Premature ejaculation: defining sex in the absence of context

Medical and psychiatric literature defines premature, early or rapid ejaculation from diverse perspectives and provides explanations and treatment options that reflect their historical development. Medical discourse focuses on premature ejaculation as a neuro-biological phenomenon with a growing ‘evidence’ base emerging for both defining the condition and treating it with selective serotonin re-uptake inhibitors (SSRIs).

Current definitions of premature ejaculation however are difficult to deploy clinically; ‘marked interpersonal distress’ is a subjective measure and not all men are able (or willing) to time their sexual activity with a stopwatch. The addition of a defined measure of intravaginal ejaculatory latency time (IELT) is, perhaps, useful for research, but less so for the individual men with premature ejaculation. Psychiatric literature considers the diagnosis and management of premature ejaculation from a behavioural perspective, where the man learnt ‘hurriedly’ and therefore got into a pattern of hurried sexual activity, although there is no compelling data (or evidence) that adoption of behavioural therapies are successful in providing a ‘cure’ for the problem.

Both medical and psychological perspectives appear based on certain assumptions, i.e. that of the construction of ‘normal’ sexual activity and function. Neither medical rationalities nor psychological perspectives consider the person who is the premature ejaculator, and both generally fail to consider his social contexts and cultural meanings or the anxieties of managing gender-determined role performances. Similarly, the ‘irrationalities’ of erotic desire, intimacy and embodiment remain largely marginal or invisible elements in the pursuit of ‘evidence’.

Whilst there is little sociological literature on the topic, premature ejaculation provides an example, par excellence, of an aspect of human experience that demonstrates the paradigmatic tensions between medical positivism and the cultural constructions of experience. This paper seeks to discuss premature ejaculation from another perspective, problematising the complexities of sometimes contradictory, social, sexual and gendered identities, and reflecting on a number of key areas that seem absent from the clinical literature on premature ejaculation.