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Premature Ejaculation

Premature Ejaculation | Jo Divine

Premature ejaculation (PE) is a common condition affecting about 30-40% of men according to Relate. It often remains undiagnosed and untreated because the sensitive nature of the problem discourages open discussion between the affected man, his partner and their doctor.

Recent research published in the Journal Of Adolescent Health (2016) found that many young men aged 16-24 experience erectile dysfunction and premature ejaculation.

In addition to having reduced sexual satisfaction, the emotional consequences impact not only upon the man but his partner too – which can lead to increased stress and anxiety, worsening the problem and breakdown in relationships.

Recent studies have shown that women do not view the duration of the intercourse as a problem but that their needs are neglected by their partner whilst he concentrates too strongly on delaying ejaculation (Burri et al 2014). For many women, being satisfied sexually does not consist solely of sexual intercourse but kissing, caressing and other forms of sexual stimulation. When a man is preoccupied with delaying his orgasm, it can make female partners feel that they are unable to share and contribute to the sexual experience, triggering feelings that their partner is behaving selfishly, just using her as a vehicle for sexual pleasure, which can lead to sexual frustration and resentment. This can often lead to avoiding sexual contact for fear of rejection and ultimately a relationship split.

What is Premature Ejaculation?

Premature ejaculation happens shortly before or after penetration. Although there is no precise time limit, it is generally considered to mean lasting less than 2 minutes. A study of 500 couples from 5 countries found that the average time between a man putting his penis inside his partner’s vagina and ejaculation is around five and half minutes (Waldinger et al 2005). However, most men are able to control when they want to ejaculate.

Retarded ejaculation

Retarded ejaculation is a delay in achieving ejaculation, or an inability to achieve ejaculation during sexual intercourse, even though the man wants to and he has a normal erection.

Retrograde ejaculation

Retrograde ejaculation is a rarer type of ejaculation problem. The sperm travels backwards and enters the bladder instead of being ejected from the urethra. The man feels the experience of an orgasm but produces little or no semen. It does not pose a threat to health but can cause infertility.

What causes Premature Ejaculation?

Causes of PE can be both physical and psychological. If a man has previously suffered from a health condition, making it difficult to maintain an erection, he may experience anxiety during sex leading to PE.

Primary PE

Normally the causes for primary PE are psychological. The following are just a few reasons cited by doctors as to the cause of primary PE.

Conditioning

Many doctors believe that early sexual experiences can affect sexual behaviour as we grow up. A teenager who conditions himself to ejaculate quickly to avoid being disturbed by his parents or siblings may find it difficult to break the habit as he gets older.

Traumatic sexual experience

Experiences such as being caught masturbating to sexual abuse can affect both men and women leading to sexual anxiety. For men, this can cause PE.

A strict upbringing

Coming from a strict family background can impact upon sexual activity later in life. Many of the sexual problems that damage people’s lives and relationships result from inadequate knowledge and even very highly educated people may believe sexual myths or incorrect information, including medical practitioners.

Listening to rigid or fearful sex education from parents, teachers, churches or the media can cause very serious problems. People experience sexual problems because they have been led to believe that the act of sex is sinful and dirty. These beliefs do far more harm than good to a person’s sexual health and well being.

Biological disorders

A number of biological factors may contribute to premature ejaculation, including:

  • Abnormal hormone levels such as low prolactin levels. Prolactin is a hormone which has a dampening effect upon sexual arousal so decreased levels can lead to a man becoming aroused in a short space of time and ejaculating quickly.
  • Abnormal levels of the brain chemicals (neurotransmitters) serotonin and dopamine appear to be involved in premature ejaculation (PE). As serotonin increases ejaculatory threshold, delays ejaculation and orgasm and dopamine decreases them, men who have PE have been shown to have lower levels of serotonin, which may help explain why they ejaculate too quickly.
  • Abnormal reflex activity of the ejaculatory system
  • Certain thyroid problems such as hyperthyroidism (over-active thyroid) and hypothyroidism (under-active thyroid)
  • Inflammation and infection of the prostate or urethra
  • Inherited traits such as decreased serotonin which may be as a result of depression or mental illness
  • Nerve damage from surgery or trauma (rare)

Secondary Premature Ejaculation

This occurs when a man who has a history of normal ejaculatory function develops a physical or psychological condition or has an unhealthy lifestyle which affects his ejaculatory function. Physical causes of secondary ejaculatory include:

Common psychological conditions include:

  • Anxiety about sexual performance, often caused by starting a new relationship or where a man has had previous ejaculatory problems in the past
  • Conflicts within a relationship
  • Retarded ejaculation

The causes can be both physiological or psychological. Possible psychological causes are similar to those mentioned above for premature ejaculation.

