“Happening, arriving, existing or performed before the proper, usual or intended time”
“The act or process of ejaculating, especially the discharge of semen by the male reproductive organs”
“The sad condition of a pathetic half-man who can never hope to satisfy a woman”
— Your gibbering, fragile psyche
At least, that’s what it can feel like when it happens. But is there an actual medical definition of premature ejaculation? After all, prematurity seems like it’s pretty dependent on perception. Is it premature for you or your partner? What if there is no partner? Just how “premature” does something have to be for it to be considered premature?
As it turns out, there are actual medical answers to just about all of these questions — but only if you’re a heterosexual male having vaginal sex (more on that later). “The consensus definition of premature ejaculation is ejaculation within one minute of vaginal penetration,” says urologist and sexual health doctor Joshua Gonzalez.
So anything longer than one minute isn’t technically premature — just disappointing.
In addition to this one-minute rule, the premature ejaculation must cause some level of distress for the male, his partner or both to be defined as premature ejaculation.
This definition is relatively new, decided upon in 2013 by the International Society of Sexual Medicine. And if this one-minute guideline seems kind of arbitrary, Gonzalez explains that after years of it having a subjective definition, the answer was purposefully defined in order to help with finding more treatments. “The goal of science in general is to define things so that you can classify and treat them,” Gonzalez explains.
Since this process of medical definition is usually seen through the lens of heterosexual health, though, does that mean that if you’re gay or having oral, anal or any other kind of sex, that you can’t be suffering from premature ejaculation? Technically: Yes. But Gonzalez explains that you’d be hard-pressed to find someone who defines it that narrowly in practice, as most will adapt the definition to treat other clients. “It’s definitely a problematic definition,” says Gonzalez, “but it’s the only one we have.”
Frequency is also a factor in the definition, as you’d only qualify as suffering from premature ejaculation if it happens at least “most” of the time. There’s also the issue of how long you’ve had this condition. There are two groups of people who suffer from it: Those with a “lifelong” affliction, where this has always been a problem, and the other where it’s been “acquired,” i.e., where someone originally had a more normal ejaculatory time, then saw a significant reduction. In the latter case, the one-minute rule wouldn’t apply specifically — it would just have to be a significant loss. (FYI: the average time is still only about six or seven minutes.)
So what causes premature ejaculation?
There are a whole host of reasons, including a possible genetic component for “lifelong” sufferers; performance anxiety, which can lead to a lack of control; and of course, it having been a while since you last got some, all of which, Gonzalez explains, basically boils down to being overly excited. It can also be a physical issue, where people have poor control of their pelvic floor muscles due to over-excitement, thus it will spasm and you’ll ejaculate quicker.
Because the cause is really just excitation, the treatments are all about suppressing that excitement. One method is referred to as the “barrier method,” which means that you’re doing something to physically block the excitement. You can, for example, try wearing a condom or spraying lidocaine spray on your penis in order to numb it, but Gonzalez notes, “There’s not a lot of long-term success with these treatments because people just don’t want to do them.”
This is only the first line of defense, though. To treat the condition more rigorously, there’s also a pharmacological approach. “Antidepressants may be prescribed, as one of the side effects is delayed ejaculation,” Gonzalez explains. “That’s because they lead to an increase in serotonin levels, which has a negative effect on sexualized excitation.” Another treatment is tramadol, an opioid that will delay the response from the penis to the brain. Sometimes am erectile dysfunction medicine is prescribed as well, so that even if someone ejaculates quickly, they’ll be ready to go again soon after.
Gonzalez explains, “Premature ejaculation is one of the hardest things in sexual health to treat because there are no FDA-approved drugs and there are no treatments that work for everyone.” Additionally, Gonzalez believes that sexual health isn’t regarded as a priority in America, which means it’s hard to get funding — this is a problem, because conducting studies can be costly and cumbersome.
Not to mention, the studies would be awkward for everyone involved. “There are a few different ways to measure this,” Gonzalez says, “But the most effective way is by using a stopwatch, where you would start upon inserting your penis into your partner’s vagina and then stop it when you ejaculate. That’s not a terribly sexy thing to do.”
So, with no approved drug expressly for this purpose and the billions of dollars it takes to get a new drug on the market, it’s likely that the state of premature ejaculation won’t change for some time. Though Gonzalez says there is one method you’ve probably heard of that may be worth giving a shot: “There isn’t really any data to prove this, but a lot of times, I’ll tell my clients that it probably wouldn’t hurt to rub one out beforehand.”