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In premature
ejaculation, a man ejaculates quickly after
sexual arousal
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Premature
ejaculation, or rapid ejaculation, is a common
type of sexual dysfunction
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Causes for this
condition usually are unknown, but it often is
related to anxiety
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Premature
ejaculation that prevents sexual intercourse
results in infertility
Premature
ejaculation (PE) is a term used to describe a
condition in which a man regularly ejects semen
(i.e., ejaculates) very soon after the onset of
sexual arousal, or sooner than he or his partner
wishes. This condition, which is also called
rapid ejaculation, is the most common type of
sexual dysfunction in men under the age of 40.
Premature
ejaculation can be primary (in men who have had
the condition since puberty), or secondary
(acquired; in men who previously had control of
ejaculation). It may develop in men who have
erectile dysfunction (impotence) and are anxious
about maintaining an erection during sexual
intercourse.
Premature
ejaculation often causes distress for the man
and for his partner. When the condition
regularly occurs before penetration, it may
prevent pregnancy.
Definition
Many men
occasionally ejaculate sooner during sexual
intercourse than they or their partner would
like. As long as it happens infrequently, it's
probably not cause for concern. However, if you
regularly ejaculate sooner than you and your
partner wish such as before intercourse begins
or shortly afterward you may have a condition
known as premature ejaculation.
Premature
ejaculation is a common sexual disorder.
Estimates vary, but some experts think it
affects as many as one out of three men. Even
though it's a common problem that can be
treated, many men feel embarrassed to talk to
their doctors about it or seek treatment.
Once thought to be
purely psychological, experts now know that
biological factors also play an important role
in premature ejaculation. In some men, premature
ejaculation is related to erectile dysfunction.
You don't have to
live with premature ejaculation treatments
including medications, psychological counseling
and learning sexual techniques to delay
ejaculation can improve sex for you and your
partner. For many men, a combination of
treatments works best.
Symptoms
There's no medical
standard for how long it should take a man to
ejaculate. The primary sign of premature
ejaculation is ejaculation that occurs before
both partners wish in the majority of sexual
encounters, causing concern or distress. The
problem may occur in all sexual situations,
including during masturbation or it may only
occur during sexual encounters with another
person.
Doctors often
classify premature ejaculation as either primary
or secondary:
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You have
primary premature ejaculation if you've had
the problem for as long as you've been
sexually active.
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You have
secondary premature ejaculation if you
developed the condition after having had
previous, satisfying sexual relationships
without ejaculatory problems.
Incidence and
Prevalence
Premature
ejaculation affects males only and can occur at
any age of adulthood. The condition is most
common between the ages of 18 and 30. It is
estimated that premature ejaculation affects
from 3070% of men during their lifetime.
The cause for
premature ejaculation is unknown, although, in
most cases, it is thought to be the result of
psychological factors (e.g., anxiety, guilt).
Rarely, the condition is caused by a physical
problem, such as over sensitivity of the
genitals or abnormal hormone (e.g.,
testosterone) levels. Certain medications (e.g.,
psychiatric drugs) may cause premature
ejaculation.
Risk factors for
the condition include erectile dysfunction
(impotence), stress, and health conditions that
cause anxiety during sex (e.g., angina, previous
heart attack).
Causes
Experts are still
trying to determine exactly what causes
premature ejaculation. While it was once thought
to be only psychological, we now know premature
ejaculation is more complicated and involves a
complex interaction of both psychological and
biological factors.
Psychological Causes
Some doctors
believe that early sexual experiences may
establish a pattern that can be difficult to
change later in life such as:
Other factors that
can play a role in causing premature ejaculation
include:
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Erectile
dysfunction. Men who are anxious about
obtaining or maintaining their erection
during sexual intercourse may form a pattern
of rushing to ejaculate which can be
difficult to change.
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Anxiety. Many
men with premature ejaculation also have
problems with anxiety either specifically
about sexual performance, or caused by other
issues.
Biological Causes
Experts believe a
number of biological factors may contribute to
premature ejaculation, including:
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Abnormal
hormone levels
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Abnormal
levels of brain chemicals called
neurotransmitters
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Abnormal
reflex activity of the ejaculatory system
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Certain
thyroid problems
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Inflammation
and infection of the prostate or urethra
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Inherited
traits
Rarely, premature
ejaculation is caused by:
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Nervous system
damage resulting from surgery or trauma
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Withdrawal
from narcotics or a drug called
trifluoperazine (Stelazine), used to treat
anxiety and other mental health problems
Although both
biological and psychological factors likely play
a role in most cases of premature ejaculation,
experts think a primarily biological cause is
more likely if it has been a lifelong problem
(primary premature ejaculation).
