February 11, 2015 • 32 mins
One in the three men are reported to suffer from premature ejaculation. But just how premature is premature ejaculation and why does it happen? Cristen and Caroline trace its medical history from inconvenience to pharmaceutical gold mine.
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Episode Transcript
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Speaker 1 (00:03):
Welcome to Stuff Mom Never told You from how Supports
dot com. Hello, and welcome to the podcast. I'm Kristen
and I'm Caroline, and a theme for this week is
ejaculation slash Valentine's Day's right, a most romantic topic, and
(00:24):
we spent a lot of time puzzling over female ejaculation
and guys, we haven't forgotten about ejaculation for you, although
this time we present another puzzle, which is premature ejaculation,
because this is something that affects even more men than
female ejaculation affects women, right, and it is definitely something
(00:49):
that has been pathologized when we you know, Kristen and
I talk a lot about women's health issues or concerns
that have been pathologized doing whether it should be or not,
and this is really no different. I mean, there are
men who experience ejaculation very very soon in the sexual
(01:10):
process and who seek out medical treatment for that. But
then we were going to get into the issue of like, okay, well,
how do you define it? So many people define premature
ejaculation differently, and is it just ejaculation that happens early
or is it simply when your sexual partner is not pleased. Yeah,
there's a lot of complexity to premature ejaculation and as
(01:32):
well as the psychological repercussions to um. So let's get
down to some ejaculation basics, shall we, Because it happens
really fast at first, at least in terms of the
fluid traveling through the urethra. It moves through the urethra
at an astounding twenty eight miles per hour or forty
(01:54):
kilometers per hour for our Canadian listeners. Hello, well, Kristen,
that's faster than a Model T four. My goodness, my goodness.
But then it slows way, way, way way down as
it exits the penis and enters the vagina or the
anus or where wherever it's going, right, it slows down
to get ready for this point zero zero one one
(02:19):
miles per hour or point zero zero one seven kilometers
per hour. And famed sex researcher Alfred Kinsey performed an
experiment that found a long distance ejaculation record of eight feet.
I'm not kidding. He like laid down sheets on the
floor and was like, fellas have at it. Eight feet.
That's pretty impressive considering how much it slows down before
(02:41):
it exits, Like as it exits the urethra, and it's
usually not a whole lot of fluid, about one or
two teaspoons on average, But there is a lot of
stuff in that semen. Yeah, let's look at the nutritional information. Yes,
sperm only makes up about one percent of semen. Then
you have secretions from the prostate, gland and vas deference,
(03:05):
as well as fructose, water, ascorbic acid, citric acid, protein enzymes,
zinc phosphate by carbonate buffers and red number four. No no, no, no,
no artificial no artificial colors, its sweeteners organic. It is organic.
(03:27):
But in terms of what's going on physically when this
is happening, So we get the penis and gorged with blood,
the scrotum contracts and applies pressure on the testicles that
are then drawn into the body as the fluid travels
from the seminal vesicles outward. Yeah, so it's a whole
the whole assembly line almost system to get it out there. Um,
(03:49):
so we've established what ejaculation is, but what is premature ejaculation. Technically,
it's one of three forms of ejaculatory dysfunction. There's pre
mature ejaculation, retarded ejaculation in retrograde ejaculation, which is when
it goes back rather than forward. And it's actually listed
(04:11):
in the Diagnostic and Statistical Manual of Psychiatric Disorders right,
and it's defined as ejaculation occurring without control on or
shortly after penetration and before the person wishes it, causing
marked distress or interpersonal difficulty. But the thing is, we
don't have a standard definition of it because you have
(04:34):
the whole question of balancing the timing of ejaculation against
your partners or your own satisfaction with how long it takes.
For instance, the American Neurological Association defines premature ejaculation as
occurring sooner than desired, either before or shortly after penetration,
(04:54):
causing distress to either one or both parties. But Masters
and Johnson, also fame sex researchers from decades ago, provided
a pretty subjective definition. They said that it was the
man's inability to inhibit ejaculation long enough to satisfy his
partner fifty of the time. Well, it's the satisfaction, uh
(05:15):
sex partner satisfaction, and also that psychological distress that it causes.
You need to have that distress factor in there too.
Clearly to meet that D s M definition. So, and
that's something that we don't we haven't talked about that
much on the podcast. We talk a lot about women,
female sexual function and psychological distress, but this is an
(05:36):
arena where we really get into male sexual function and
psychological distress. But but there are some more concrete guidelines,
although they are quite heteronormative as well. Caroline, that's right.
One of the characteristics of premature ejaculation that really plays
a huge role in defining it is called the intra
(05:57):
vaginal ejaculatory LATENCYTIL time or i e l T. So basically,
according to this idea, you are experiencing premature ejaculation if
your i e l T is always before or within
about one minute of penetration or eight to fifteen thrusts.
But like Kristen said, the fact that the first letter
(06:19):
in a defining characteristic of premature ejaculation is I for
intro vaginal, it's pretty outa specific. But keep that in
mind because we're going to talk later in the second
half of the podcast about how sexual orientation may or
may not play into premature ejaculation and the more subjective guidelines.
(06:41):
But moving into more of the medical specifics of premature ejaculation,
there are two widely recognized types, primary, which is a
lifelong premature ejaculation, and secondary, which is more acquired or situational.
