ORIGINAL RESEARCHCanadian and American Sex Therapists' Perceptions of Normal and Abnormal Ejaculatory Latencies: How Long Should Intercourse Last?
Introduction
In the fantasy model of male sexuality, men have large penises, rock-hard erections, and can sustain sexual activity all night long [1]. It appears that many men and women hold this fantasy. In an online survey, Ablow asked how long sex should last [2]. Though his survey was flawed as it did not define “sex” and did not report a response rate, the results were compelling: only 14% of men wanted sex to last 10 minutes or less, 50% wanted sex to last 30 minutes, and 36% wanted it to last 1 hour or longer. For women, the figures were 18%, 52%, and 29%, respectively. Overall, over 80% of men and women wanted sex to last 30 minutes or longer.
In a more methodologically rigorous study, Miller and Byers broke sex into two components, foreplay and intercourse, and asked both partners in heterosexual couples to report actual and desired length for each component [3]. Men wanted sex, foreplay and intercourse combined, to last an average of 37 minutes and women an average of 33 minutes. Comparing actual to desired time, both sexes wanted an increase in length of both components, but wanted more of an increase in the length of intercourse than foreplay. The men wished an increase from a reported time of 7.86 minutes in intercourse to a desired length of 18.45 minutes; women wished an increase from 7.03 minutes to 14.34 minutes. With both men and women wanting intercourse to last more than twice as long as self-reported length, this seems a situation ripe for disappointment and dissatisfaction.
Miller and Byers used self-report to measure time and it is possible that this gives a biased estimate of intercourse length. Recently, there have been two large studies that have used stopwatches to time intravaginal ejaculatory latency, the time that elapses from penetration of the vagina by the penis to ejaculation, more objectively 4, 5. Waldinger et al. studied men from five countries, excluding those who were not in stable heterosexual relationships and having intercourse regularly. They found the overall median ejaculatory latency to be 5.4 minutes, though their sample underrepresented men with short ejaculatory latencies [4]. Based on these data, Waldinger et al. defined intravaginal latencies of less than 1 minute as “definite” premature ejaculation and latencies from 1 to 1.5, or perhaps 2, minutes as “probable” premature ejaculation [6].
Patrick et al. studied 1,587 heterosexual couples in the United States and, in addition to measuring ejaculatory latency, conducted clinical interviews to diagnose premature ejaculation. Thirteen percent of the men met American Psychiatric Association criteria for premature ejaculation: “Persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it” (p. 249) [7]. Patrick et al. found that the median ejaculatory latency for men who did not meet criteria for premature ejaculation was 7.3 minutes; for men with premature ejaculation it was 1.8 minutes. Ejaculatory latencies for some of the men who met criteria for premature ejaculation were up to 20 minutes, showing that premature ejaculation in DSM-IV-TR is not defined solely by intravaginal latency.
Given the discrepancy between how long people think sex should last and the actual time from penetration to ejaculation, it is not surprising that ejaculatory latency is a common sexual concern. Almost 30% of 18–59-year-old men, in a representative U.S. sample, reported that in the previous year there had been a period of at least several months when they reached climax too quickly [8]. A similar epidemiological study in Britain found almost 12% of men reporting concerns about premature orgasm [9].
Being concerned about reaching climax too quickly is not the same as meeting criteria for premature ejaculation. Waldinger has suggested a new typology for rapid ejaculation, including the category “premature-like ejaculatory dysfunction” to capture men who, though their ejaculatory latencies are in the normal range, perceive themselves as having, and are preoccupied with, rapid ejaculation 10, 11. He suggests education and/or psychotherapy as the first-line treatment for these man, rather than medication.
Further evidence of how a person's evaluation of sexual functioning has an impact on sexual and relationship satisfaction comes from a study by Patrick et al. that used path analysis to explore distress in men with rapid ejaculation [12]. They found that ejaculatory latency played an indirect role, influencing perceived degree of control over ejaculation. Perceived degree of control over ejaculation then went on to influence both personal distress related to the speed with which ejaculation occurred and satisfaction with sexual intercourse. These two variables subsequently were associated with the degree to which the men perceived ejaculatory latencies to cause difficulty in relationships. Thus, ejaculatory latency was not directly associated with distress.
Purdon and Holdaway assessed the impact of nonerotic thoughts during sexual activity in undergraduate men and women and measured sexual functioning and sexual satisfaction.[13] They classified nonerotic thoughts into four categories: (i) performance concerns; (ii) external consequences (e.g., pregnancy); (iii) emotional consequences (e.g., guilt); and (iv) body image. They found that the more nonerotic thoughts reported during sex and the more anxiety over the thoughts, the poorer sexual function was for both men and women. Thought frequency and anxiety were also associated with impaired sexual satisfaction for women. This study shows the influences that subjective thoughts have on sexual function.