Risk Factors
Various factors
can increase your risk of premature ejaculation,
including:
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Impotence. You
may be at increased risk of premature
ejaculation if you occasionally or
consistently have trouble getting or
maintaining an erection. Fear of losing your
erection may cause you to rush through
sexual encounters. As many as one in three
men with premature ejaculation also have
trouble maintaining an erection.
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Health
problems. If you have a medical concern that
causes you to feel anxious during sex, such
as a heart problem, you may have an
increased likelihood of hurrying to
ejaculate.
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Stress.
Emotional or mental strain in any area of
your life can play a role in premature
ejaculation, often limiting your ability to
relax and focus during sexual encounters.
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Certain
medications. Rarely, drugs that influence
the action of chemical messengers in the
brain (psychotropics) may cause premature
ejaculation.
Tests and Diagnosis
Doctors
diagnose premature ejaculation based on a
detailed interview about your sexual history.
Your doctor may ask a number of very personal
questions and may want to include your partner
in the interview. While it may be uncomfortable
for both of you to talk frankly about sex, the
details you provide will help your doctor
determine the cause of your problem and the best
course of treatment. A mental health
professional may help make the diagnosis.
Your doctor will
want to know about your health history, and may
perform a general physical exam. You doctor may
ask you questions about:
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How often you
have premature ejaculation
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Whether you
have premature ejaculation only with a
specific partner or partners
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Whether you
have premature ejaculation every time you
have sex
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How often you
have sex
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How you feel
premature ejaculation affects your enjoyment
of sex and your quality of life
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Whether you
also have trouble getting and maintaining an
erection (erectile dysfunction)
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Your use of
prescription medications and recreational
drugs
To evaluate
whether psychological factors may influence your
premature ejaculation, your doctor or mental
health professional may also want to know about:
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Your
religious upbringing
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Your
early sexual experiences
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Your
sexual relationships, past and present
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Any
conflicts or concerns within your current
relationship
If you have both
premature ejaculation and trouble getting or
maintaining an erection, your doctor may order
blood tests to check your male hormone
(testosterone) levels or other tests.
Complications
While premature ejaculation doesn't increase
your risk of serious health problems, it can
cause distress in your personal life, including:
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Relationship strains.
The most common complication of premature
ejaculation is relationship stress. If
premature ejaculation is straining your
relationship, ask your doctor about
including couple's therapy in your treatment
program.
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Fertility problems.
Premature ejaculation can occasionally make
fertilization difficult or impossible for
couples who are trying to become pregnant.
If premature ejaculation isn't effectively
treated, you and your partner may need to
consider infertility treatment.
Prevention
In
some cases, premature ejaculation may be caused
by poor communication between partners or a lack
of understanding of the differences between male
and female sexual functioning. Women typically
require more prolonged stimulation than men do
to reach orgasm, and this difference can cause
sexual resentment between partners and add
pressure to sexual encounters. For many men,
feeling pressure during sexual intercourse
increases the risk of premature ejaculation.
Open communication between sexual partners, as
well as a willingness to try a variety of
approaches to help both partners achieve
satisfaction, can help reduce conflict and
performance anxiety. If you're not satisfied
with your sexual relationship, talk with your
partner about your concerns. Try to approach the
topic in a loving way and to avoid blaming your
partner for your dissatisfaction.
If
you're not able to resolve sexual problems on
your own, talk with your doctor. He or she may
recommend seeing a therapist who can help you
and your partner achieve a fulfilling sexual
relationship
To Learn Ejaculatory Control
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Don't use drugs or
alcohol. They're distracting and they
interfere with the self-awareness crucial to
learning ejaculatory control.
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Appreciate whole-body
sensuality. Men often think sex happens only
in the penis and only during intercourse.
That view is a one-way ticket to premature
ejaculation (not to mention erection
problems, and women with those proverbial
headaches). The best sex involves
head-to-toe arousal. Men learning how to
approach -- but not arrive at -- their point
of no return, need to appreciate whole-body
sensuality, the pleasure potential in every
square inch of the body. Whole-body
sensuality releases tension. Tense bodies
that have no other outlet often find release
through involuntary ejaculation. But as you
learn to appreciate sensual pleasure from
head to toe, whole-body arousal takes the
pressure off your penis, and you last
longer.
