PE Definition by Helen Singer Kaplan

Helen Singer Kaplan was a sex therapist in the 1970s and 80s, who in her own way was as much a pioneer in the treatment of premature ejaculation as Masters and Johnson were, back in the 50s and 60s. Her definition of premature ejaculation centered on the man's ability to control when he came. In other words, she was defining the sexual dysfunction in terms of how much voluntary control the man had over his orgasm and ejaculation.

Men who ejaculated rapidly and uncontrollably, often with little warning that they were about to reach orgasm and ejaculate, could therefore be defined as premature ejaculators, or or at least as severely lacking in ejaculatory control, whilst men who exercised a greater degree of choice over the point at which they came during sexual activity, could be said to have greater staying power, and would not be classed as having PE.

Now on the face of it, this seems very sensible, because one of the things that's immediately apparent to all therapists who are working in this field is that many men who come quickly (although not all of them) certainly lack any choice or control over the timing when they ejaculate. I've heard many a man say that he is taken by surprise by his "release"; that it seems to come from nowhere, without any warning. In some ways, over the years, I've actually felt tempted to apply this as my own definition of premature ejaculation, because I think men who experience this lack of ejaculatory warning are having a different experience to the man who knows that he's going to come quite soon, but can do little to stop it. One of the reasons I say this is that classically men who were defined as having PE would be the ones who had no warning about their impending ejaculation. But in the end, I also accept that it is the outcomes and effects of sex that matter: in other words, if a man reaches orgasm and shoots his load too quickly, to use the vernacular expression which seems very appropriate in this case, then he most likely has a dysfunction that needs attention, if only because he or his partner would feel better if he had greater control. From a treatment perspective, it's important to keep in mind that the man's degree of control, or perceived degree of control, over his ejaculation can influence the treatment strategies which one uses.

Helen Singer Kaplan used the stop-start technique, which is described on this website. Essentially, the method was based on showing a man how to identify the sensations that preceded his orgasm (in terms of Masters and Johnson's sexual response cycle, these were the sensations that indicated the man was about to make the transition from the arousal phase to the orgasm phase of his sexual response cycle; in biological terms the sensations represent the release of semen from the seminal vesicles into the posterior urethra, prior to its expulsion from the body moment of ejaculation; in layman terms, this is the "point of no return", or "point of ejaculatory inevitability"). In addition, a man was shown how to gauge his own level of arousal on a scale between 0 and 10, where 10 represents the point at which he would inevitably ejaculate. With these two pieces of information at hand, a man could learn to extend his sexual longevity by interrupting his "dash to orgasm".

He could practice during masturbation by stimulating himself until he reached a high level of arousal, near orgasm, but not at the point of emission. By interrupting the cycle of his sexual arousal, simply by stopping stimulation for a few seconds so that his arousal decreased, though his erection remained hard, he would then be able to take more stimulation before reaching "the point of no return" next time. In treatment, he was instructed to continue rhythmically stroking the shaft tip of his penis until he reached the point of no return again. By repeating this process three times ejaculating on the fourth time freely and quickly, he would discover that his capacity to take sexual stimulation without reaching the point of no return, the point ejaculatory inevitability would be significantly increased.

At this point in our attempt to define premature ejaculation I'd like to consider some of the wider ranging issues that arise in our search for criteria by which we can definitively identify a sexual dysfunction that affects so many men.

The first question is - who or what determines what "premature" or "rapid" actually means? More to the point, perhaps, is rapid ejaculation really a sexual dysfunction, or is it merely a lifestyle condition? Is it possible that it could simply be part of the normal range of human sexuality, and if so why should we bother to treat it?

I think it's clear from these questions that accurate and scientific diagnosis, let alone definition, of PE will continue to be elusive. So instead of searching for a scientific definition of the condition, let's look for the common factors in the definitions that are available.

They all speak of the time between penetration and ejaculation; they all speak of voluntary control of ejaculation or the lack of it; and they all refer to the occurrence of distress or interpersonal disharmony because of it. There is actually another definition of PE produced by the World Health Organization (referred to as ICD–10) which defines premature ejaculation as an ejaculation which occurs within 15 seconds of intercourse beginning - this seems so short as to be practically useless.

