Overcoming Premature Ejaculation: Causes and Treatment Options

Been there, done that. Admit it, men. Premature ejaculation (PE). It's happened to nearly all of us. Only most of us are too embarrassed or ashamed to talk about it. We don't, however, have to take it lying down. Men's sexuality experts, medical professionals, and the pharmaceutical industry are out there, well aware of this predicament, and they do have a few tricks to offer. Premature ejaculation can be overcome.

PE Definition

First, a definition, from the International Society For Sexual Medicine: "Premature ejaculation is a male sexual dysfunction characterized by ejaculation which always or nearly always occurs prior to or within about one minute of vaginal penetration; and, inability to delay ejaculation on all or nearly all vaginal penetrations; and, negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intimacy." While PE is not a serious physical ailment like a heart attack or arthritis, it can lead to serious psychological issues, such as depression and anxiety. Many men report shame, embarrassment, and anger at not being able to last long enough during intercourse to please their partners. In some cases, PE has led to relationship breakup and divorce.

PE Causes

So what causes PE? Like many physical issues, it's extremely complicated and not fully understood. For starters, there may be a Darwinian "survival of the fittest" component-the prehistoric males who ejaculated quickly after starting intercourse were more likely to pass on their genes than those who took longer (and were more likely to be interrupted or attacked by a competitor). Sexually unsatisfied ladies can blame Darwin for their man's rapid discharge.

PE may be due to any number of male psychological issues. PE can go all the way back to when men typically first discovered the pleasure of ejaculation--teenage masturbation. Frequently at that age, fear of being caught in the act led to masturbating extremely quickly to avoid detection. Or, like a drug addict searching for a quick high, guys pleasured themselves in a frenzy just to speed up the mental rush during orgasm. Thus, for some men, rapid ejaculation, and subsequently PE during intercourse, was a learned behavior.

PE can also be due to more generalized psychological problems, such as high levels of stress or anxiety. Sometimes these conditions are directly connected to sexual performance, like worrying about pleasing their partner. Stress and anxiety from other sources, like the workplace, financial issues, or lack of sleep can also lead to PE. By working with a doctor, getting these more general mental issues under control can reduce PE.

For many, the root of PE is believed to be biological. The nervous system of many men may be excessively wired toward stimulation, such that minimal triggering of the nerve endings in the penis leads to a disproportionately large release of the body's chemical messengers associated with ejaculation. For these men, PE has been a life-long problem.

Treatment Approaches-Mental

Now, the good news. Measures can be taken to halt premature ejaculation, or at least to delay it to an acceptable level. These methods can include mental approaches, physical tactics, and drug therapy. Mentally, the idea is quite simple, to reduce the man's excitement level during sex, and thereby lengthen the time before ejaculation. By actively focusing their thoughts during sex on something unrelated, or even unpleasant, men can sometimes sidetrack the rapid ejaculation response. In actuality, this method seldom works very well or for very long. Besides, one's partner is likely to perceive such inaction as a lack of interest or commitment and get angry.

Treatment Approaches-Physical

Physical tactics have a greater and more time-honored success rate toward preventing PE. A simple one is just to pull out and stop penis stimulation when the man feels ejaculation nearing. By waiting a few minutes for the feeling to pass, the man can then resume the sexual activity anew. While some, including the female, may find this withdrawal method a bit frustrating, by focusing on alternate means of pleasing his partner during this period, such as oral sex, the encounter needn't suffer.

A second tactic for reducing the physical stimulation of the penis during sex is to wear a condom, or even two or three. Guys generally don't like condoms for the very reason that the touch and pressure sensitivity of the penis is reduced. For premature ejaculators, however, some loss in sensitivity is offset by being able to last longer and increase the satisfaction of the female partner.

Another widely used procedure, related to the withdrawal method, is known as the "squeeze technique," popularized by sex researchers Masters and Johnson in 1970. As before, when the man feels ejaculation about to occur, he pulls out. Rather than just waiting, he, or his partner, immediately squeezes the penis just behind the head, where the foreskin starts, including the urethra. It's not necessary to squeeze to the point of pain, only enough to stop the orgasm from progressing. Only a few seconds of squeezing is generally required for the feeling to pass, then intercourse can be resumed. This squeezing procedure can be repeated several times, as often as necessary, during a sexual encounter, before climaxing. Anecdotally, some females enjoy doing the squeezing and feel it heightens their pleasure levels.

