counting strokes. No particular length of time is ‘too quick’ or ‘too long’ unless a couple finds it is a problem for them” (p. 206).

The DSM-IV (APA, 1994), which provides the most often used criteria for PE (Metz, Pryor, Nesvacil, Abuzzahab, & Koznar, 1997), defines the disorder as the “persistent or recurrent onset of orgasm and ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it” (p. 509). Similar to erectile disorder, distinctions are made between lifelong and acquired type, generalized and situational type, and due to psychological or combined (i.e., psychological and medical) factors. Age and the frequency of current sexual activity are also considered in the diagnosis of the disorder.

Causes

Metz et al. (1997) found that some of the physiological causes of PE include sexual infrequency, hypersensitivity of the glans penis, pelvic fractures, urological problems, diabetes, prostatitis, arteriosclerosis, and neurological disease. Again, the psychological causes attributed to PE depend on the theoretical and therapeutic orientation of the clinician. According to Kaplan (1974), some psychoanalysts view PE as symptomatic of unresolved Oedipal conflicts reflecting a sadistic attitude toward women; the man’s objective is to quickly soil the woman and deprive her of pleasure. In her later research, however, Kaplan (1989) found that men with PE are no more or less hostile toward women than other men are.

Cognitive-behaviorists (McCabe, 2001; McCarthy, 1989; Metz & McCarthy, 2003) seek to change internalized negative cognitions and behavior associated with faulty learning or conditioning which may have reinforced shortened ejaculatory latency, negative learning and attitudes about sex, and various emotional problems such as anxiety and depression. Relationship or systemic causes include poor communication, unrealistic expectations about sexual performance, sexual performance anxiety generated by demands from a partner, power or control struggles, and the fear of intimacy (Betchen, 2001b).

Treatment

Those who examine PE from an organic perspective are most

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