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Whole-body sensuality
means relaxation, but the "relaxation"
involved in great sex is not the kind that
includes an easy chair, a six pack, and
Monday Night Football. It's the kind you
feel after a hot bath or a good massage. In
fact, bathing or showering together before
lovemaking can help men relax and appreciate
whole-body sensuality -- and last longer.
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Breathe deeply. One
very easy way to stay relaxed while making
love is to breathe deeply. The body has a
natural tendency to breathe deeply during
sex. But many men fight it. They think they
should stay in control by not breathing
deeply and making the little love-moan
sounds that go along with it. But when men
work to control their breathing, they often
sacrifice ejaculatory control. Try breathing
deeply. Let your breath go. Many men are
amazed how much this one little change
improves their premature ejaculation.
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Start with
masturbation with a dry hand. By varying how
you caress your penis, you can learn to stay
highly aroused for quite a while without
coming. When you feel yourself approaching
your point of no return, simply back off a
bit, stroke yourself more gently or not at
all, and stay aroused without ejaculating.
Then as you feel yourself getting a little
distance from your point of no return,
return to more vigorous self-stimulation.
Repeat this several times over several
sessions. Approach your point of no return,
then back off. For most men, it doesn't take
long to develop good ejaculatory control
while alone.
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Then move on to
masturbation with a lubricated hand. Use
saliva, vegetable oil, or a commercial
sexual lubricant. For most people,
lubricants increase the sensual intensity of
erotic fondling. Follow the same program:
Masturbate until you approach your point of
no return, then back off. Repeat this
several times over several sessions.
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Once you have good
control during masturbation, and appreciate
whole-body sensuality, and feel comfortable
breathing deeply during lovemaking, then
you're ready for the couples program -- if
you're in a couple. The couple approach is
called the "Stop-Start Technique." First,
arrange "stop" and "start" signals with your
lover, for example, a light pinch or tap, or
a tug on an ear.
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Then, your lover
strokes your penis by hand as you lie still.
When you approach your point of no return,
give the "stop" signal. Your lover
immediately stops stroking you and simply
holds your penis gently, as you continue to
breathe deeply and pays close attention to
the sensations you're feeling. When you no
longer feels close to ejaculation, gives the
"start" signal, and your lover begins
stroking you again. How many stops and
starts should you do? A half-dozen over a
15-minute period works well for most
couples. Do what feels comfortable for you.
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With stop-start, the
focus is on the man. He's the one learning
the new skill. But don't forget the woman's
sensual needs. As part of each practice
session, she might guide your hand over her
to show you what she likes.
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Once you've gained
good ejaculatory control with your lover's
hand, try the same stop-start procedure with
oral caresses. Again, you begin by lying
still.
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Once you've gained
good control orally, feel free to start
moving. You're making love again -- but now
you have ejaculatory control.
Congratulations.
Here are some other suggestions for lasting
longer:
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The man-on-top
(missionary) position can be fun, but it's
harder for most men to control their
ejaculatory timing, because they have to
hold themselves up. Try making love with the
woman on top. This position is more relaxing
for men, and it often helps ejaculatory
control.
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Make some noise. Love
moans help men (and women) relax, and they
often help men last longer.
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It's important to
understand that learning ejaculatory control
takes time and practice. You may feel a
little awkward along the way. Try to
maintain a sense of humor about any
accidental spills.
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Some penile skin
creams advertise that they help a man last
longer. These products contain topical
anesthetics that dull sensation in the
penis. If you like to play with penile
sensation, there's no harm in using them.
But they're not a good idea for learning to
last longer. They dull sensation. But the
key to lasting longer is for the man to
become more familiar with what he feels so
he can back off from his point of no return
while still remaining highly aroused.
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Finally, the program
we recommend for learning ejaculatory
control is very likely to provide your lover
with greater sexual enjoyment -- but not
just because you last longer. Women
generally prefer leisurely, playful,
whole-body, massage-oriented sensuality that
includes the genitals but is not limited to
them. Women's main complaints about men's
sexual style are that it's too rushed, too
mechanical, too eager for intercourse, and
that it focuses only on the breasts and
genitals. Women generally feel that the
whole body is a sensual playground and can't
understand why so many men explore only a
few corners of it. Like women, penises
generally prefer leisurely, playful,
whole-body, massage-oriented lovemaking. The
rushed, penis-centered, intercourse-fixated
sex style puts a lot of pressure on the
penis, and leads to premature ejaculation.
But when men make love the way women prefer,
whole-body arousal takes the pressure off
your penis and you last longer. Basically,
if men would make love the way women prefer,
women would have fewer complaints, and men
would have fewer sex problems.
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