And there are two additional proposed types of premature o
jack relation which are normal variable premature ejaculation which is
(07:04):
inconsistent and situational, and then premature like ejaculation, which contains
subjective perceptions of premature ejaculation although your intro vaginal ejaculatory
latency time is normal, in other words, someone feeling insecure
because he thinks that he's coming too soon even though
(07:26):
his i e LT is normal within the normal range,
which is around five minutes. And speaking of rates and
what is common and what is normal, the prevalence rate
of premature ejaculation is one in three men, and according
to a two thousand seven global survey, about a quarter
of men across all age groups struggled with it, and
(07:49):
a two thousand five survey calculated an even higher prevalence
rate of thirty percent. And we should mention that there
is a thirty percent co occurrence rate of premature ejaculation
and a rectile to function, and we're not going to
get into erectile this function in depth in this podcast
because it kind of deserves its own podcast. But in
case you're wondering, those things can go hand in hand,
(08:10):
but not all the time. It's actually less common than
you might think. But not surprisingly, it can have a
negative impact not only on the person who is dealing
with perhaps a low I e l T that intervaginal
ejaculatory latency time, but also on the relationship with that
(08:31):
person's sex partner. Yeah, this is coming from study published
in the Journal of Sexual Medicine, which we sided quite
a bit in our previous episode on female ejaculation. But
they found that nine percent of women reported a low
sex drive and sexual dissatisfaction when they were with a
man who suffered from premature ejaculation. But forty eight percent
(08:56):
of these women said that the real problem was that
there partners, their sexual partners weren't paying enough attention to
their needs like kissing and caressing, and instead we're more
focused on boosting their performance or duration. And almost a
quarter of those women also reported that the man's ejaculatory
problems lead to relationship breakups. And that's something just in
(09:19):
routine google searches that we were doing looking for sources
um and experiences with premature ejaculation. That came up a
lot on message boards in terms of guys being distressed
about either getting into relationships or having relationships that broke
up because of this issue. So it's a it's a
very real factor in some relationships for sure, right and
(09:42):
this leads many people to seek out treatment. And some
of the typical treatments include behavioral things like the squeeze
or the stop and start technique, which is basically, uh,
stopping when you feel like you're about to reach orgasm,
letting the urge path, and then continuing. Squeeze technique is
basically squeezing the penis until that urge subsides and then continuing.
(10:04):
There's also the application of topical anesthetics, which for me
as a lady with lady parts, just makes me feel
squeamish because it's numbing, like a like a Lydic Caneah yeah,
I don't want Lyda cane anywhere near my lady bits.
But that's also you find that kind of stuff too
on certain kinds of condoms that are the long last condoms.
(10:27):
It contains that kind of stuff to uh desensitize the
penis um so that they'll last longer. True. And in
addition to topical anesthetics, you have oral medications, including antidepressants.
This is actually becoming a more and more common prescription
for premature ejaculation because we we we hear a lot
(10:49):
about antidepressants depressing sexual function as well, and for that reason,
certain antidepressants, particularly an S s R I call peroxytine,
has been found to delay ejaculations. There was a randomized
control trial which found that proxytine delayed ejaculation from one
(11:10):
point five minutes to seven point seven minutes, so pretty significant.
And on top of that too, because of the psychological aspect,
because of the relationship aspect of it as well, counseling
might be involved as well. But there are also some
experimental treatments some people are looking into too, right, Caroline, Yeah,
things like virtual reality treatment and also a desensitizing band
(11:33):
that can be worn during masturbation. Not to mention herbal
treatments that people seek out, things like fi medium leaf extract,
ginko beloba, asian gin singh root who knows, I I
don't but probably not horny goat weed, Caroline, but like
female ejaculation. Premature ejaculation has been a medical mystery for
(11:55):
a long time. And what's fascinating to see though, with
the the history of premature ejaculation, what doctors think about it.
It's actually gone through certain distinct phases in terms of
kind of the the overarching model that doctors and scientists
think that it originates from. And this is coming from
an invaluable paper by Marcel de Waldinger called the History
(12:20):
of Premature Ejaculation, and he goes all the way back
to ancient Greek writings that mention ejaculation ante portas, which
means ejaculation before the gate, before the gate didn't quite
make it into the gate outside the gate um. But
it wasn't until the late nineteenth century where we have
it first described as a disorder. So in eighteen eighties
(12:43):
seven you have the first case of quote rapid ejaculation
in medical literature. Yeah, and then in nineteen o eight
we get the first psychoanalytic paper written about it by
a student of Freud that paid a lot of attention
to premature ejaculations effect on the female partner. So this
is when we first get into like, ah, well, other
(13:04):
people might not be happy with it. Yeah, and this
kind of kicks off the first major period of premature
ejaculation classification that Waldinger identifies, which is from nineteen seventeen
to nineteen fifty, which is the neurosis and psycho somatic
disorder phase. UM. So you have premature ejaculation thought to
(13:27):
be a neurosis linked to unconscious conflicts often treated with psychoanalysis,
and you have the term ejaculation prey cox being introduced
deduced to describe premature ejaculation. So it's not it's not
yet called premature ejaculation because I mean it's it's more
of a site. They think it's more of a psychological thing.
(13:47):
Right in nineteen and the nineteen thirties, we actually get
the first drug developed to treat erectile dysfunction, and it's
called TESTA four ten. And then in ninety three a
German endochronologist by the name of Ben how Shapiro sorry
sorry for my accent, proposed the psycho somatic model, and
this basically says that premature ejaculation is a combination of
(14:10):
an over anxious constitution and an inferior ejaculatory apparatus. As
a point of least resistance, for emotional pressure. This is
also when we get the early recognition of the two
types of premature ejaculation primary versus secondary, and Shapiro was
also the first to note he didn't call it genetic,
(14:32):
but he was the first to note that men who
experienced this issue also had family members who were likely
to experience the problem also. But in we move out
of psycho somatic and into more of the learned behavior model,
and this would last until the early nineties. And this
learned behavior viewpoint was really developed by Masters and Johnson
(14:55):
who focused on the performance anxiety driven cycle of premature
jack reculation. So if it happens, you kind of freak out,
and then you're worried about it, and then the next
time you start having sex, you start worrying that it
will happen again, and so the cycle continues. And so
through that they developed that squeeze technique to almost retrain
(15:19):
the penis. And with the squeeze technique, not only do
you squeeze the penis when you to stop sex when
you think that you're about to prematurely ejaculate, you also
sort of let it d too, miss d and gorge
a little bit and just gott to chill out, and
then you start going again and it will rengorge, and
then you just do that over and over again, which
(15:42):
apparently has has its successes, but also obviously has its
detractions as well because it can inhibit the flow of
sexual activity. Right, But there. Squeeze technique actually was built
off of an earlier stopped start technique which we mentioned earlier,
which was developed in nineteen fifty six by I'm not
(16:04):
kidding urologist James Siemens. Oh man, that's perfect, yeah, he
just he was the first to describe this stop start
masturbation technique not necessarily just with sex, but also with masturbation.
