Delay Your Ejaculation!

Background to premature ejaculation

Premature ejaculation (PE) is without doubt the most common sexual problem in men under 40 years of age. Most doctors who work with men complaining of early ejaculation define PE as an ejaculation within a certain timescale (say two minutes) which also happens before both sexual partners wish it to do so. The problem with defining PE is that it is only a problem - and therefore only really exists as a condition within a relationship - if both partners are unhappy about it. Many couples live with rapid ejaculation and build their other sexual activities around it (e.g. by giving the woman an orgasm before sexual intercourse through masturbation or cunnilingus). If a rapid ejaculation happens more than fifty percent of the time a couple engage in sexual intercourse, then treatment may be appropriate.

Of course, as has been repeatedly stated on this and many other websites, many women do not reach orgasm through intercourse, so it is possible that this definition is inadequate. For example, when a man is actually able to last for twenty minutes during sex before he ejaculates, but his partner requires thirty minutes of thrusting during intercourse before she can reach orgasm by vaginal stimulation, it is questionable whether the man is suffering from premature ejaculation! (Indeed, few experts would call this premature ejaculation!)

Male and female sexual response has at least 3 phases: sexual desire (libido), sexual excitement (arousal), and orgasm.

Premature ejaculation may be defined as primary or secondary PE. Primary PE is a category for men who have had t as a lifelong experience during sex. Secondary PE suggests a man once had acceptable ejaculatory control, but now, for some reason, has begun to experience premature ejaculation later in life. Although much work has gone into the condition, no one really knows why some men ejaculate faster than others - indeed, it could be that fast ejaculation is actually normal. But a psychological cause is most likely...

Pathophysiology of Premature Ejaculation

Premature ejaculation as a psychological problem does not involve any known disease of the male reproductive tract or any so far discovered problems of the brain or nervous system. Could the problem lie somewhere in the male reproductive system (i.e., penis, prostate, seminal vesicles, testicles)? The answer is that we do not really know. But when PE happens before satisfying intercourse is completed, both the man and his partner will be dissatisfied both emotionally and physically.

Premature ejaculation has often been spoken of as a psychological problem. As you may have seen, some experts have suggested that young men are conditioned by societal pressures to ejaculate in rapid order because of fear of discovery when masturbating or during early sexual experiences. But although this may become a habit, it's hard to imagine it is actually an ingrained physiological response which cannot be changed later in life. Therefore, some researchers have suggested there may be a physical cause, such as differences in nerve conduction rates or hormonal differences between men: even hyper-excitability or oversensitivity of the penile nerves has been suggested. This would stop down-regulation of their sympathetic nervous system pathways and inhibit delay of orgasm.

In some cases premature ejaculation represents other issues: e.g. a cardiac patient may fear a myocardial infarction during sex, and so develop premature ejaculation.

But it is logical from an evolutionary point of view that males who ejaculated rapidly would have more success when mating and fertilizing a female than those who needed prolonged mating time. Therefore, the genes of a male who came quickly would stand more chance of passing his genes on to the next generation - and also, a male who took a long time to mate might well be killed because of his vulnerability during intercourse.

Frequency of premature ejaculation

Premature ejaculation occurs in between 30 and 70% of men. The percentage is similar in all age categories: of course, erectile dysfunction becomes more common in older age groups. Since many men do not discuss rapid or premature ejaculation with their doctor, probably because of embarrassment or a sense of hopelessness around a cure, or even because they are satisfied with the quality of their ejaculations (no matter how quickly they occur), the proportion of men who have premature ejaculation in their lives is almost certain to exceed conventionally accepted figures of 30%.

Race and premature ejaculation

No firm data exists on the subject.

Age and premature ejaculation

Premature ejaculation is most common in younger men (in an age group between 18 and 30 years) but is far from uncommon in men aged 45-65 years, where it is often associated with erectile dysfunction.

Treating Premature Ejaculation

Treatment will vary according to whether premature ejaculation has been a lifelong problem (i.e., primary) or has been acquired later in life (i.e., secondary).

