History

Waldinger (5,15) distinguishes four periods in the approach to and treatment of premature ejaculation.

The First Period (1887-1917): Early Ejaculation

In 1887, Gross (16) described the first case of early ejaculation in medical literature. A second report of von Krafft-Ebing (17) followed in 1901. Although publications were rare, it is worth noting that during the first 30 years of its existence in the medical literature, early ejaculation was viewed as an abnormal phenomenon but not significantly as a psychological disturbance.

The Second Period (1917-1950): Neurosis and

Psychosomatic Disorder

In 1917, Abraham (18) described early ejaculation as ejaculatio praecox and stated that it was a symptom of a neurosis caused by unconscious conflicts. Treatment should consist of classic psychoanalysis. On the other hand, some physicians stated that premature ejaculation was due to anatomical urological abnormalities, such as a too short foreskin frenulum or changes in the posterior urethra, which had to be treated with incision of the foreskin or electrocautery of the verumontanum. In 1943, Schapiro (19) argued that premature ejaculation was neither a pure psychological nor a pure somatic disorder, but a psychosomatic disturbance caused by a combination of a psychologically overanxious constitution and a weak ejaculatory system. Schapiro described two types of premature ejaculation, type B in which early ejaculation existed from the first intercourses and type A, which led to erectile dysfunction. Many years later, both types became distinguished as the primary (lifelong) and secondary (acquired) forms of premature ejaculation (20).

The Third Period (1950-1990): Learned Behavior

The biological component of premature ejaculation and therefore also drug treatment, advocated by Schapiro, was ignored by the majority of sexologists who advocated psychoanalytic treatment. This neglect became even more pronounced after Masters and Johnson (21) claimed the high success rates of behavioral therapy in the form of the squeeze technique, an adaptation of the stop-start technique published by Semans (22) in 1956. Masters and Johnson stated that men with premature ejaculation had learned this rapidity behavior as a result of their rushed initial experiences of sexual intercourse.

The Fourth Period (1990 to Present): Neurobiology and Genetics

Since the 1990s, there has been an increasing number of publications on the efficacy of SSRIs, clomipramine, and topical anesthetic creams in delaying ejaculation. At the same time, in 1998, Waldinger (1) postulated a new neuro-biological view arguing that premature ejaculation is related to disturbance of serotonin (5-HT) receptors in specific areas of the central nervous system with a possible genetic vulnerability (5,23).

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