But Masters and Johnson were saying that this performance anxiety
really stemmed from the fact that they believe that the
(16:24):
men who experienced it had relied on rapid ejaculation and
rapid orgasms earlier in life, and that it just became
a habit that had to be unlearned. So basically, if
you're used to either sneaking in sex or masturbation so
that nobody catches you, and you're used to like, oh,
this has to be fast, it has to be fast.
It's just a habit that you've developed that has created
(16:47):
a lot of performance anxiety in your adult life and
it has to be unlearned. But then once we get
to two thousand five, we enter the neurobiology and psycho
pharmacology phase, and then this is when we start learning
about how lifelong premature ejaculation, that primary premature ejaculation has
neurobiological and genetic underpinnings. And this is also when those
(17:11):
S S R I or antidepressant treatments begin to emerge.
And notably, we have the first successful oral drug developed
to treat erectile disorder, which is produced by Fiser, which
is going to lead to a new medical discipline of
sexual medicine, because you know, if your Fiser, you're like, hey,
(17:33):
this seems like a common problem. We're gonna make a bill,
gonna make a lot of money off of it. And
that leads us into the present phase, which really focuses
on the pharmaceutical industry and pursuing the genetics behind this issue.
And so this is when we've gotten a lot of
DNA research that reveal more links with that lifelong or
primary premature ejaculation, and so what scientists are looking more
(17:55):
closely at now are certain um genetic mutations in some
men that might interfere with what's called the central serotone
or genic and dopaminergenic system, your serotonin and dopamine in
other words, that is been associated with the mechanics that
influence your I E l T. So they think it
(18:18):
has to do with your neurotransmitters that are released and
produced as you're having sex as sort of setting off
that physiological premature ejaculation. And they have uncovered some genetic links,
but it's not fully understood yet, probably because of the
different kinds of premature ejaculation that men experienced, as well
(18:42):
as the still the subjectivity of it, this kind of
vague definition that happens um and we're going to get
into more of those nuances of premature ejaculation and things
that might or might not influence it when we come
right back from a quick break and now back to
(19:04):
the show. So in the first half of the podcast,
we talked about what doctors know about premature ejaculation, which
is a lot, but still not enough to know exactly
how to precisely treat it for this commonly sided statistics
(19:27):
of one in three men experiencing it. But we do
know that masturbation is not a likely culprit. Guys, if
you're experiencing premature ejaculation, masturbation can actually be your friend. Yeah,
because masturbating before sex can slow down this whole process.
Dr Debbie herbenock Over at the Kinsie Institute says that
(19:47):
masturbation can actually help men retrain their ejaculatory habits by
employing that stop start method that we mentioned earlier. But
we mentioned the whole heateronormal of definition of for instance,
the I E L T earlier. So what what about
that issue? What about gay men versus straight men? Is
(20:09):
this a global universal man problem or is one man
more likely to experience it over another. Well, the question
is a little difficult to conclusively answer because, as with
a lot of research on sexuality, the framework for premature
ejaculation has largely been among hetero men having sex with
(20:31):
vaginas um. But there was an article published in g
Q about premature ejaculation that interviewed a sex columnist who
said that gay guys rarely enquire about premature ejaculation, which
prompted Dan Savage to wonder whether it's more of a
straight guy thing, because, as he wrote, there is no
(20:52):
premature in quotes ejaculation when it comes to two guys,
because it's just as he sort of framed it. And
Dan Savage, for those of you who don't know, is
a really well known sex columnist and controversial to some
who are cringing that I'm mentioning his name on this podcast,
But he is a gay man and has experienced directly
with gay sex, and from his standpoint, there's just no
(21:14):
premature about it. Because of the nature of gay sex.
It's an issue of efficiency, yes he put it. He
put it that way, Yeah, and and clearly that that's
gonna be a different dynamic when it comes to men
and women having sex because as a lot of us know,
it can often take longer for women to orgasm and
(21:35):
the fact that two in five women rarely come solely
through vaginal penetration, right, And so studies have found that
premature ejaculation is the least reported of the sexual dysfunctions
among gay and bisexual men. Yeah, there is a study
looking at this in April two. It was focused specifically
(21:56):
on sexual dysfunctions in Belgian HIV positive gay men, so
very specific study example, and among that study population there
was an eighteen percent premature ejaculation self report, right, so
lower than that one in three number. But again, maybe
it's just because we haven't looked into it closely enough. Yeah,
there was a two thousand nine study in the International
(22:19):
Society for Sexual Medicine Journal, and of the respondents in
the study reported some form of sexual dysfunction, and the
main ones were performance anxiety, low sexual desire, and pain
during sex. Premature ejaculation just was not one of those
main sexual concerns. Yeah, and they compared this, The study
(22:43):
authors compared it to you another study among straight men
who had a report of past year premature ejaculation. So
still though not as high as one in three um.
But the study authors wrote that quote comparing sexual dysfunctions, symptoms,
and men who have sex with women and men who
have sex with men and drawing conclusions about their differences
(23:06):
may not be appropriate as the two groups have different
cultural norms, interpretation of sexual dysfunction, questions, sexual expectations, and
gender sex partners. So we might not be able to
draw inferences from premature ejaculation from gay men based on
the commonality of it among straight men because it's a
(23:27):
completely different kind of sex. But really interesting to see
how perhaps um intra anal ejaculatory latency time might be
quite different than intra vaginal ejaculatory latency time. But the
question that brings up once we look at this nuance
of sexual orientation, how that may or may not so
(23:48):
much change this number. It leads to this question of
whether it is really as prominent of a dysfunction as
we think of with that one in three number that
is bandied about so often, or whether it's something that
we're slowly being primed to think of more as a dysfunction,
because we are in the pharmaceutical age, right where pharmaceutical
(24:11):
companies are creating a medical solution quote unquote to all
sorts of quote unquote problems. Yeah, and really we have
viagraa to thank for that, because viagra is such a
money maker, right, And so yeah, pharmaceutical companies are looking
at the profits from Viagra and thinking, well, God, if
I can prey on other sexual insecurities, then surely I
(24:32):
can make a pretty penny as well. And so there
was this two thousand nine New York Times article that
talked all about this and mentioned that there's little actual
concrete evidence to suggest that there is an epidemic of
premature ejaculation in the way that drug commercials or men's
health articles will tell you that there is. And the
article also called into question that one in three statistic um.
