Premature Ejaculation: A psychophysiological review

Abstract

This review examines the most common male sexual dysfunction, premature ejaculation (PE). The prevalence, classafication, neurophysiology, neuropharmacology, and psychologacal studies thatofer evidence useful for understanding and clinically evaluating PE are reviewed. It is proposedthat there are two basic kinds of PE: biogenic and psychogenic. Studies reporting pharmacologzcal aspects of ejaculation offer some suggestions regarding the mechanisms of ejaculation as well as possible pharmacologic aid for some premature ejaculators. The traditional assumption amongsex therapists that PE is almost universally caused 4 psychologacal features, and easily treated with sex therapy behavioral techniques, is drawn into question. Based on the limited available results from systematic investigations, behavioral treatments for PE remain benejicial to only a minority of men three years afer treatment ends, suggesting that this male dysfunction is daficult to treat effectively. The mediocre results reported in treatment outcome studies may be due, in part, to reports on heterogeneous groups of premature ejaculators, for whom treatment has beengeneralized rather than targeted to the specific type of PE. We propose a biologzcal and psychologzcal etiology. With more discriminating assessment and more specific diagnosis of PE, and withtreatment designed to address the particular type of PE, long–term outcome should improve for this common sexual dysfunction.