Section snippets
Aims
One important source of expectations regarding the length of intercourse is the opinion of experts, which may be disseminated through popular media or direct clinical contact. In the present study, we queried experienced sex therapists to see how long they thought coitus should last, from intromission until ejaculation, in an effort to quantify expert opinion on this matter.
Methods
The 180 full members of the Society for Sex Therapy and Research (SSTAR) who were listed in the membership directory with addresses in the United States or Canada were the target population. Licensed clinicians (e.g., psychologists, physicians, social workers, marriage/family therapists, nurses) with at least 3 years of clinical experience diagnosing and providing treatment for sexual problems are eligible for full membership in SSTAR, as are researchers with at least one sexuality publication
Main Outcome Measure
The survey asked for background information (age, sex, degree, years of experience, etc.) and had questions that asked about ejaculatory latencies that were “too short,”“adequate,”“desirable,” or “too long.” The respondents were asked to give their “professional opinion as a sex therapist and/or researcher” as to, for example, “What is an adequate amount of time to elapse in coitus from penile penetration of the vagina to ejaculation?” The question was asked four times, with the italicized word
Results
Thirty-four (68%) of the target sample returned surveys. One respondent indicated no clinical experience and felt unable to provide responses to the ejaculatory latency questions. The remaining 33 respondents were fairly evenly split between men (45%) and women. The majority of respondents (85%) were doctorally prepared (PhD or MD) and were psychologists (64%). The group had a mean age of 58 years (range 34 to 72 years) and was clinically experienced, having been in practice for an average of
Discussion
There are several strengths and limitations in the present study that should be noted before interpreting the results. Many of the limitations relate to the sample. One is that all respondents came from two countries on one continent. As Waldinger et al. found country-to-country differences in median ejaculatory latency, it is likely that sex therapists in different countries would have different perceptions of normal and abnormal ejaculatory latencies [4]. Thus, the results of the present
Conclusion
Though the news that lay public expectations for sexual performance are unrealistic may not be new to people in the field of sexual medicine, it still needs dissemination. The results from the present study, by providing a realistic not a fantasy model of sexuality, are useful both in treating people with sexual concerns and dysfunctions, and, with wider circulation, in preventing the onset of sexual dysfunctions.
Conflict of Interest: None declared.
Category 1
- (a)
Conception and Design
Eric W. Corty; Jenay M. Guardiani
- (b)
Acquisition of Data
Eric W. Corty; Jenay M. Guardiani
- (c)
Analysis and Interpretation of Data
Eric W. Corty; Jenay M. Guardiani
Category 2
- (a)
Drafting the Article
Eric W. Corty; Jenay M. Guardiani
- (b)
Revising It for Intellectual Content
Eric W. Corty; Jenay M. Guardiani
Category 3
- (a)
Final Approval of the Completed Article
Eric W. Corty; Jenay M. Guardiani
Acknowledgment
The authors wish to thank Steve Levine, Caroline Pukall, and the anonymous reviewers for comments on earlier drafts of this article.
References (16)
- et al.
A multinational population survey of intravaginal ejaculation latency time
J Sex Med
(2005) - et al.
Premature ejaculation: An observational study of men and their partners
J Sex Med
(2005) - et al.
Proposal for a definition of lifelong premature ejaculation based on epidemiological stopwatch data
J Sex Med
(2005) - et al.
Changing paradigms from a historical DSM-III and DSM-IV view toward an evidence-based definition of premature ejaculation. Part II-Proposals for DSM-V and ICD-11
J Sex Med
(2006) The need for a revival of psychoanalytic investigations into premature ejaculation
J Men's Health Gender
(2006)- et al.
Interrelationships among measures of premature ejaculation: The central role of perceived control
J Sex Med
(2007) The new male sexuality
(1992)- Ablow K.Thanks for taking this poll. n.d. Available at: http://drkeith.warnerbros.com/quiz/thanks_sex.html (accessed...
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2020, Sexual MedicineCitation Excerpt :Current PE was assessed using the self-reported IELT. An IELT less than 2 minutes is considered to be PE.48 31 participants (3.1%) reported an IELT of 2 minutes or less.
Comments on "considerations for an evidence-based definition of premature ejaculation in the DSM-V"
2010, Journal of Sexual MedicinePremature ejaculation: Bother and intravaginal ejaculatory latency time in Iran
2009, Journal of Sexual MedicineCitation Excerpt :However, IELT in normal population has been studied only in a very small number of countries with small samples, and the resultant proposed normal limits and cutoffs have failed to gain widespread acceptance. For example, while the ISSM has proposed the 1‐minute cutoff point based on the three studies aforementioned, most recent studies have adopted a 2‐minute cutoff [14–21]. In our opinion, there is a need for the sexual medicine community to reach a consensus on the clinical diagnostic and therapeutic approach to those patients who consider themselves as premature ejaculators and actively and insistently seek treatment but have IELTs of more than 1–2 minutes (within 5 minutes).