Physical causes include:

  • Spinal cord injury
  • Multiple sclerosis
  • Diabetes (normally type 1)
  • Surgery to the prostate or bladder
  • The ageing process

Some medications have side effects which can cause PE. They include:

  • Antidepressants, especially those that inhibit the uptake of serotonin as low serotonin can cause PE
  • Drugs used to control blood pressure such as beta blockers
  • Drugs used to control some conditions of mental illness such as psychosis whereby a person is unable to distinguish between reality and fantasy
  • Muscle relaxants, such as baclofen, used in the treatment of motor neurone disease and multiple sclerosis
  • Strong painkillers, such as naproxen and methadone (widely used to treat heroin addicts)

Retrograde ejaculation

This type of ejaculatory dysfunction is caused by damage to the nerves or muscles that surround the neck of the bladder (the point at which the urethra connects with the bladder). During the normal ejaculatory process, the semen is pushed out of the testicles and up through the urethra. The muscles of the neck of the bladder close tightly at the moment of orgasm preventing the semen from entering the bladder.

When these muscles are damaged, they do not work and the neck of the bladder cannot close, causing the semen to enter the bladder rather than the urethra. Prostate gland or bladder surgery are the most common causes of retrograde ejaculation. Other causes include some of the medical conditions mentioned above.

Diagnosing ejaculation problems

Most men realise they have a problem either through their own sexual behaviour or it may be discussed by their sexual partner. It is important to seek medical advice as the problem could have more serious underlying causes. Many men feel embarrassed to discuss PE with their GP but often the cause can be identified and easily treated.

What will your GP ask you

As with any medical condition, your GP will ask about your family medical history and any underlying conditions you or your family members may have, such as diabetes, heart disease or high blood pressure.

You will also be asked about your sexual and mental health to establish if there may be a psychological cause to your problem. They will also ask you about your lifestyle, including diet, exercise and what type of job you do as well as any problems in your life that could be causing stress. It is important to be clear and concise with your answers so that your GP can diagnose the problem correctly and prescribe the more appropriate treatment.

A rectal examination may be conducted to check for an enlarged prostate gland and to check the nerves of your penis for any damage. Your GP may carry out a visual examination of your pelvis to check for injury or infection. Blood and urine specimens may be taken to check your hormone and cholesterol levels.

Treating ejaculatory problems

If the problem is due to a physical cause, your GP can suggest suitable treatment options such as drug therapy or surgical intervention. If you feel too embarrassed to seek advice there are a few self help options you can try at home. These include:

  • Using a thicker condom to decrease sensation or a performance enhancing condom, which contains a numbing gel such as lignocaine inside it.
  • Masturbate 1-2 hours before having sex
  • Take deep breaths to shut down ejaculatory reflex
  • Have sex with your partner on top to allow them to pull away when you are close to orgasm
  • Think of something boring whilst having sex or take breaks and focus on non sexual thoughts.

Masturbation

Masturbatory patterns are forms of learned behaviour that often need to be unlearned. Orgasming quickly to avoid being disturbed trains your body to always respond in this way. You need to change this masturbation mentality of goal-oriented orgasm to one that focuses on taking your time and getting comfortable with heightened sensations. By giving yourself at least 20 minutes of masturbation time before allowing yourself to ejaculate, you can reduce the incidence of PE. Start by focusing on the start-stop method and penile stimulation of the shaft and glans (head) as the glans are generally the most sensitive areas of the penis and are continuously stimulated inside the vagina. The stop-start method is a tested method which enables a man to learn ejaculatory control and last longer during sexual intercourse.

By stimulating the penis until the point of no return (just before orgasming) then stopping to allow the feeling of orgasm to subside, repeating this twice and then allowing the orgasm to occur after the third time, a man can teach his mind and body to be comfortable with being in a heightened state of arousal and learning to recognise when the onset of orgasm is approaching. The idea is to increase the length of the plateau phase of the sexual response cycle and put more distance between the excitement and orgasm phase.

Begin your 20-minute stroking without lube and using just your imagination. Slowly work up to using imagery and lubrication. Try to control your ejaculation for a few seconds longer each day.

Penis sleeves

Using a penis sleeve has been shown to help PE by helping the man to build stamina and control when he ejaculates. Many are designed to mimic vaginal stimulation, such as Tenga eggs, penis sleeves or artificial vaginas (Fleshlight). Each of these likely have internal ribbed and studded portions that offer heightened states of stimulation, which you will learn to enjoy and control.

Regular use of a penis sleeve can help you learn to control when you ejaculate and once you have mastered more control you can initiate sexual intercourse with your partner using the same techniques you used with the penis sleeve. The Fleshlight Stamina Training Unit is designed exactly for this purpose.

