The physical causes of premature ejaculation

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An email: I am 25 and have met a girl with whom I have sex five or sex times every week-end. This is great but for the fact that I come too quickly, and she never reaches orgasm during intercourse. I feel very frustrated, because we both enjoy sex but it would be nice to come during intercourse, even though I always help her to reach orgasm afterwards. I want to give her an orgasm while we are enjoying sex. She feels the same way but I just don't know how to last longer in bed. When I try harder it seems even less likely I can ever control my ejaculation.

Another email: I am 40 and have been married for several years, but I have never been able to stop myself ejaculating long enough to get my wife to orgasm during sex. I give her oral sex before I go into her but not being able to make love properly means I feel sexually inadequate. When I masturbate it takes me up to 10 minutes to ejaculate, so why am I so quick during sex?  I hardly my penis in the soft warm wetness of her vagina when I come. My wife is getting fed up of this, and so am I for that matter. 

Another email: I am 46 and have been married 17 years. Until recently our sex life was very satisfying; but eighteen months ago I started coming too soon. I believe most men do this on occasion but after a few months, it's no better - a few thrusts and I've ejaculated. My wife is sympathetic but frustrated. Is there anything I can do about it?

These three emails are typical of the queries I get from men with premature or rapid ejaculation - one of the common sexual problems among men, it is common among young men but also happens to men of all ages - and can occur in mid-life when other issues and sexual difficulties also develop.

Premature or rapid ejaculation may occur even before the penis is in the vagina, but it mostly happens inside of two minutes after penetration or intromission. The short time of penetration deprives the woman of the pleasure of feeling her man inside her, and sometimes of the chance of an orgasm as well. Most men can't thrust after they ejaculate since they lose their erection or the glans is too sensitive, but for young men blessed with a continuing erection, this may be one answer to the problem.

For older men, a second go at lovemaking after the initial premature ejaculation may help. However, may men simply can't get another erection - one ejaculation is enough for them, and so some other strategy is needed. Except for men with a high sex drive, who can obtain an erection in a short space of time, few middle-aged men can keep their sexual desire very long after they have ejaculated. (It seems very few men with a high sex drive actually experience premature or too rapid ejaculation.)

What are the causes of premature ejaculation?

Premature ejaculation seems to be mostly psychologically based. But there are some physical causes: a few men seem to have hypersensitive nerves in the penile glans and frenulum. It has been suggested that circumcision may help by exposing the glans and reducing its sensitivity, but there are only seconds difference in the time between penetration and ejaculation in uncircumcised and circumcised men. A few of these men have discovered that anesthetic cream can improve their staying power.

The cream with lignocaine can be rubbed into the glans and frenulum up to half an hour before intercourse. If the penis is washed well before sex play begins, it is even possible for the woman to offer fellatio without any unpleasant taste. However, a lot of men have reported that these creams are useless: they may find that if they can experiment, this problem can be resolved. For example, try using the cream an hour before sex, or use twice the suggested application of cream; with such experiments, you may discover your exact personal requirements.

Another physical cause of premature ejaculation - the short frenulum - is difficult to treat. (The frenulum is the band of skin which joins the skin of the penile shaft to the surface of the glans - it is full of sensitive nerves which bring on erection and help to produce orgasm.) The skin of the penile shaft always moves a little during sex, especially when the penis moves forward into the vagina - the skin of the shaft is pulled downwards, which pulls the frenulum tighter. This pulling action stimulates the nerves in the frenulum and can assist in reaching orgasm. A man who is uncircumcised and has a short frenulum as well is even more likely to ejaculate quickly because when his foreskin moves back and forth it exerts an even greater pressure on the nerves of the frenulum.

However, short frenulums are not common. Sometimes surgery (cutting the frenulum) has been used to help stop the frenulum pulling on the glans and so stimulating the orgasm-producing nerves. However, since cutting the frenulum severs the nerves, the man may find he can no longer reach orgasm as easily - indeed, possibly at all. If the nerves of the glans are also insensitive, the man in question may well have great difficulty in reaching orgasm. In one case, this operation was carried out and as a result, the man, instead of ejaculating too soon, could not ejaculate at all.

A more practical answer to deal with premature ejaculation caused by short frenulums is to try stretching the frenulum. A man can do this by getting hard and erect, then holding his penis firmly just below the coronal rim, while pulling the skin of the penile shaft down towards his pubic area. As he does this, the frenulum stretches. He should stop when it hurts and then keep it stretched until he starts to feel he may ejaculate. He then ceases stretching until the imminent-orgasm-like-sensations dissipate, then repeat the process. By stretching his frenulum for five or six minutes daily for several days he may find that his frenulum becomes permanently stretched and he has cured his premature ejaculation.

Other physical causes of premature ejaculation

Inflammation of the urethra and/or prostate may also cause premature ejaculation. This is a strong suspect for sudden onset PE after a life of ejaculating with control. There may only be slight symptoms of urethral irritation or prostatitis, most often a burning sensation while releasing urine and frequent desire to urinate.

Prostatitis is the result of bacteria travelling up the urethra to the prostate gland. The symptoms are urgency of desire to urinate, a frequent need to urinate, unclear or cloudy urine, possibly with blood in it, reduced sexual desire, loss of erection and premature ejaculation. Infected sinuses, tonsils and abscesses are all suspects for the bacterial infection:  in a man over forty, premature ejaculation or too rapid ejaculation indicate a consultation is needed without delay. Prostatitis can be cleared up with antibiotics, and when cured, the rapid ejaculation trouble will also disappear.

One last word. I receive about twenty emails a month from men asking me how they can overcome rapid ejaculation. They often believe frequent masturbation during adolescence has caused later loss of control, but the evidence does not support this: frequency of teenage masturbation is not related to later too-rapid ejaculation.