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Premature Ejaculation

What is premature ejaculation?

Premature ejaculation is one of the most common sexual problems. The condition is most often described as being an inability to delay ejaculation to a point when it is mutually desirable for both partners. The definition of when ejaculation is premature is subjective. While some men have trouble controlling their orgasm upon entry, others consider 5-10 minutes of copulation too little time. How long a man is able to last is not the important factor in diagnosing premature ejaculation. The crucial issue is if a man is satisfied with the length of coitus.

How is premature ejaculation caused?

Most men have experienced this problem at some time in their life. Premature ejaculation was once thought to be caused by drugs or certain infections such as urethritis, but popular wisdom suggests it is more psychological in nature. The exact cause of the condition, however, still remains a mystery.

Premature ejaculation often occurs during the first experiences with sex, and in this case is most commonly attributed to anxiety. The majority of men gradually learn to control their orgasm, and have no lasting effect. Some men will develop a longer-term anxiety toward sex, which can cause a prolonged experience with premature ejaculation.

Sexual behavior is also a factor. The longer the period since last ejaculating, the quicker young men typically reach orgasm. Younger men tend to ejaculate more quickly than older men, as experience seems to be associated with ejaculatory control.

What can I do to delay ejaculation?

Masters and Johnson method

The best way to fighting premature ejaculation is learning how to identify and control the sensations leading up to orgasm. The Masters and Johnson method does just that. The Masters and Johnson method requires a great deal of patience and practice, but is very effective. Follow the steps below.

You may want to start with masturbation. Begin by bringing yourself to a point relatively close to climax, and stop, allowing yourself to relax before starting again. Each time you do this, bring yourself closer and closer to orgasm until you cannot control it any longer. Repeating this procedure a number of times on different occasions will help you learn where your point of climax is.

Once you have an idea about your ¡®point of no return¡¯ you should be able to direct stimulation from your partner leading up to orgasm. The best way to practice this method is with a caring lover, although you can try to prepare by yourself. With your partner, engage in non-coital stimulation (like masturbation or oral sex) and gradually allow yourself to reach that point just before ejaculation. At that point, signal your partner to stop (often this is done with a light squeeze or sound) and allow yourself to partially lose your erection. Repeat these steps several times to get the hang of it. You should practice these steps for several days before you attempt intercourse.

Once you are ready to try intercourse, lay on your back and direct your partner to slowly allow you to penetrate. As soon as you feel that you are about to climax, signal to your partner or give a gentle push upward. Relax for a bit, then begin again. You should soon be able to control your ejaculation and enjoy having sex.

Although the method is extremely effective, it could take weeks before you get it just right. Remember, be patient and try not to put too much pressure on the situation. If you don¡¯t get it the first time, shrug it off and remember that you are working towards something that takes time. If you still have trouble, don¡¯t hesitate to contact a sex therapist for guidance.

Squeeze technique

The squeeze technique is really just a variation of the Masters and Johnson method, except that the assisting partner squeezes the tip or base of the penis just before the point of climax to essentially cancel the orgasm. The ¡®squeeze¡¯ forces blood out of the penis and reduces the erection. You may want to use the squeeze technique if the Masters and Johnson method alone is not working.

Other techniques

Desensitizing creams are products which purport to lessen the sensations felt by men during intercourse so that they can last longer. The limitation that many men feel these creams have is that they make intercourse less pleasurable by decreasing stimulation.

Masturbation is a technique used by many young men to increase their level of control. It is thought that masturbation before sexual activity will lessen the amount of desire a man feels thereby increasing control. This technique is not very effective, however, as level of arousal is only part of what contributes to the condition.

Condoms are an effective means of reducing the amount of stimulation experienced during sex. Some men find that a condom helps them prevent premature ejaculation by lowering their arousal. If one condom does not decrease the stimulation enough, then put on one more. Condoms provide excellent protection against STDs and pregnancy, so they¡¯re certainly worth a try.

Sexual positions can affect a man's ability to control his ejaculation. The typical ¡®missionary¡¯ position (on top of your partner) is not the best position while attempting to control ejaculation. Try laying on your back, allowing the partner to control copulation. In this position you are more relaxed, and can guide your partner easily.

Premature Ejaculation

Premature ejaculation is defined as consistently ejaculating before you want to. Unfortunately, our societal emphasis on ejaculation as the goal of intercourse exacerbates the "performance anxiety" that often causes premature ejaculation in the first place. Men may try a number of strategies to delay ejaculation such as thinking of baseball scores or doing multiplication tables. Some of these techniques can cause men to be emotionally detached during intercourse. Some techniques that are less distancing include:

Take a more global, less penis-centric approach to pleasure.

Try the "squeeze technique." Simply squeeze the head of the penis by hand as ejaculation approaches, wait until the response passes, and then continue.

Use an extra strong (and thereby less thin, and sensitive) condom.

Increase the frequency of ejaculations.

Talk to a therapist.

Consider medications.

A common side effect of one class of antidepressants is "sexual dysfunction." These Selective Serotonin Reuptake Inhibitors (SSRI) medications such as Prozac, Zoloft, Paxil, Celexa, and others, actually can inhibit the ability to ejaculate. Because of this, they have been used by some clinicians in the treatment of premature ejaculation. Your doctor or therapist can give you more information on this treatment.

SSRI

Medications of the selective serotonin reuptake inhibitor (SSRI) class have been tremendously successful and have impacted how we view both mental illness and our society as a whole. The first, and most well known, medication in this class is Prozac (fluoxetine). Prozac and the other SSRIs (e.g., Zoloft, Paxil, Celexa) have revolutionized our acceptance of depression as a disease. The incredible success and widespread use of these medications have made us take a closer look at ourselves, and how we, as a species, have adapted to our modern society.

The SSRIs function much the way as do other antidepressants in that they change the chemical concentration of neurotransmitters within the brain. One of the most important aspects of these medications are their ability to selectively effect serotonin while leaving other brain chemicals alone. This allows an effect to occur while minimizing the more serious side effects seen with other medications that are not selective in their effect. The chemical structure of Prozac (fluoxetine) is below.

SSRIs help not only people with depression but also those with obssessive-compulsive disorder, bulimia, anxiety, and panic disorder. SSRIs may cause a decrease in libido and an inability to attain orgasm in men or women. SSRIs may also disrupt sleep, causing daytime fatigue. Headaches, sweating, nausea, slight weight loss, diarrhea, and tremor are some side effects that may occur in certain patients. SSRIs cause increased sensitivity to the sun in certain people as well. SSRIs work by preventing neurons (nerve cells) from pulling in the serotonin that is floating in the space between neurons. This allows more serotonin to build up and improves communication between the neurons.

Over 70% of surveyed depressed and non-depressed people report that a good sex life is very important to them. Both depression itself and some of the medications used to treat it may cause problems in sexual function. People may experience decreased desire to have sex, erection impairment, ejaculation impairment, and orgasm delay (in men or women). Psychiatrists can help by trying non-medication therapies in conjunction, switching medications, or adjusting dose or scheduling (drug holiday) of a medication.

For more detailed information on this issue, check out the following books:

How to Overcome Premature Ejaculation (by Helen Singer Kaplan)

Impotence Assist: The Causes, Treatments, and Prevention of Weak Erections (Impotence) and Premature Ejaculation (by Dr N Beck)

Additional excellent books on this and other topics can be found in the Resources section.