Ejaculatory Dysfunction—The Evolution of a New Understanding

Chris G. McMahon


Transl Androl Urol. 2016;5(4):402-408. 

In This Article

Abstract and Introduction


As long as man has breathed, his fascination, pursuit and quest for the perfect sexual experience have remained one of his principal raisons d'être. After thousands of years, millions of words and pictures, and billions of attempts, he still often finds the goal largely unobtainable. Until recently, our understanding of premature ejaculation (PE) was an eclectic mix and homogenization of ancient historical and culturally diverse influences. However, recent basic and clinical research has resulted in a new understanding and a paradigm shift in the way we classify, define, evaluate, diagnose and treat PE.


In many ancient cultures and times, there were many references to the importance of ejaculation and the art of love and sexuality. The Bible states that semen was intended to be deposited only in vaginas and mainly for the purpose of procreation. Men were told: "Be fruitful, and multiply and replenish the earth" (Genesis 2). The punishment for not obeying God's law was death, as Onan was to discover to his peril. Onan's father, Judah, forced him to marry his brother's widow Tamar, whom he did not love. Onan discovered that during coitus he could not ejaculate into Tamar: "he spilled it (semen) on the ground, and the thing which he did displeased the Lord: wherefore He slew him" (Genesis 38).

The Indian god Shiva, who has the power to destroy and create, is often represented with an erect phallus, a symbol of power and fertility. Because Shiva always holds back his seed, the "lingam" (penis) remains erect, as a potential creator.[1] Semen is considered to be a precious substance in Indian cultures and many myths have been created around it.[2] Atharva-ved, one of the ancient Indian religious books mentions that 100 drops of blood are required to make one drop of semen. Loss of semen was considered then (and still is) as a loss of strength. Male weakness caused by a loss of semen is called "mardana-kamzori";[2] this and premature ejaculation (PE) is collectively known as "Dhat syndrome".[3]

The Kama Sutra was written between the first and fourth centuries AD by Mallanaga, a bachelor belonging to the Vatsyayana sect. It is best described as the lifestyle book of its era which was devoted to personal discipline and offered a range of knowledge that the reader may acquire, to find (and keep) a partner. It gave suggestions on many subjects, from how to freshen the breath by chewing betel leaves to a range of sexual positions that "seems often to be addressed to a contortionist".[4] Although initially published in Britain in 1876, it was considered by Victorian England to be far too lewd and was not officially available until 1963.

Part two of the Kama Sutra deals exclusively with sexual intercourse and considers different lengths of time to ejaculation as having various merits. The author believed that "The first time of union the passion of the man is intense, but on subsequent union the reverse of this is true". He observed that, "if a male be long-timed, the female loves him the more, but if he be short timed, she is dissatisfied with him". He concludes "that males when engaged in coition, cease of themselves after emission and are satisfied, but it is not so with females". This is a clear reference to the fact that PE causes bother, frustration and relationship friction.

Chinese sexology can be traced back many dynasties. The Tang Dynasty (618–907 AD) was considered to be sexually free, and during this period sex was positively encouraged as the means to good health. Early Taoist philosophers saw frequent and long-lasting sex as promoting balance between the Yin (negative, dark, feminine) and Yang (positive, bright, masculine). Sex was considered the very essence of nature and harmony. It was also thought that to ejaculate ("chi") made the man weak for the next sexual encounter. Delaying or suppressing ejaculation was felt to be beneficial, and a disciplined approach to delaying ejaculation became popular. In the Ming Dynasty [1368–1644], attitudes to sex became more restricted, and by the Qing Dynasty [1644–1911], sexuality was repressed and regulated.[5]

In sixteenth century Tunisia, Sheikh Nefzawi, adviser to the Grand Vizier of Tunis, wrote a book on the art of love was called The Perfumed Garden, the Islamic version of the Kama Sutra. He makes specific reference to PE, but offers no remedy for the problem. "When the mutual operation is performed, a lively combat ensues between the two actors who frolic and kiss and intertwine. Man in the pride of his strength, works like a pestle, and the woman, with lascivious undulations, comes artfully to his aid. Soon all too soon the ejaculation comes!"

Erotic life flourished at all levels of society in ancient Egypt.[6] Life, the afterlife, fertility and creation are important parts of Egyptian history, and representations of such can be seen on many temple carvings and paintings. Of particular interest were the remedies that the ancient Egyptians considered useful for various sexual ailments and problems. The lotus flower was an important icon in ancient Egypt.[7] Magical properties have been associated with the lotus flower since it arose at the beginning of time from the waters of Nun (the original waters).[1] It was immortalized in modern times when lotus and corn flowers were discovered in the coffin of Tut-Ankh-Amon. At the first ray of the sun, the lotus flower opens up and releases a hyacinth like scent. When an Egyptian buried his nose in a lotus flower and kept it there for a while, the effect on him may have been considerable, and the scent may have been sufficient to achieve an alteration in consciousness.[8] This may have had the effect of reducing anxiety and possibly delaying ejaculation, although there is no specific mention of PE.