Any doctor or therapist who sees a man with this condition has, de facto, to make three extra judgments, including: (1)  whether or not the condition has recently risen (acquired PE) or it's been present for the whole of the man's life (lifelong PE); (2) whether it occurs only in specific situations or in every sexual situation a man is involved with; and (3) whether it is the result of psychological factors alone, or psychological and physical factors together.

It turns out that when you apply these additional diagnostic criteria to the definition of PE, about two thirds of men have lifelong form the dysfunction, while only a third have the acquired type. (Acquired means that PE has developed later in life, whilst lifelong means that it has been present from his first sexual encounter.)

The complexity and difficulty of diagnosis and definition of premature ejaculation is demonstrated very clearly indeed by the fact that there have been reports that lifelong "sufferers" may benefit less from treatment in the long-term with SSRI type drugs than those who acquired the condition some time after their sexual career had started.  It follows therefore that acquired PE requires the therapist or doctors to investigate whatever may be causing the symptoms, such as relationship stress, medication, illness or even erectile failure. In similar vein, the generalized type of premature ejaculation, referring to a situation where a man experiences a rapid release under all sexual conditions, would seem to be caused by psychological factors.

As you can see, adding specifiers such as lifelong or acquired, and generalized versus situational, to the basic definition of premature ejaculation produces many more problems and increases the difficulty of objectively diagnosing and defining this dysfunction.

And as iif this were not enough, all current definitions have a degree of vagueness that makes it hard to apply them – for example, terms such as "shortly after penetration" are very vague – a fact which has led various therapists over the years to joke that the subjectivity and elusiveness of the various definitions of premature ejaculation may as well be replaced by the simple statement that "I know it when I see it!" And although that sounds amusing, the fact is, in the eyes of the man who is experiencing PE, it is sufficient definition..... (Or is it? Read on to find out why it is not.)

All of this difficulty in diagnosis and definition affects not only scientific researchers but doctors and therapists too. In many studies published in scientific journals, markedly different times between penetration and ejaculation have been used to define rapid ejaculation. It's only recently that more objective data about IELT (intra-vaginal ejaculatory latency time, the time between penetration and ejaculation) has become available. This has revealed that the average duration of intercourse in what we may call "non-premature ejaculating" men is 7.3 minutes, while among men with the condition it's just under 2 minutes. But even here there is considerable overlap between the two groups, perhaps as you might expect. And, perhaps unsurprisingly, even here, in a large study of almost 1600 men, it transpired that a simple question regarding the man's perception of his degree of voluntary control of ejaculation proved to be the best indicator of whether or not a man had premature ejaculation.

So at this point you may well be wondering whether or not it's actually worth trying to form a definition, and what purpose it might actually serve. The answer to that is to be found in the treatment methodology that is used for a man who seeks help. Indeed, the broader approach to a man who comes for treatment may depend on which definition one uses.

In certain cases, Helen Singer Kaplan's definition of rapid ejaculation is appropriate, where the cause of the man's rapid ejaculation is simply the fact he hasn't learned the techniques necessary to establish voluntary control of orgasm and arousal. In other cases, a definition that specifies a certain time for intercourse is important in determining treatment, as in the case of a man who presented himself for treatment because his girlfriend was complaining that he hadn't been able to give her an orgasm during intercourse (and that therefore he must have premature ejaculation). On investigation it transpired this man could easily last 20 minutes before he ejaculated with no difficulty, and it was hard to convince him that he did not require treatment for PE! He certainly did not match any standard definition of premature ejaculation. This is a not uncommon phenomenon where a woman whose own orgasmic difficulties prevent her from enjoying sex blames her man and his ejaculatory capacity.

Premature ejaculation definition  Definition by Masters and Johnson  Definition by Alfred Kinsey  Definition by DSM IV  Definition by Helen Singer Kaplan  Definition of premature ejaculation today

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