(24:55):
It said that it's actually based on a report on
sexual dysfunction in the US, which has been disputed by
some sexologists because it was based on a sociology survey
from that was not created by epidemiologists to answer sexual
health questions, so that one in three statistic might not
(25:16):
be so concrete after all, right, because the study from
twelve in the Journal of Sexual Medicine, our favorite journal lately,
found a thirteen percent self reported premature ejaculation prevalence rate,
and this was focused on an Asia Pacific region sample population.
So it also those seems like whatever, if you change
(25:39):
the population group that you're looking at, the numbers start
to change to you. Which is really interesting, Yeah, because
so much of this has to do with the very
subjective idea of sexual satisfaction and what does sexual satisfaction
mean for different populations, both geographically but also in terms
of your sexual orientation and who you prefer to have
sex with well, and the set kind of sex to
(26:00):
you that you are watching. This was something that I
didn't find any studied data on, but I had to
wonder whether the accessibility of porn has maybe artificially inflated
premature ejaculation self reporting. Maybe that is where that proposed
(26:20):
category of the premature like ejaculation, where guys are perfectly
in the normal I e L T range, but they
think that they're coming too soon because they're watching porn,
where perhaps guys are lasting a really long time, right,
And a psychologist who's quoted in that New York Times
article points out, like, hey, everybody, calm down. There's fast
(26:41):
and slow versions of people in all categories of life.
They say they're slow and fast walkers, slow and fast eaters,
slow and fast breathers. And so when you tell someone
they're a fast ejaculator, it makes it sound like there
is a right time to ejaculate, and if you ejaculate before,
it's a medical problem. Yeah. So it's a lot of
(27:02):
the research left me at least with a number of
question marks, Like, clearly this is an issue for a
lot of men and a lot of the sex partners
of these men. But I feel I do feel like
that one in three number is being thrown in our
faces a lot for a very specific marketing purpose. Yeah,
(27:25):
I mean you have both men and women being told
that they are dysfunctional when it comes to sexuality, because
you're telling a lot of women that you're taking too
long or why haven't you had an orgasm? And you're
telling men. Men are being told, well, you're you're orgasm
ing too fast and you're not giving your partner a
chance to achieve orgasm herself. And so I mean everybody's
(27:46):
insecurities are sort of being played upon. Yeah, and this
is still in in the backdrop of culture and society
where so much of sex, even though it might be out,
you know, we might consume a lot of poor might
see sex in TV and movies, but in our day
to day lives, talking about sex is still largely taboo.
Sexual communication is still you know, a big challenge for couples,
(28:11):
whether they're one night standing couples or long term couples.
So yeah, it's it's definitely a complex issue that I
think we'll need more than S s R I antidepressants
to solve. But we're also talking about this as to
humans with vaginas who don't experience this kind of physiological
(28:33):
mechanism at all, So fellas, we really want to hear
from you on this issue, or anyone who has been
in a relationship where premature ejaculation has been an issue.
We want to hear from you on this topic. Mom
Stuff at how stuff works dot Com is our email address.
You can also tweet us at mom Stuff podcast or
messages on Facebook, and we've got a couple of messages
to share with you right now. So I gotta let
(29:00):
here from Elaine about our episode on a brief History
of panties, and she wanted She pointed out that she
has no problem with the word panties, so thank you
for noting that, Elaine. But she had some insight into
the woolen underwear that we both cringed at the thought of.
She writes about the wool it actually breathes much better
(29:20):
than cotton and is highly absorbed, so absorbent that for
moms who use cloth diapers, there are wool covers called
soakers that absorb any leaks. Alpaca is super soft. I
believe it's more expensive than Sheep's wool, and I think
it's up there with marino wool from Sheep in terms
of softness. So if you've had an itchy will sweater,
it wasn't marino or alpaca. And maybe you have an
(29:42):
experienced wool that can be non itchy, but it's out there.
So apparently woolen Andy's could be quite comfortable and absorbent.
She goes on to say, my girl Scout Troop had
some training with our outdoor expert before our backpacking camping trip,
and he told us cotton is rotten and should be
forgotten in favor of wool. Wool wick sweat away from
your body. Cotton routine sweat as you hike, for example,
(30:05):
making you cold or just wet. Anyway, just sharing some
facts about wool that explain why actually it may have
made a lot of sense as an undergarment and is
still used today for babies who wear cloth pipers. So thanks.
So I have an email here from Molly. She says,
I was wondering if you've done an episode that covers
(30:26):
mother daughter relationships and touches on some of the anecdotal stuff.
Mom did tell me stories of your own as well
as listeners. I heard and loved your podcasts on the
history of the advice column, but I'm really curious about
the history of advice given from mother to daughter. The
demographic of your audience spans a large range of ages.
I was thinking that generational differences are bound to pop
up in terms of advice people received from their mothers,
(30:48):
and think that I could be a really interesting and
funny thing to explore. Your history of panties episode made
me think of this. You mentioned the cotton underwear talk,
and it reminded me of a piece of advice my
mother instilled in me. It's pretty silly, the kinds of
things you just take his fact of life without questioning
science or reasoning when it comes from your mom. This
kind of thing happened to me a few weeks ago.
(31:10):
I was hooking up with a new guy and I
had put my PJS on. My mom always stressed not
to wear underwear or abroad to bed because quote, it
gives everything time to breathe. So, without thinking, I climb
into bed commando and he's a little shocked, as if
it's like some gift to him. He mentions it in
this annoying, all knowing tone, and I'm caught off guard. Immediately,
(31:30):
my brain just goes, hey, this is a fact of life,
and you don't wear those to bed, It's unhealthy. Instead
of trying to explain this fact of life out loud,
I just rolled my eyes and told him it seriously.
Wasn't meant to impress anyone. So she says thanks to
reading Love the show. It was one of the best
discoveries I made this summer. I listened while I worked
as a housekeeper, and that's not a loaded gender related topic.
(31:51):
I don't know what is. Shared it with my mom,
who has really taken to it as well. Looking forward
to hearing more great episodes in the future. So thank
you for listening, Molly, mother daughter, Stuff Mom Never Told
You fans, I love it, inter generational love it Mom.
Stuff at house stuff works dot com is where you
can send us your emails and re links to all
(32:12):
of our social media as well as all of our blogs, videos,
and podcasts, including this one with our sources. If you
want to learn more about the science of premature ejaculation,
head on over to stuff Mom Never Told You dot
com for more on this and thousands of other topics.
