Understanding Premature Ejaculation: Lessons from a Review of 1130 Cases

When it comes to premature ejaculation (PE), the answers are rarely black and white. An important older study, "Premature Ejaculation: A Review of 1130 Cases" by Bernard Schapiro (source), published in 1943, remains a foundational reference in understanding the complex nature of PE.

Schapiro's key message is clear: PE is neither purely psychological nor purely physical. Instead, it arises from a dynamic mix of both. Emotional stress, performance anxiety, and even unresolved guilt can interact with physical factors like hypersensitivity of the glans or a short frenulum to create a situation where ejaculation feels impossible to control.

Interestingly, Schapiro categorized PE into two types: hypotonic and hypertonic. Hypotonic PE is associated with exhaustion, nervous fatigue, and sometimes excessive masturbation. Men facing this type often experience both PE and erectile difficulties, and benefit from physical strengthening therapies like rest, exercise, or even testosterone treatment. Hypertonic PE, on the other hand, stems from excessive sexual tension and quick reflexes. It is common among younger men and those with highly reactive erotic responses. Here, calming treatments like sedatives were considered more effective.

One of the fascinating psychological observations made in this study is the comparison of PE to stuttering. Just as a person might lose control over speech under emotional pressure, a man with PE can lose ejaculatory control due to similar tension disrupting the complex neuromuscular coordination needed for sexual performance. Anxiety creates a shortcut to automatic, uncontrolled reactions.

Physical factors, while not the sole cause, were not dismissed either. About 3 percent of cases were linked to hypersensitivity, and another 2 percent were due to a short frenulum.

Interestingly, surgical lengthening of the frenulum often resolved PE in these cases.

Schapiro also strongly emphasized the importance of habit retraining. Building better habits, such as relaxing the pelvic floor during arousal and practicing controlled masturbation, was seen as crucial. He pointed out that forming new sexual habits takes time and persistence — an idea that remains central to modern approaches today.

Another important highlight is the role of partner support. A positive and encouraging partner attitude significantly reduced anxiety, making therapy and retraining much more successful. Emotional safety, it seems, is just as vital for sexual stamina as any physical exercise.

While some treatments from the 1940s, like the use of specific sedatives, are outdated today, the fundamental insights from this study still hold: PE is a multifaceted issue requiring a combination of emotional, psychological, and physical strategies.

In short, "Premature Ejaculation: A Review of 1130 Cases" reminds us that lasting change comes from understanding the whole picture, addressing both mind and body, and being patient with the process of building new habits.