Primary premature ejaculation - factors associated with early ejaculation

• Prior psychological difficulties: there is some evidence men with prior psychiatric conditions have higher rates of PE than other men
• Traumatic sexual episodes during childhood or adolescence - even discovery by mother or father masturbating can produce inhibiting guilt: shame and punishment for masturbation is also a cause of inhibited sexual responses during adulthood
• Family incest or sexual assault, sexual assaulted by either family members or non-family members
• Difficulties with work, socializing, studies
• General attitude toward sex (for example, is it seen as shameful or dirty)
• Abnormal or guilt inducing sexual preferences, fantasy life, and sexual arousal patterns
• Strict religious upbringing with negative teachings about sex
• Guilt about sexual relationships
• A pattern of early ejaculation even before sexual intercourse began
• Problems with the sexual attitudes and sexual responses of the female partner
• Relationship dynamics: are the couple harmonious or do they fight a lot?
• Blame or lack of support from the female partner

Secondary premature ejaculation - factors of relevance

• Has PE been a problem in previous relationships?
• In the current relationship, is early ejaculation a long-standing problem or has it started recently?
• Is conflict between the two partners present? Who is dominant: is the relationship generally equal in the balance of power, both sexual and non-sexual?
• Is the female partner supportive?
• Does the man have a problem with erectile dysfunction (ED), and if so, what is its relationship to the rapid ejaculation?
• Can intercourse be completed satisfactorily?
• Does premature ejaculation occur during other forms of sex play? 
• Does the female partner reach orgasm during intercourse, or does she require direct clitoral stimulation to reach climax?
• If ED began after the premature ejaculation, then both need treating; if the ED came first, the premature ejaculation may be a secondary sexual dysfunction, which resolves spontaneously when the man has regained his erectile power.

Causes of premature ejaculation

The cause of premature ejaculation is considered psychological, although no one really knows.

• Deep-seated emotional disturbance may be causing PE
• Deep anxiety about sex due to traumatic experiences including family incest, sexual assault, conflict with one or both parents, or other psychological disturbances.

• Performance anxiety is often a major factor.
• Performance pressure - such as fear of not being able to satisfy the partner - can be caused by many things, including ED.
• Previous ED or imagined erectile failure may precipitate premature ejaculation.
• Comments such as "You aren't much of a man, you can't stay hard or satisfy me" may reduce his sexual self-confidence.
• If the woman can't come through sexual intercourse, and doesn't tell her partner, he may feel like a failure - which in some sense he will be since he seeks to do the impossible.

Women may have anorgasmia or severely delayed orgasm. Delayed or difficult orgasm in the female partner may define the man's premature ejaculation.

Drug usage and premature ejaculation are often linked.

Lubricating fluids produced by Cowper's glands may be taken as ejaculate by te sexually naive.

Erectile dysfunction (ED) can be a symptom in men who are actually experiencing premature ejaculation.

In men with premature ejaculation

• checks of serum testosterone (free and total) and prolactin levels may reveal some underlying hormonal issue if premature ejaculation and impotence are both present
• depression may cause impotence or premature ejaculation
• vibrational threshold testing is considered experimental
• including the female partner in the treatment and counseling helps
• the first step is to relieve any performance pressure on the man

Treatment of premature ejaculation

One approach is to use the stop-start or squeeze-pause technique popularized by Masters and Johnson.

The woman slowly masturbates her partner but stops as soon as he senses ejaculatory inevitability.

Then, she should firmly squeezes his penis just under his glans - uncomfortable but not painful. Masturbation stimulation should begin once more when the man loses the feeling that his ejaculation is imminent.

The process is repeated / practiced for ten cycles or more.

Most men find a gradual improvement in ejaculatory control.

After a period, the couple sit facing each other, positioned so the female partner's legs cross on top of her partner's. She can arouse him by rubbing his penis against her vulval area. As before, when he approaches ejaculation, she can squeeze and stop all stimulation, then repeat the process.