Doesn't house to works dot com
Welcome to Stuff Mom Never told You from how Supports
dot com. Hello, and welcome to the podcast. I'm Kristen
and I'm Caroline, and a theme for this week is
ejaculation slash Valentine's Day's right, a most romantic topic, and
(00:24):
we spent a lot of time puzzling over female ejaculation
and guys, we haven't forgotten about ejaculation for you, although
this time we present another puzzle, which is premature ejaculation,
because this is something that affects even more men than
female ejaculation affects women, right, and it is definitely something
(00:49):
that has been pathologized when we you know, Kristen and
I talk a lot about women's health issues or concerns
that have been pathologized doing whether it should be or not,
and this is really no different. I mean, there are
men who experience ejaculation very very soon in the sexual
(01:10):
process and who seek out medical treatment for that. But
then we were going to get into the issue of like, okay, well,
how do you define it? So many people define premature
ejaculation differently, and is it just ejaculation that happens early
or is it simply when your sexual partner is not pleased. Yeah,
there's a lot of complexity to premature ejaculation and as
(01:32):
well as the psychological repercussions to um. So let's get
down to some ejaculation basics, shall we, Because it happens
really fast at first, at least in terms of the
fluid traveling through the urethra. It moves through the urethra
at an astounding twenty eight miles per hour or forty
(01:54):
kilometers per hour for our Canadian listeners. Hello, well, Kristen,
that's faster than a Model T four. My goodness, my goodness.
But then it slows way, way, way way down as
it exits the penis and enters the vagina or the
anus or where wherever it's going, right, it slows down
to get ready for this point zero zero one one
(02:19):
miles per hour or point zero zero one seven kilometers
per hour. And famed sex researcher Alfred Kinsey performed an
experiment that found a long distance ejaculation record of eight feet.
I'm not kidding. He like laid down sheets on the
floor and was like, fellas have at it. Eight feet.
That's pretty impressive considering how much it slows down before
(02:41):
it exits, Like as it exits the urethra, and it's
usually not a whole lot of fluid, about one or
two teaspoons on average, But there is a lot of
stuff in that semen. Yeah, let's look at the nutritional information. Yes,
sperm only makes up about one percent of semen. Then
you have secretions from the prostate, gland and vas deference,
(03:05):
as well as fructose, water, ascorbic acid, citric acid, protein enzymes,
zinc phosphate by carbonate buffers and red number four. No no, no, no,
no artificial no artificial colors, its sweeteners organic. It is organic.
(03:27):
But in terms of what's going on physically when this
is happening, So we get the penis and gorged with blood,
the scrotum contracts and applies pressure on the testicles that
are then drawn into the body as the fluid travels
from the seminal vesicles outward. Yeah, so it's a whole
the whole assembly line almost system to get it out there. Um,
(03:49):
so we've established what ejaculation is, but what is premature ejaculation. Technically,
it's one of three forms of ejaculatory dysfunction. There's pre
mature ejaculation, retarded ejaculation in retrograde ejaculation, which is when
it goes back rather than forward. And it's actually listed
(04:11):
in the Diagnostic and Statistical Manual of Psychiatric Disorders right,
and it's defined as ejaculation occurring without control on or
shortly after penetration and before the person wishes it, causing
marked distress or interpersonal difficulty. But the thing is, we
don't have a standard definition of it because you have
(04:34):
the whole question of balancing the timing of ejaculation against
your partners or your own satisfaction with how long it takes.
For instance, the American Neurological Association defines premature ejaculation as
occurring sooner than desired, either before or shortly after penetration,
(04:54):
causing distress to either one or both parties. But Masters
and Johnson, also fame sex researchers from decades ago, provided
a pretty subjective definition. They said that it was the
man's inability to inhibit ejaculation long enough to satisfy his
partner fifty of the time. Well, it's the satisfaction, uh
(05:15):
sex partner satisfaction, and also that psychological distress that it causes.
You need to have that distress factor in there too.
Clearly to meet that D s M definition. So, and
that's something that we don't we haven't talked about that
much on the podcast. We talk a lot about women,
female sexual function and psychological distress, but this is an
(05:36):
arena where we really get into male sexual function and
psychological distress. But but there are some more concrete guidelines,
although they are quite heteronormative as well. Caroline, that's right.
One of the characteristics of premature ejaculation that really plays
a huge role in defining it is called the intra
(05:57):
vaginal ejaculatory LATENCYTIL time or i e l T. So basically,
according to this idea, you are experiencing premature ejaculation if
your i e l T is always before or within
about one minute of penetration or eight to fifteen thrusts.
But like Kristen said, the fact that the first letter
(06:19):
in a defining characteristic of premature ejaculation is I for
intro vaginal, it's pretty outa specific. But keep that in
mind because we're going to talk later in the second
half of the podcast about how sexual orientation may or
may not play into premature ejaculation and the more subjective guidelines.
(06:41):
But moving into more of the medical specifics of premature ejaculation,
there are two widely recognized types, primary, which is a
lifelong premature ejaculation, and secondary, which is more acquired or situational.