The actual position used during intercourse can also play a role in PE. The commonly used missionary position, with the man on top and thrusting deeply, provides a very high degree of sensory stimulation to the penis and often leads to rapid ejaculation. By switching places for intercourse, such as the reverse missionary position, where the woman is on top, the degree of penis stimulation is reduced and his orgasm is frequently delayed. Other physical tactics, which similarly reduce the level of stimulation of the penis, are also helpful. For instance, the male could insert only the head of the penis, where there are fewer nerve endings, into the vagina and make only narrow thrusts. Alternatively, after full insertion, the man can use a side-to-side motion while pressing against the clitoris, rather than thrusting. By focusing initially on movements which stimulate the woman rather than himself, he should be able to lengthen considerably the time to orgasm.

Treatment Approaches-Pharmaceutical

The remaining way to attack PE is via pharmaceuticals. Although, in the United States, there are currently no medications explicitly approved for the treatment of PE, several drugs are, nevertheless, effective. These drugs, already on the market for other indications, include topical anesthetic creams and certain antidepressants; delayed ejaculation is a common side-effect. By taking advantage of this side-effect, known as an off-label use, doctors can legally prescribe these medicines to treat PE.

The anesthetic creams, which include lidocaine and prilocaine, work by dulling the sensitivity of the penis. These creams are rubbed onto the penis before sexual activity, allowing the active ingredients to soak through the skin to become effective, then are wiped off. The resulting lowered touch sensitivity typically lengthens the time to reach climax, but may also reduce the man's pleasure level. Additionally, some females have reported that their vaginal sensitivity and pleasure is also reduced after such application on the penis. Allergic reaction is a rare side effect to these topical anesthetic creams.

The class of drugs most frequently used to treat PE is known as SSRI (selective serotonin reuptake inhibitor) antidepressants and includes sertraline (Zoloft), paroxetine (Paxil), and fluoxetine (Prozac). Another anti-PE drug is an antidepressant in a different class, the tricyclics, called clomipramine (Anafranil). Still another class of antidepressants useful for PE treatment, the SNRIs (serotonin and norepinephrine reuptake inhibitors), includes bupropion (Wellbutrin) and venlafaxine (Effexor). Typically, following discussions with a doctor, the dose of any of these drugs will be adjusted, beginning from a low level taken only a few hours before intercourse, to daily dosing, until the desired delay in ejaculation is achieved. If the first drug attempted is not successful, switching to one from a different class may be required. These antidepressants can have other side effects, including dry mouth, drowsiness, nausea, reduced sensitivity of the penis, and decreased libido, so your doctor will want to keep the dose as low as possible. Each of these drugs is now available in generic form, so cost should not be a big issue preventing their use. For many men with chronic PE problems, these drugs, at the right doses, work extremely well. They can frequently maintain an erection and continue intercourse for 5, 10, even 20 minutes or more before reaching orgasm. Those men taking one of these antidepressants may even outlast their female partners, thus maximizing her experience as well.

Alternative to Treatment

There's still another strategy for premature ejaculators to consider-simply go with the flow. By that approach, the male can simply accept that the initial ejaculation is going to happen fast. Some doctors even recommend that the man masturbate before sex with his partner. Since having a second orgasm almost always takes longer than the first one, the idea here is to go ahead and get the first orgasm over and out of the way. Then the man can initiate intercourse with his partner, lasting longer this time and making it more likely to satisfy her. If this orgasm still arrives too quickly, and the man can still develop another erection, he can go for another round. Younger guys have the best shot at this tactic, since aging makes it take longer and become more difficult to reload. Orgasms after the first one also tend to be less intense and pleasureful, so there is a limit here.

Conclusion

Bottom line, men, is that we don't have to feel depressed, anxious, or embarrassed by premature ejaculation. We can take matters into our own hands. Talk to a doctor and your partner, and institute one or more of these approaches. Conquering PE will do wonders in enhancing confidence, sex life, and general well-being. To overcome PE, to last longer during intercourse, and hopefully, to be on the other end of a woman's multiple orgasm, is a destination well worth seeking.