Premature ejaculation: symptom or disease?
April 29th, 2014 by admin | Posted in Premature ejaculation
Tags: premature ejaculation
As with all sexual disorders, PE is a symptom of an intrapsychic, relational, genetic, or medical pathology, rather than a disease or dysfunction in itself. From a clinical point of view, this suggests that in any case of PE, the physical and/or psychological disease/dysfunction behind the symptom must be carefully sought and addressed. This approach to therapy is usually described as etiologic, particularly when it succeeds in curing the disease. For example, bibliotherapy (with books) is an appropriate etiologic therapy for PE that is caused by ignorance of the condition on the part of the patient, while propylthiouracil is an etiologic therapy for hyperthyroidism-induced PE. On the other hand, a drug (such as an antidepressant) that delays the ejaculatory reflex may be considered a symptomatic type of therapy, as is the majority of psychological and medical therapies for PE that are currently available. To find PE and Erectile Dysfunction Drugs in Canada click here.
Conventional algorithms for the investigation and treatment of PE are based on the assumption that the condition has exclusively organic or psychogenic etiology, with the latter being considered the main cause. The distinction between psychosocial (or psychodynamic) and organic (or medical) causes of PE then produces a default corollary that psychological PE should be treated by the psychosexologist, while organic PE must be cured by the andrologist. These extreme, reductive views are dangerous for the growth of sexology and for the ultimate goal of the patient’s well-being. In modern medicine, the mind–body separation has become obsolete. While it is clear that all psychological processes are regulated by neuronal activity (somatopsychic evidence), it is also plain that all psychogenic dysfunctions modulate organic processes (psychosomatic evidence). Psychological processes should be considered as inextricably bound with organic ejaculation function and dysfunction processes. This more holistic approach allows PE to be considered as a psychoneuroendocrine and urological disorder that affects not only the patient, but also his partner.
It should be noted, however, that the widely used adjective “psychogenic” is overtly inappropriate due to the fact that elements of psychological stress can result from the loss of ejaculatory control, irrespective of the primary cause. Thus, all cases of PE could become psychogenic, even if the PE originates as a symptom of an organic etiology. As couples with a sexual problem generally wait two years or more before asking for professional help, marital discomfort often develops secondary to PE. On these grounds, the treatment of PE cannot be exclusively pharmacological. In contrast, PE may be a symptom of an existing marital conflict in some couples, and, in these cases, couple therapy may not be sufficient to cure the relational PE.
History of Premature Ejaculation by ViagraSydney.com
During the evolution of human sexuality, the ability to control the timing of ejaculation has become one of the most important features of a couple’s sexual health. In animals, sexual intercourse is usually a brief episode. In fact, due to an adaptive mechanism (coitus citus), male genitalia are designed to ejaculate quickly. Even during coital activity, the animal must be ready to attack or flee, thus making it essential to deposit semen with the fastest and safest technique. For example, the sequence of approach, penetration, and ejaculation in chimpanzees lasts just six seconds. Since one of the principal aims of human sexuality is pleasure, however, men have learned to control ejaculation in order to enhance their own and their partners’ enjoyment. It can be postulated on the basis of these considerations that ejaculatory control is not natural, but cultural. For this reason, lack of ejaculatory control has a profound psychorelational basis, and its treatment is amenable to male and/or couple psychotherapy.
PE was rarely described in the literature of classic sexology. As noted by Waldinger, the first case report on PE was not published until 1887, and the psychoanalyst K. Abraham first introduced the term ejaculatio praecox in 1917. Even in the popular and scientific sexology texts in circulation before and during the first half of the twentieth century [with the notable exception of Huhner’s treatise], PE was not included in the list of sexual disorders. As the purpose of sex was largely considered to be solely a means of reproduction until relatively recently, in consequence, PE was not thought of as pathological.
Similarly, in his historic survey on human sexuality, Kinsey rejected PE as a sexual dysfunction when he found that 75% of men ejaculated within two minutes of penetration. In contrast, in the same period, Shapiro argued that PE may be considered the result of the combination of a hyperanxious constitution with anatomical defects. It was only after reliable contraceptives became available during the sexual and feminist revolution of the mid-1960s—particularly with the “discovery” of the female orgasm—did PE become important in the cohort of symptoms connected with male sexual performance.