And there are two additional proposed types of premature o
jack relation which are normal variable premature ejaculation which is
(07:04):
inconsistent and situational, and then premature like ejaculation, which contains
subjective perceptions of premature ejaculation although your intro vaginal ejaculatory
latency time is normal, in other words, someone feeling insecure
because he thinks that he's coming too soon even though
(07:26):
his i e LT is normal within the normal range,
which is around five minutes. And speaking of rates and
what is common and what is normal, the prevalence rate
of premature ejaculation is one in three men, and according
to a two thousand seven global survey, about a quarter
of men across all age groups struggled with it, and
(07:49):
a two thousand five survey calculated an even higher prevalence
rate of thirty percent. And we should mention that there
is a thirty percent co occurrence rate of premature ejaculation
and a rectile to function, and we're not going to
get into erectile this function in depth in this podcast
because it kind of deserves its own podcast. But in
case you're wondering, those things can go hand in hand,
(08:10):
but not all the time. It's actually less common than
you might think. But not surprisingly, it can have a
negative impact not only on the person who is dealing
with perhaps a low I e l T that intervaginal
ejaculatory latency time, but also on the relationship with that
(08:31):
person's sex partner. Yeah, this is coming from study published
in the Journal of Sexual Medicine, which we sided quite
a bit in our previous episode on female ejaculation. But
they found that nine percent of women reported a low
sex drive and sexual dissatisfaction when they were with a
man who suffered from premature ejaculation. But forty eight percent
(08:56):
of these women said that the real problem was that
there partners, their sexual partners weren't paying enough attention to
their needs like kissing and caressing, and instead we're more
focused on boosting their performance or duration. And almost a
quarter of those women also reported that the man's ejaculatory
problems lead to relationship breakups. And that's something just in
(09:19):
routine google searches that we were doing looking for sources
um and experiences with premature ejaculation. That came up a
lot on message boards in terms of guys being distressed
about either getting into relationships or having relationships that broke
up because of this issue. So it's a it's a
very real factor in some relationships for sure, right and
(09:42):
this leads many people to seek out treatment. And some
of the typical treatments include behavioral things like the squeeze
or the stop and start technique, which is basically, uh,
stopping when you feel like you're about to reach orgasm,
letting the urge path, and then continuing. Squeeze technique is
basically squeezing the penis until that urge subsides and then continuing.
(10:04):
There's also the application of topical anesthetics, which for me
as a lady with lady parts, just makes me feel
squeamish because it's numbing, like a like a Lydic Caneah yeah,
I don't want Lyda cane anywhere near my lady bits.
But that's also you find that kind of stuff too
on certain kinds of condoms that are the long last condoms.
(10:27):
It contains that kind of stuff to uh desensitize the
penis um so that they'll last longer. True. And in
addition to topical anesthetics, you have oral medications, including antidepressants.
This is actually becoming a more and more common prescription
for premature ejaculation because we we we hear a lot
(10:49):
about antidepressants depressing sexual function as well, and for that reason,
certain antidepressants, particularly an S s R I call peroxytine,
has been found to delay ejaculations. There was a randomized
control trial which found that proxytine delayed ejaculation from one
(11:10):
point five minutes to seven point seven minutes, so pretty significant.
And on top of that too, because of the psychological aspect,
because of the relationship aspect of it as well, counseling
might be involved as well. But there are also some
experimental treatments some people are looking into too, right, Caroline, Yeah,
things like virtual reality treatment and also a desensitizing band
(11:33):
that can be worn during masturbation. Not to mention herbal
treatments that people seek out, things like fi medium leaf extract,
ginko beloba, asian gin singh root who knows, I I
don't but probably not horny goat weed, Caroline, but like
female ejaculation. Premature ejaculation has been a medical mystery for
(11:55):
a long time. And what's fascinating to see though, with
the the history of premature ejaculation, what doctors think about it.
It's actually gone through certain distinct phases in terms of
kind of the the overarching model that doctors and scientists
think that it originates from. And this is coming from
an invaluable paper by Marcel de Waldinger called the History
(12:20):
of Premature Ejaculation, and he goes all the way back
to ancient Greek writings that mention ejaculation ante portas, which
means ejaculation before the gate, before the gate didn't quite
make it into the gate outside the gate um. But
it wasn't until the late nineteenth century where we have
it first described as a disorder. So in eighteen eighties
(12:43):
seven you have the first case of quote rapid ejaculation
in medical literature. Yeah, and then in nineteen o eight
we get the first psychoanalytic paper written about it by
a student of Freud that paid a lot of attention
to premature ejaculations effect on the female partner. So this
is when we first get into like, ah, well, other
(13:04):
people might not be happy with it. Yeah, and this
kind of kicks off the first major period of premature
ejaculation classification that Waldinger identifies, which is from nineteen seventeen
to nineteen fifty, which is the neurosis and psycho somatic
disorder phase. UM. So you have premature ejaculation thought to
(13:27):
be a neurosis linked to unconscious conflicts often treated with psychoanalysis,
and you have the term ejaculation prey cox being introduced
deduced to describe premature ejaculation. So it's not it's not
yet called premature ejaculation because I mean it's it's more
of a site. They think it's more of a psychological thing.
(13:47):
Right in nineteen and the nineteen thirties, we actually get
the first drug developed to treat erectile dysfunction, and it's
called TESTA four ten. And then in ninety three a
German endochronologist by the name of Ben how Shapiro sorry
sorry for my accent, proposed the psycho somatic model, and
this basically says that premature ejaculation is a combination of
(14:10):
an over anxious constitution and an inferior ejaculatory apparatus. As
a point of least resistance, for emotional pressure. This is
also when we get the early recognition of the two
types of premature ejaculation primary versus secondary, and Shapiro was
also the first to note he didn't call it genetic,
(14:32):
but he was the first to note that men who
experienced this issue also had family members who were likely
to experience the problem also. But in we move out
of psycho somatic and into more of the learned behavior model,
and this would last until the early nineties. And this
learned behavior viewpoint was really developed by Masters and Johnson
(14:55):
who focused on the performance anxiety driven cycle of premature
jack reculation. So if it happens, you kind of freak out,
and then you're worried about it, and then the next
time you start having sex, you start worrying that it
will happen again, and so the cycle continues. And so
through that they developed that squeeze technique to almost retrain
(15:19):
the penis. And with the squeeze technique, not only do
you squeeze the penis when you to stop sex when
you think that you're about to prematurely ejaculate, you also
sort of let it d too, miss d and gorge
a little bit and just gott to chill out, and
then you start going again and it will rengorge, and
then you just do that over and over again, which
(15:42):
apparently has has its successes, but also obviously has its
detractions as well because it can inhibit the flow of
sexual activity. Right, But there. Squeeze technique actually was built
off of an earlier stopped start technique which we mentioned earlier,
which was developed in nineteen fifty six by I'm not
(16:04):
kidding urologist James Siemens. Oh man, that's perfect, yeah, he
just he was the first to describe this stop start
masturbation technique not necessarily just with sex, but also with masturbation.
But Masters and Johnson were saying that this performance anxiety
really stemmed from the fact that they believe that the
(16:24):
men who experienced it had relied on rapid ejaculation and
rapid orgasms earlier in life, and that it just became
a habit that had to be unlearned. So basically, if
you're used to either sneaking in sex or masturbation so
that nobody catches you, and you're used to like, oh,
this has to be fast, it has to be fast.
