Premature Ejaculation
What is Premature Ejaculation?
Premature ejaculation is defined as an inability to delay ejaculation until it is mutually desirable for both partners, becoming a cause of stress and dissatisfaction. The classification ‘premature’ is subjective – it is not based on time, for instance, but rather on the impact the timing has on the sexual experience.
For some men who experience premature ejaculation, it is a lifelong condition that has affected them ever since they started to have orgasms, while for others it is acquired over a period of time. For some men, premature ejaculation is situational; it may occur only on some occasions. The causes and potential treatment options vary for individual patients.
Causes of Premature Ejaculation
It is not uncommon for early sexual experiences to be associated with the need for the act to be completed as quickly as possible. For example, the fear of getting caught during masturbation or having sex in risky locations, such as a car. The impulse for speed may persist into situations where it is no longer needed or appropriate. For many men, control over orgasms can be learned gradually.
The natural and understandable anxiety felt by many men can develop into a long-term anxiety related to sex. This can have the counter-productive effect of persistent premature ejaculation and performance pressures. This is a particularly frequent occurrence in new relationships.
When researchers interviewed men who had good control over their orgasm, they made an interesting discovery. These men, unlike those who ejaculate prematurely, were able to identify the point at which ejaculation is unstoppable. They could also initiate corrective action prior to reaching that point.
It may seem counter-intuitive, but an underlying problem can sometimes result from a low level of desire or lack of sexual arousal. On some occasions, it is quite possible for a man to have a strong erection without strong sexual arousal. In such instances, the man needs to be more aroused, which would allow more control over the ejaculation.
Treatment for Premature Ejaculation
There are two main approaches to tackling the problem of premature ejaculation: behavioral training and direct physical therapy. The most appropriate plan for treatment depends on the situation and may include either therapy or a combination of both.
Psychotherapy and Behavioral Training
This is a psychological and behavioral therapy that offers a way of learning to identify and control the sensations which trigger an orgasm. It requires a lot of patience and practice but is very effective and can be done at home, ideally with a caring partner.
Start by engaging with your partner in sexual stimulation that does not involve penetration, such as oral sex or masturbation, gradually approaching the point just before ejaculation. Stop at this point and let yourself relax and partially lose your erection before starting again. Repeat this a few times, each time approaching orgasm closer and closer until it cannot be held back any longer. Repetition will help you to identify your point of climax and enable you to control it. When you feel ready to try intercourse, follow the same pattern. Stop right before you are about to climax, relax, and then start again.
Try not to put too much pressure on yourself. If you don’t get it right at first, it’s OK – it may take time but it’s worth it in the end.
This is a variant of the ‘Masters and Johnson method’ with the difference being that the helping partner squeezes either the base or the tip of the penis just prior to the point of orgasm, essentially canceling it. The action forces blood away from the penis, thus reducing the erection. This technique could be used on its own or in combination with the ‘Masters and Johnson’ method.
Men can also learn increased levels of control through masturbation training or pausing for a change of position during sex. Some men even find that ejaculation before engaging in sex is an effective way to increase the time before they climax. Another helpful trick can be to learn how to focus more away from the genital aspects of the experience and concentrate on feeling pleasure in other parts of the body. A variant of this method is to reduce sensation by focusing thoughts on something completely unrelated to sex.
Direct Physical Therapy
This is a psychological and behavioral therapy that offers a way of learning to identify and control the sensations which trigger an orgasm. It requires a lot of patience and practice but is very effective and can be done at home, ideally with a caring partner.
Creams, gels, and sprays designed to decrease sensation in order to delay ejaculation are available. Many of these can be bought over the counter and do not need a prescription. The downside of these treatments is that by decreasing penile sensation, sex may be less pleasurable. They can also influence the partner’s sensation and pleasure as well.
Try not to put too much pressure on yourself. If you don’t get it right at first, it’s OK – it may take time but it’s worth it in the end.
Like topical anesthetics, condoms can reduce sensation during sex, which can help delay ejaculation. If necessary, the effect can be increased by combining a condom with a topical desensitizing treatment.
Medications used for depression, such as tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs), can be used off-label to delay ejaculation. Men who experience erectile dysfunction, as well as premature ejaculation, could also benefit from phosphodiesterase-5 inhibitors (PDE5i) such as Viagra or Cialis.