Penis pumps

Penis pumps can often help you overcome PE by training you to control when you ejaculate. The Bathmate Hydromax is ideal for improving penis health. Gentler on the penis than a conventional penis pump, it uses water to create a vacuum rather than air.

Male Pelvic Floor Exercises

Men have a pelvic floor too, just like women but very few men are aware that doing pelvic floor exercises can increase penile hardness and rigidity, improving the quality of your erections. Pelvic floor therapy has been shown to be a safe and effective therapy for PE, improving control over ejaculatory delay and increasing the time it take to ejaculate. Pastore et al (2012)

It is recommended that you seek advice from a physiotherapist, trained in men’s health to instruct you how to do these exercises correctly.

Be more sexually imaginative

Although many men find it hard to believe, many women enjoy shorter sessions of sexual intercourse. Initiate a conversation about what you both enjoy and you might be surprised. Partners of men who suffer from PE often feel short changed when it comes to their pleasure as their partner concentrates on not ejaculating too quickly and neglects their needs.

Ask your partner what would give them the most pleasure or help them to orgasm. Using a vibrator on her clitoris, stimulation with fingers or oral sex can help her to orgasm. Spending more time having foreplay means that your partner may have their orgasm before you do and then they don’t mind if sexual intercourse isn’t as long as they might like it to be.

Incorporate bondage into your sex play to spice things up and make foreplay more fun. Try using silky cuffs and ties or blindfolds to create a sensory deprived sexual experience.

Using some of the techniques mentioned above can help men with PE to sustain longer sexual intercourse.

Couples’ Therapy

Couples’ therapy encourages couples to explore issues that may be affecting their relationship and are given advice about how to resolve them. Such issues could be impacting upon their sexual relationship, increasing their feelings of anxiety and anger.

A therapist may teach them the stop-start technique, getting the woman to stimulate her partner, then stop at the point of orgasm. This is the same as the technique described below except the woman is stimulating the man instead.

Drug therapy

Medication can be used to treat PE but many of the drugs have side effects and it is more beneficial to explore the techniques and methods mentioned above before resorting to medication if possible.

Retarded ejaculation

If side effects of your medication is the cause of retarded ejaculation, your GP may be able to offer an alternative drug.

Sex Therapy

Sex therapists use a combination of psychotherapy and structured changes in your sex life to help increase feelings of enjoyment and satisfaction in your sex life and help to make ejaculation easier. During each session you are given the opportunity to discuss any emotional or psychological issues related to your sexuality and sexual relationship, in a non judgemental way and strictly in confidence.

Your therapist may suggest activities to do at home in private which can include:

  • Watching or reading erotic films or books prior to having sex to promote sexual stimulation. Exploring erotic fantasies or sex games to make your sexual intercourse more exciting. Many couples are often surprised at what erotic inner thoughts their partner may have and this can help increase their sexual pleasure.
  • Using lubricants to make sex feel more pleasurable. It is important to use a product that is safe, such as YES organic lubricant. Many couples seem to think they do not need to use a lubricant because they should be naturally “wet” when having sex, but hormonal changes throughout the month, pregnancy and the menopause can alter the level of natural lubrication within the vagina. Vaginal dryness is always linked to the menopause but younger women and men can benefit from using lubricants too.
  • Using sex toys, such as “vibrators”: articles/sex-toy-tips/can-sex-toys-improve-your-sex-lifeor couples’ toys can heighten pleasure during sexual intercourse. Often thought as the preserve of women’s only play, many couples incorporate the use of sex toys into their sex play to make their sexual experience more fun and pleasurable.

Retrograde ejaculation

Most men do not need treatment for retrograde ejaculation as they tend to enjoy a normal sex life. Problems occur when they want to start a family. Medication can be used to strengthen the muscles around the neck of the bladder to prevent the sperm from entering the bladder after orgasm.

However, if there is significant nerve damage, medication will not be effective. Treatment may involve using in-vitro fertilisation or artificial insemination using a sperm sample collected from the man.

It is important to seek appropriate medical advice if you do have a problem. Many websites offer drugs or herbal remedies to help PE but some of these drugs are not licensed for use in the UK and there is serious doubt about their safety.

If you do suffer from PE, do not suffer in silence because you are too embarrassed to seek help. Your problem may be easily resolved after consulting your GP, so make that appointment as soon as possible and start enjoying sex again.

Useful Websites

College Of Sex and Relationship Therapists : www.cosrt.org.uk
Chartered Society of Physiotherapy : www.csp.org.uk
Relate : www.relate.org.uk