“We prefer to talk of rapid ejaculation rather than early ejaculation," explains Fiona Bourdon, sexologist and psychotraumatologist at Sexopraxis. But discussing this problem, precisely, is so rare that clinical studies on the subject are lacking. Just as the number of men concerned varies, the statistics range from 5 to 30%. In addition to the lack of consultations, there are many different definitions of the disorder, which affect the extent of the affected population. "The 5% figure cited by the American registry seems more realistic to me," says Julien Blanc, doctor at the Urology Department of CHUV, responsible for the andrology consultation. This speciality deals with problems of the male reproductive and urological system. Nevertheless, it is not recognised as a medical speciality in itself by the Swiss Federation of Doctors. Technically, depending on the institution, country, or era, it is urologists, gynaecologists, endocrinologists, or even dermatologists who provide consultations.
Self-esteem is impacted
For Julien Blanc, premature ejaculation is defined as occurring without control within a minute of penetration and causing psychological distress. "The disorder must persist for several months, and other pathologies must be excluded," he says. Moreover, there are two main types of premature ejaculation, those that have always been present and those, rarer, that appear during life. We distinguish further, according to the definitions, because it is necessary to take into account people who consider themselves premature, even though they are not. "As long as ejaculation, whether premature, normal or even late, generates a feeling of discomfort for the couple or for oneself, it’s important to talk about it," continues Julien Blanc.
The physiological hypothesis
Regarding the physiological explanation of this disorder, Julien Blanc also lacks information. “It’s not clear what’s happening; we assume a hypersensitivity of the glans associated with hormonal and psychological changes.” Ejaculation is a reflex that normally occurs following stimulation of the glans. It is influenced by brain control through numerous neural circuits connecting the brain to the genital organ. In this process, the neurotransmitter serotonin plays an important role by inhibiting the ejaculation reflex. People with a disorder of the serotonin system may have difficulty inhibiting this reflex. As serotonin is also involved in mood management, the link to mental health remains largely misunderstood. However, rapid ejaculation, beyond performance anxiety, sometimes appears to be related to trauma. "The disorder can be linked to sexual abuse during childhood," explains Fiona Bourdon. Ejaculating quickly then means putting an end, as soon as possible, to the sexual relationship experienced as unbearable, because it is assimilated to past sexual abuse. The body is therefore in a state of hypervigilance and reacts accordingly. Other times, rapid ejaculation is linked to a learning defect, that is, a lack of knowledge of one’s body, sensitivity and sensoriality. "This learning defect is sometimes related to the beginning of sexuality shaped by pornography consumption."
The only drug specifically approved for premature ejaculation, Dapoxetine, acts on serotonin by increasing its levels. Other options include antidepressants, sprays that reduce glans sensitivity, analgesics and psychotherapies. "It is difficult to estimate the success rate of all these approaches," says Julien Blanc.
Beyond duration
With Dapoxetine, increasing the time before ejaculation by three or four times leaves us, at best, with two or three minutes. This added duration can change everything for some, but not for others. Consultation is therefore also an opportunity for dialogue about sexuality, which helps us combat false beliefs. "For example, some patients are unaware that after ejaculation it is normal to have no erection, or that lasting for five minutes is quite standard," says Julien Blanc. Only then can appropriate measures be taken, thanks to the various possibilities for improvement. For Fiona Bourdon, one solution is to act at the level of sexual health policies. “To achieve a more fulfilling sexuality, it is essential to nurture the sensual aspect of the bond with one’s own body, as much as the sexual. Being totally in contact with one’s bodily sensations and those of the other excludes, de facto, the performative dimension of the sexual relationship, that is to say, penetrative and orgasmic.”
