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In premature ejaculation the man recurrently achieves orgasm and ejaculation before he wishes to do so. The diagnosis is made when the man regularly ejaculates before or immediately after entering the vagina or following minimal sexual stimulation. The clinician should consider factors that affect duration of the excitement phase, such as age, novelty of the sexual partner, and the frequency and duration of coitus. A man a premature ejaculator cannot control ejaculation for a sufficient length of time during intravaginal containment to satisfy his partner in at least one half of their episodes of coitus. That definition assumes that the female partner is capable of an orgasmic premature ejaculation.
Premature ejaculation is more common today among college-educated men than among men with less education and is thought to be related to their concern for partner satisfaction. It is estimated that 30 percent of the male population have the dysfunction, and about 40 percent of men treated for sexual disorders have premature ejaculation.
Difficulty in ejaculatory control may be associated with anxiety regarding the sex act or with unconscious fears about the vagina. It may also result from negative cultural conditioning. The man who has most of his early sexual contacts with prostitutes who demand that the sex act proceed quickly or in situations in which discovery would be embarrassing, such as in an apartment shared with roommates.
Treatment
Paroxetine appears to be superior to placebo in the pharmacological treatment of premature ejaculation when administered on a chronic or as needed basis. Oral paroxetine (Zoloft) 20 mg.
In cases of premature ejaculation an exercise known as the squeeze technique is used to raise the threshold of penile excitability. In that exercise the man or the woman stimulates the erect penis until the earliest sensations of impending orgasm and ejaculation are felt. Penile stimulation is then stopped abruptly, and the coronal ridge of the penis is forcibly squeezed for several seconds.
A man with a sexual desire disorder or erectile disorder is sometimes told to masturbate to demonstrate that full erection and ejaculation are possible. In cases of lifelong female orgasmic disorder the woman is directed to masturbate, sometimes using a vibrator. Kegel's exercises to strengthen the pubococcygeal muscles may be introduced; that is, the woman is instructed to contract her vagina voluntarily.