It's just a habit that you've developed that has created
(16:47):
a lot of performance anxiety in your adult life and
it has to be unlearned. But then once we get
to two thousand five, we enter the neurobiology and psycho
pharmacology phase, and then this is when we start learning
about how lifelong premature ejaculation, that primary premature ejaculation has
neurobiological and genetic underpinnings. And this is also when those
(17:11):
S S R I or antidepressant treatments begin to emerge.
And notably, we have the first successful oral drug developed
to treat erectile disorder, which is produced by Fiser, which
is going to lead to a new medical discipline of
sexual medicine, because you know, if your Fiser, you're like, hey,
(17:33):
this seems like a common problem. We're gonna make a bill,
gonna make a lot of money off of it. And
that leads us into the present phase, which really focuses
on the pharmaceutical industry and pursuing the genetics behind this issue.
And so this is when we've gotten a lot of
DNA research that reveal more links with that lifelong or
primary premature ejaculation, and so what scientists are looking more
(17:55):
closely at now are certain um genetic mutations in some
men that might interfere with what's called the central serotone
or genic and dopaminergenic system, your serotonin and dopamine in
other words, that is been associated with the mechanics that
influence your I E l T. So they think it
(18:18):
has to do with your neurotransmitters that are released and
produced as you're having sex as sort of setting off
that physiological premature ejaculation. And they have uncovered some genetic links,
but it's not fully understood yet, probably because of the
different kinds of premature ejaculation that men experienced, as well
(18:42):
as the still the subjectivity of it, this kind of
vague definition that happens um and we're going to get
into more of those nuances of premature ejaculation and things
that might or might not influence it when we come
right back from a quick break and now back to
(19:04):
the show. So in the first half of the podcast,
we talked about what doctors know about premature ejaculation, which
is a lot, but still not enough to know exactly
how to precisely treat it for this commonly sided statistics
(19:27):
of one in three men experiencing it. But we do
know that masturbation is not a likely culprit. Guys, if
you're experiencing premature ejaculation, masturbation can actually be your friend. Yeah,
because masturbating before sex can slow down this whole process.
Dr Debbie herbenock Over at the Kinsie Institute says that
(19:47):
masturbation can actually help men retrain their ejaculatory habits by
employing that stop start method that we mentioned earlier. But
we mentioned the whole heateronormal of definition of for instance,
the I E L T earlier. So what what about
that issue? What about gay men versus straight men? Is
(20:09):
this a global universal man problem or is one man
more likely to experience it over another. Well, the question
is a little difficult to conclusively answer because, as with
a lot of research on sexuality, the framework for premature
ejaculation has largely been among hetero men having sex with
(20:31):
vaginas um. But there was an article published in g
Q about premature ejaculation that interviewed a sex columnist who
said that gay guys rarely enquire about premature ejaculation, which
prompted Dan Savage to wonder whether it's more of a
straight guy thing, because, as he wrote, there is no
(20:52):
premature in quotes ejaculation when it comes to two guys,
because it's just as he sort of framed it. And
Dan Savage, for those of you who don't know, is
a really well known sex columnist and controversial to some
who are cringing that I'm mentioning his name on this podcast,
But he is a gay man and has experienced directly
with gay sex, and from his standpoint, there's just no
(21:14):
premature about it. Because of the nature of gay sex.
It's an issue of efficiency, yes he put it. He
put it that way, Yeah, and and clearly that that's
gonna be a different dynamic when it comes to men
and women having sex because as a lot of us know,
it can often take longer for women to orgasm and
(21:35):
the fact that two in five women rarely come solely
through vaginal penetration, right, And so studies have found that
premature ejaculation is the least reported of the sexual dysfunctions
among gay and bisexual men. Yeah, there is a study
looking at this in April two. It was focused specifically
(21:56):
on sexual dysfunctions in Belgian HIV positive gay men, so
very specific study example, and among that study population there
was an eighteen percent premature ejaculation self report, right, so
lower than that one in three number. But again, maybe
it's just because we haven't looked into it closely enough. Yeah,
there was a two thousand nine study in the International
(22:19):
Society for Sexual Medicine Journal, and of the respondents in
the study reported some form of sexual dysfunction, and the
main ones were performance anxiety, low sexual desire, and pain
during sex. Premature ejaculation just was not one of those
main sexual concerns. Yeah, and they compared this, The study
(22:43):
authors compared it to you another study among straight men
who had a report of past year premature ejaculation. So
still though not as high as one in three um.
But the study authors wrote that quote comparing sexual dysfunctions, symptoms,
and men who have sex with women and men who
have sex with men and drawing conclusions about their differences
(23:06):
may not be appropriate as the two groups have different
cultural norms, interpretation of sexual dysfunction, questions, sexual expectations, and
gender sex partners. So we might not be able to
draw inferences from premature ejaculation from gay men based on
the commonality of it among straight men because it's a
(23:27):
completely different kind of sex. But really interesting to see
how perhaps um intra anal ejaculatory latency time might be
quite different than intra vaginal ejaculatory latency time. But the
question that brings up once we look at this nuance
of sexual orientation, how that may or may not so
(23:48):
much change this number. It leads to this question of
whether it is really as prominent of a dysfunction as
we think of with that one in three number that
is bandied about so often, or whether it's something that
we're slowly being primed to think of more as a dysfunction,
because we are in the pharmaceutical age, right where pharmaceutical
(24:11):
companies are creating a medical solution quote unquote to all
sorts of quote unquote problems. Yeah, and really we have
viagraa to thank for that, because viagra is such a
money maker, right, And so yeah, pharmaceutical companies are looking
at the profits from Viagra and thinking, well, God, if
I can prey on other sexual insecurities, then surely I
(24:32):
can make a pretty penny as well. And so there
was this two thousand nine New York Times article that
talked all about this and mentioned that there's little actual
concrete evidence to suggest that there is an epidemic of
premature ejaculation in the way that drug commercials or men's
health articles will tell you that there is. And the
article also called into question that one in three statistic um.
