Sexual dysfunctions induced by stress of timed intercourse and medical treatment

Authors


Sir,

Is premature ejaculation (PE) during vaginal intercourse really a male sexual dysfunction?

Byun et al. [1] wrote ‘In men PE is more common than delayed ejaculation. Timed intercourse imposes a substantial degree of stress on men’. PE is a male sexual dysfunction characterised by ejaculation that always or nearly always occurs prior to or within ≈1 min of vaginal penetration, and the inability to delay ejaculation on all or nearly all vaginal penetrations, and negative personal consequences [2].

Sexual medicine experts consider PE only in the case of vaginal intercourse. PE is limited to heterosexual men engaging in vaginal intercourse, as there are few studies available on PE research in homosexual men or during other forms of sexual activity [2].

Today PE is considered the cause of the failure to vaginal orgasm in the partner, with negative psychological consequences in males. Byun et al. [1] wrote ‘The impact of impending timed intercourse on sexual dysfunction and the behaviour of male partners has only recently been investigated’. Until a few decades ago during vaginal intercourse PE did not involve discomfort in males because orgasm was not essential for female sexual satisfaction: ‘Until the mid-twentieth century, many people (including some medical authorities) believed that women were not capable of orgasm. This belief undoubtedly reflected a cultural bias: sex was seen as something the man did to the woman for his own gratification. Women were told for centuries to do their wifely duties by making themselves available to their husbands for sex’ [3].

As a matter of fact the vaginal orgasm does not have any scientific basis and is a theory that was invented by Freud in 1905. The vagina does not have an anatomical structure that can cause an orgasm; a minority of women says they experience vaginal orgasm because this is the term that is explained to them by sexologists. The ‘vaginal orgasm’ that some women report is caused by the surrounding erectile organs, i.e. clitoris, vestibular bulbs and pars intermedia, labia minora, corpus spongiosum of female urethra. Distinguishing between clitoral and vaginal orgasm is not correct from a physiological view point [3, 4].

The vaginal orgasm and G-spot do not exist [3-5], therefore the duration of penile–vaginal intercourse is not important for a woman's orgasm. Even today there exists only one model of physical relations: foreplay, penetration, intercourse, and ejaculation. Many men think long intercourse is the key to having orgasm during intercourse, but long intercourse is not helpful to most women. As male ejaculation does not automatically mean the end of sex for most women, touching and kissing can be continued almost indefinitely. Men think of the preliminaries as an unnecessary delay, and sexologists describe non-coital sexual activity (i.e. partner masturbation and oral sex) by the term ‘foreplay’, which implies that these acts are preliminary to intercourse, making intercourse the main event, but some people prefer other forms of sexual activity instead of coitus. Intercourse must not be the focal point of sex, ‘foreplay’ is misleading term and it must be discarded [3].

Physiologically female sexual satisfaction is based on orgasm and resolution. Women with effective sexual stimulation have the physical capability of being orgasmic at all ages: clitoral stimulation is important for achieving the orgasm [3, 4].

Byun et al. [1] wrote ‘Physicians and clinicians should acknowledge the potentially harmful effects of timed intercourse on the physical and mental health of men’. Physicians and clinicians must acknowledge that PE is normal and it is common for any healthy adolescent man. It is important for teenagers to understand that PE is absolutely normal at this age. PE is really normal in adolescent males, especially during their first sexual encounters [3].

Men with PE have no negative personal consequences during masturbation: as a matter of fact PE does not exist when the orgasm and ejaculation are obtained by masturbation. By masturbation adolescent will understand their responses and men will be able to gain better control also during intercourse.

Masturbation provides a safe means of sexual experimentation, improving sexual self-confidence. In the ‘stop-start’ method the male stimulates the penis manually until him feels that he is rapidly approaching ejaculation, at which time he stops all stimulation until the sense of ejaculatory urgency disappears. Stimulation then begins again, and the stop-start cycle is repeated several times before the man is allowed to ejaculate. In the ‘squeeze’ technique the man puts his first and second fingers on the frenulum of the penis and places his thumb just below the coronal ridge on the opposite side of the penis. A firm pressure is applied for about four seconds and then abruptly released. The ‘squeeze’ technique reduces the urgency to ejaculate. It must begin at the early stages of masturbation and continue periodically, every few minutes. In the basilar squeeze the squeezing is at the base of the penis [3].

PE has become the centre of a multimillion dollar business: PE during vaginal intercourse is not a male sexual dysfunction. ‘PE does not exist if both partners agree that the quality of their sexual encounters is not influenced by efforts to delay ejaculation’ and ‘Some females may be grateful to get it over with quickly’. [3]. Physicians and clinicians must acknowledge two specific methods called the ‘stop-start’ method and the ‘squeeze’ technique that helps recondition the ejaculatory reflex during masturbation. Non-coital sexual acts after male ejaculation can be used to produce orgasm in women. Physicians, clinicians, urologists, gynaecologists, sexologists, and sexual medicine experts should define having sex/making love, as the situation in which orgasm happens in both partners with or without vaginal intercourse: a definition for all human beings [4, 6].

Sexual dysfunctions are conditions in which the ordinary physical responses of sexual function are impaired. The study of the functions of the human body must be made in the subject: questionnaires for male ejaculation and female orgasm must too assess masturbation [7].

Ancillary