FF: Understanding Premature Ejaculation: Causes, Treatments, and Strategies

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Last week I talked about erectile problems. Today, premature ejaculation.

Premature ejaculation is defined in a variety of ways, but most scientists define it as always climaxing less than two minutes after the start of intercourse. Most men with PE last less than a minute, and that’s the most common definition. The best studies say about 30% of all men have this condition, so it’s not rare.

Before we talk about why and what can be done, let’s eliminate things which are similar but different. If a man has premature ejaculation, he ALWAYS ejaculates very quickly during intercourse. Most men will ejaculate faster than they like on occasion; this is normal. Most men don’t last long their first few times having intercourse, and most come fast if it has been a good while since they had sex. Even if you’ve done something else to climax in the interim, intercourse after a long time without intercourse is likely to result in faster climax. Some men start to climax more quickly because of erectile problems: they thrust harder to stay erect, resulting in a quicker orgasm. Stress and nervousness can also cause more rapid ejaculation. None of these is PE.

Why a sizeable percentage of men ejaculate within a minute or so of entering the vagina has been debated for years. Most early theories said it was in the mind, or suggested it was a habit gained from trying to climax in a hurry during hidden masturbation or “back seat sex” as a teen. However, none of these theories has held up to study, and we now know the condition is hard-wired into the mind and body. Men who have PE have a defect in a gene controlling release of the neurotransmitter dopamine, and there is growing evidence the condition is inherited for most who have it. This means you’re not doing it intentionally, and you can’t stop doing it by force of will.

There are many claims on the Internet for techniques and pills to “cure premature ejaculation”. Sounds good, but they don’t work. If a man climaxes quickly because of bad habits or being over aroused, things like start/stop training or “the squeeze technique” may help, but for men with true PE these methods are useless. Suggestions to “think of baseball” or “do math” in your head don’t help either. Masturbating shortly before intercourse doesn’t help most men, as they are just as fast their second time.

What really does help?:

• Wearing multiple condoms to reduce sensation helps a bit for some men, but not for others.
• Desensitising creams and sprays help men slow down. The trick here is to get enough to lose some sensation without being totally numb. Newer formulations are better at this, but still the added time is limited. Promescent is one that has good research and solid reviews.
• Off label prescriptions for SSRI drugs will help most men last longer. This generally means lasting two to four times as long. Paroxetine, brand name Paxil, and sertraline, brand name Zolof, are the most commonly used. You will need a doctor to give you an off label prescription, but that should not be difficult. Both drugs can be purchased on Amazon pharmacy for less than $10 a month.
• There is some evidence that pelvic floor exercises can help. Good studies show an increase of about four-fold, which is as good as most drugs.
• I can’t find data on using more than one of the above at the same time, but it could help.
• There are new developments that are being tested. These usually become available in the rest of the world before the FDA approves them.

Some other ideas:

• If you stay erect after climax, keep going. If you get too sensitive, slow down a bit, it will pass. Use of a penis ring can help you stay firm enough to continue intercourse if you tend to lose your erection too quickly.
• Accept this is what you have to work with, and make the best of it. Pleasure her to orgasm(s) in whatever way she likes, with intercourse before, after, or in-between.
• Some men only climax quickly during intercourse, being able to last longer when their wife pleasures them by hand or mouth. With this in mind, you could sometimes skip intercourse and spend time pleasuring each other in other ways.
• Use pseudocourse (described yesterday). Many men with PE will climax quickly doing this, but she can continue till she is satisfied.

The bottom line here is this is like any other challenge; you choose how to see and deal with it. I realise not being able to have intercourse for as long as you want is disappointing, but it doesn’t prevent you from giving your wife all the sexual pleasure she can handle. If you learn how to make her feel good in other ways, she probably won’t spend much, or any, time thinking about what she’s “missing”.

[This post first appeared July 22, 2012.]

Image Credit: © Karen Roach | stock.adobe.com
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