(24:55):
It said that it's actually based on a report on
sexual dysfunction in the US, which has been disputed by
some sexologists because it was based on a sociology survey
from that was not created by epidemiologists to answer sexual
health questions, so that one in three statistic might not
(25:16):
be so concrete after all, right, because the study from
twelve in the Journal of Sexual Medicine, our favorite journal lately,
found a thirteen percent self reported premature ejaculation prevalence rate,
and this was focused on an Asia Pacific region sample population.
So it also those seems like whatever, if you change
(25:39):
the population group that you're looking at, the numbers start
to change to you. Which is really interesting, Yeah, because
so much of this has to do with the very
subjective idea of sexual satisfaction and what does sexual satisfaction
mean for different populations, both geographically but also in terms
of your sexual orientation and who you prefer to have
sex with well, and the set kind of sex to
(26:00):
you that you are watching. This was something that I
didn't find any studied data on, but I had to
wonder whether the accessibility of porn has maybe artificially inflated
premature ejaculation self reporting. Maybe that is where that proposed
(26:20):
category of the premature like ejaculation, where guys are perfectly
in the normal I e L T range, but they
think that they're coming too soon because they're watching porn,
where perhaps guys are lasting a really long time, right,
And a psychologist who's quoted in that New York Times
article points out, like, hey, everybody, calm down. There's fast
(26:41):
and slow versions of people in all categories of life.
They say they're slow and fast walkers, slow and fast eaters,
slow and fast breathers. And so when you tell someone
they're a fast ejaculator, it makes it sound like there
is a right time to ejaculate, and if you ejaculate before,
it's a medical problem. Yeah. So it's a lot of
(27:02):
the research left me at least with a number of
question marks, Like, clearly this is an issue for a
lot of men and a lot of the sex partners
of these men. But I feel I do feel like
that one in three number is being thrown in our
faces a lot for a very specific marketing purpose. Yeah,
(27:25):
I mean you have both men and women being told
that they are dysfunctional when it comes to sexuality, because
you're telling a lot of women that you're taking too
long or why haven't you had an orgasm? And you're
telling men. Men are being told, well, you're you're orgasm
ing too fast and you're not giving your partner a
chance to achieve orgasm herself. And so I mean everybody's
(27:46):
insecurities are sort of being played upon. Yeah, and this
is still in in the backdrop of culture and society
where so much of sex, even though it might be out,
you know, we might consume a lot of poor might
see sex in TV and movies, but in our day
to day lives, talking about sex is still largely taboo.
Sexual communication is still you know, a big challenge for couples,
(28:11):
whether they're one night standing couples or long term couples.
So yeah, it's it's definitely a complex issue that I
think we'll need more than S s R I antidepressants
to solve. But we're also talking about this as to
humans with vaginas who don't experience this kind of physiological
(28:33):
mechanism at all, So fellas, we really want to hear
from you on this issue, or anyone who has been
in a relationship where premature ejaculation has been an issue.
We want to hear from you on this topic. Mom
Stuff at how stuff works dot Com is our email address.
You can also tweet us at mom Stuff podcast or
messages on Facebook, and we've got a couple of messages
to share with you right now. So I gotta let
(29:00):
here from Elaine about our episode on a brief History
of panties, and she wanted She pointed out that she
has no problem with the word panties, so thank you
for noting that, Elaine. But she had some insight into
the woolen underwear that we both cringed at the thought of.
She writes about the wool it actually breathes much better
(29:20):
than cotton and is highly absorbed, so absorbent that for
moms who use cloth diapers, there are wool covers called
soakers that absorb any leaks. Alpaca is super soft. I
believe it's more expensive than Sheep's wool, and I think
it's up there with marino wool from Sheep in terms
of softness. So if you've had an itchy will sweater,
it wasn't marino or alpaca. And maybe you have an
(29:42):
experienced wool that can be non itchy, but it's out there.
So apparently woolen Andy's could be quite comfortable and absorbent.
She goes on to say, my girl Scout Troop had
some training with our outdoor expert before our backpacking camping trip,
and he told us cotton is rotten and should be
forgotten in favor of wool. Wool wick sweat away from
your body. Cotton routine sweat as you hike, for example,
(30:05):
making you cold or just wet. Anyway, just sharing some
facts about wool that explain why actually it may have
made a lot of sense as an undergarment and is
still used today for babies who wear cloth pipers. So thanks.
So I have an email here from Molly. She says,
I was wondering if you've done an episode that covers
(30:26):
mother daughter relationships and touches on some of the anecdotal stuff.
Mom did tell me stories of your own as well
as listeners. I heard and loved your podcasts on the
history of the advice column, but I'm really curious about
the history of advice given from mother to daughter. The
demographic of your audience spans a large range of ages.
I was thinking that generational differences are bound to pop
up in terms of advice people received from their mothers,
(30:48):
and think that I could be a really interesting and
funny thing to explore. Your history of panties episode made
me think of this. You mentioned the cotton underwear talk,
and it reminded me of a piece of advice my
mother instilled in me. It's pretty silly, the kinds of
things you just take his fact of life without questioning
science or reasoning when it comes from your mom. This
kind of thing happened to me a few weeks ago.
(31:10):
I was hooking up with a new guy and I
had put my PJS on. My mom always stressed not
to wear underwear or abroad to bed because quote, it
gives everything time to breathe. So, without thinking, I climb
into bed commando and he's a little shocked, as if
it's like some gift to him. He mentions it in
this annoying, all knowing tone, and I'm caught off guard. Immediately,
(31:30):
my brain just goes, hey, this is a fact of life,
and you don't wear those to bed, It's unhealthy. Instead
of trying to explain this fact of life out loud,
I just rolled my eyes and told him it seriously.
Wasn't meant to impress anyone. So she says thanks to
reading Love the show. It was one of the best
discoveries I made this summer. I listened while I worked
as a housekeeper, and that's not a loaded gender related topic.
(31:51):
I don't know what is. Shared it with my mom,
who has really taken to it as well. Looking forward
to hearing more great episodes in the future. So thank
you for listening, Molly, mother daughter, Stuff Mom Never Told
You fans, I love it, inter generational love it Mom.
Stuff at house stuff works dot com is where you
can send us your emails and re links to all
(32:12):
of our social media as well as all of our blogs, videos,
and podcasts, including this one with our sources. If you
want to learn more about the science of premature ejaculation,
head on over to stuff Mom Never Told You dot
com for more on this and thousands of other topics.
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