Premature Ejaculation Treatment

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Premature ejaculation treatment

Premature ejaculation is the most common male sexual problem. As we know, one of the fundamental problems with premature ejaculation is that there is no universally accepted definition, nor is there a drug treatment for it. (At least, not one approved for use in America.) Even so, most of us would probably recognize a case of premature ejaculation, especially if one were the man in question! The accepted treatment for premature ejaculation continues to be behavioral therapy - the question is whether or not there is a better approach, or a more effective one.

Most experts would agree that between a quarter and four tenths of all men experience ejaculation before they wish it to happen. Of course, perception is a big factor in this condition, and most doctors or therapists will use the definition in The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, which is: "Premature ejaculation is persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the man in question wishes it."

In addition, when you define premature ejaculation this way, the definition specifies that premature ejaculation must cause marked distress or interpersonal difficulty. Another definition is that premature ejaculation is "persistent or repeated ejaculation with little stimulation before or just after penetration and certainly before the man wishes it, and over which the man in question has almost no voluntary control." There's also a rider that the speed of ejaculation must cause the man or his partner some emotional distress. Well, that of course is highly subjective, and not all couples are bothered to that extent by a quick ejaculation, even if the man in question would like to be able to last longer in bed.

The key things, of course, in identifying premature ejaculation are that (1) there is a short interval between penetration (intromission) and ejaculation, (2) that there is a lack of voluntary control over ejaculation and that (3) there is some emotional upset for one or both partners. Now, those of us who have counseled men with premature ejaculation might take issue with the idea that "upset" or "distress" on the part of one or both partners is a necessary antecedent for the condition to be defined as premature ejaculation. Certainly I have met many men who wished they could last longer in bed but who do not allow it to cause them emotional distress or suffering!

There is one definition, in the International Classification of Diseases, Tenth Edition, that specifies a time limit for the length of lovemaking - fifteen seconds. Well, that seems nothing less than ridiculous, for many men who ejaculate within two (or five) minutes would probably consider themselves premature ejaculators, so fifteen seconds is ludicrous, and in any case, any defined cut-off time is purely arbitrary.

Having said that, most experts agree that men who ejaculate within one minute of insertion or penetration have premature ejaculation. Waldinger and colleagues have done much to define time limits between insertion and ejaculation that may be considered to fall within the definition of premature ejaculation. Their median is 5.4 minutes. Such definitions have been welcomed by researchers as a way to assess the effectiveness of treatments.

Obviously it's crucial for men who have premature ejaculation to identify themselves as having no voluntary control over their ejaculation - and I think one point that many researchers miss is that men who cannot control their ejaculation may well not understand that it is in fact possible to exert voluntary control over such an apparently involuntary bodily function. In my view they may well be upset about the lack of control that they have in bed over their ejaculation, but they often do not appreciate that it is in fact possible to control ejaculation through voluntary effort.

Historically, premature ejaculation was though of as a purely psychological problem and behavioral therapy was thought of as the best treatment. The so-called "stop-start technique" was the first and classic treatment for premature ejaculation - it requires a man's partner to stimulate his penis until he is almost at the point of no return, then to stop the stimulation until he knows he is no longer near ejaculation (in other words, until his arousal has dropped below the point at which there is a danger of him ejaculating). The pattern of stimulation and stopping stimulation is repeated until there is a degree of control over ejaculation. A similar technique was put forward by Masters and Johnson in 1970, though they asked the man's partner to squeeze his frenulum after she stopped stimulating him - presumably because such pressure can cause a loss of erection, so it will obviously take longer for him to get fully aroused again.

The reality, of course, is that many cases of premature ejaculation are caused by a lack of sexual confidence, by psychosexual anxiety, and by interpersonal issues such as anger or lack of interest in the partner's well-being, pleasure or satisfaction (what you might call a kind of sexual selfishness). Although teaching these techniques to delay ejaculation has been a main plank of psychosexual therapy, it may well be much more important in a psychodynamic sense for therapy to be directed at helping a man regain his sexual confidence, reduce his sexual performance anxiety, and more than anything else to resolve any interpersonal difficulties with his sexual partner. Treatment success is rather variable (although the methods on this website are about as successful as you can get), and the reasons for that appear to be that ejaculation is a spinal reflex which is strongly controlled by higher cortical centers - in other words, establishing voluntary control over it is difficult.

Well, that is a matter of opinion. I think that when the motivation to cure premature ejaculation is there, establishing voluntary control is not actually that difficult. Sure, it takes time and practice, but the key thing is motivation. This control can be developed. It is influenced by past experiences and present context, but there are a very few men with what one might consider to be definitive premature ejaculation; that is to say, an ejaculation latency which is so short and difficult to control that they may be considered to have a genetic bias towards early ejaculation.

Needless to say, it has been suggested that rapid ejaculation is an evolutionary advantage: the faster you fuck, the safer you are, and the more likely are your genes to pass on to the next generation. This may be so, but it doesn't alter the fact that today premature ejaculation is a social, if not an evolutionary, handicap.

So what is the answer? One answer is to adopt a multi-disciplinary approach which combines all available treatment methods.

Premature ejaculation, based upon the Asian Journal of Andrology, 2008 Jan; 10: 102-109