Finally, intercourse may be attempted, with the woman on top so that she can withdraw his penis if he approaches ejaculation and apply a squeeze to reduce his urge to ejaculate.

Another therapy - desensitizing cream for the man

SS Cream (a combination of 9 ingredients, mainly herbal) desensitizes the penis and helps men with premature ejaculation to delay their ejaculation.

SS Cream is not approved by the US Food and Drug Administration (FDA), but a similar principle applies to lidocaine cream or other topical anesthetic agents; they are safe as long as the man has no allergy to the active ingredient,

If the man is relatively young, he may find that his ejaculatory control is much better if he attempts intercourse a second time soon after his arousal has dropped.

It may be helpful to masturbate to orgasm 1-2 hours before sex is planned. The interval for achieving a second ejaculation is much longer, and a man can usually exert better control. This is not so effective for an older man, because of problems in getting a second erection.

The most effective drug to help with premature ejaculation is a selective serotonin reuptake inhibitors (SSRIs) or a tricyclic antidepressants with SSRI-like activity. These drugs have a side effect of a tendency to delay reaching orgasm. Medications with SSRI side effects have therefore been offered to men with premature ejaculation. There is, however, no drug is approved by the FDA for treatment of rapid ejaculation.

Some studies have shown that selective serotonin reuptake inhibitors (SSRIs) and drugs with SSRI-like side effects can be effective in treating PE. SSRIs have been the most effective in delaying too-rapid ejaculation.

Premature ejaculation associated with erectile dysfunction (ED) may resolve if the ED is treated successfully with sildenafil (Viagra), vardenafil (Levitra), tadalafil (Cialis), or even the older drug alprostadil (Caverject, Muse). If a man has depression-related ED only, the use of an antidepressant drug with few or no sexual effects might be used to avoid creating delayed ejaculation or even anorgasmia. These would include bupropion HCl (Wellbutrin) or venlafaxine HCL (Effexor). Needless to say, if a man has premature ejaculation, rectile problems, and depression, an antidepressant with SSRI side effects may help solve the premature ejaculation issue.

Drug Category: Selective serotonin reuptake inhibitors

Their action is linked to reducing uptake of serotonin in the central nervous system. SSRIs have weak effects on norepinephrine and dopamine neuronal reuptake. They do not antagonize adrenergic, cholinergic, GABA, dopaminergic, histaminergic, serotonergic, or benzodiazepine receptors; this means they have fewer adverse anticholinergic effects than the family of tricyclic antidepressants.

SSRIs cause sexual side effects, including delay in sexual orgasm for both men and women; while delayed in reaching orgasm caused by an SSRI is an adverse effect in women, the same may not be true in men. Indeed, it can help to overcome too-rapid orgasm. Sertraline (Zoloft), paroxetine (Paxil), and fluoxetine (Prozac) are helpful SSRIs for treating premature ejaculation.

The optimal treatment for premature ejaculation is unknown, but single dosing before sex works for some men, while daily use of the medication may be necessary for others. The daily dose may be increased gradually until a therapeutic effect is achieved. If one SSRI doesn't help, using a second alternative is reasonable. After 6 weeks at maximal dose with no improvement, no further treatment is recommended.

Drug Category: Topical anesthetic agents

Topical anesthetic agents reduce penile sensitivity and delay ejaculation, and are probably the lowest-risk medication for premature ejaculation, having no adverse systemic effects. they may be used with antidepressants, and behavioral therapy.

Drug Category: Phosphodiesterase type 5 inhibitor (PDE5 inhibitor)

Studies have shown that Viagra and other PDE5 inhibitors work better is topping PE when combined with SSRIs. We don't know why, but it may be that an improved erection from the PDE5 inhibitor causes inhibition of ejaculation via down-regulation of receptors involved in somatosensory latency times. More likely, a lower level of performance anxiety causes greater sexual self-confidence. PDE5 inhibitors are safe and effective as part of a treatment regime for premature ejaculation where there is no other contraindication.

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