Premature Ejaculation: Patient Information
Premature Ejaculation, PE, has recently been redefined as ejaculation occurring less than 1 minute after vaginal penetration all, or nearly all of the time, and without the ability to delay all or nearly all of the time. The condition must cause the sufferer distress. PE is the commonest form of male sexual dysfunction. It occurs in up to one third of men, although far fewer than this seek help.
Within the animal kingdom, PE is pretty uniform. Only dolphins, some insects, and humans deliberately prolong intercourse for sexual enjoyment. There is a biological advantage in getting it over with quickly so as to return to hunting, fighting etc.! Most men are able to reach orgasm very quickly, and often train themselves to do so by rapid masturbation. They usually learn control during early sexual experience particularly when in a happy, relaxed environment.
Primary or lifelong PE is increasingly called “rapid ejaculation.” It will have occurred since the first sexual experience, and occurs with all partners. It often runs in families and can be seen as an inherited sensitivity of the orgasmic reflex. Unlike secondary PE, it does not improve with time.
Men who suffer Secondary or acquired PE may have had a rather strict, or repressive upbringing with regard to sexuality. They may have been exposed to strong, religious teachings. They may have been sexually abused. Their first sexual experiences may have been associated with anxiety, guilt, and embarrassment. Some men seem to have trained their “fight and flight” responses to rapid activation. Such men are quick tempered, physically trained, they may work for the Defence or Police Forces.
Anxiety Disorder will also increase the chances of PE. Once it has occurred, anxiety about the PE itself further increases such anxiety and becomes a vicious cycle. PE can also be secondary to other sexual anxieties such as difficulty in sustaining an erection or fear of causing pain to a sexual partner. Certain drugs such as decongestants, or stimulant medication may also cause PE. Rarely local inflammation or infection of the genital tract can lead to PE.
Some men complain of a lack of control but have a normal IELT (intra-vaginal ejaculatory latency time.) Others will have a short IELT but are not distressed by this.
A full medical, psychological, and sexual history should be taken. Physical examination will exclude medical conditions. It is always preferable to be seen with your partner to clarify the problem and discuss possible causes, and treatments.
The mainstay of treatment for Primary PE is medication that lowers the sensitivity of the serotonin receptors. These drugs are known as SSRI’s and are also used in the treatment of depression and anxiety. When used in conjunction with relaxation and retraining techniques they can be highly effective treatments. Unfortunately many men need to continue such treatments in the long term. Newer agents are also under investigation. The pain killer tramadol is also effective in some men.
As the cause of Secondary PE is psychological, successful treatments require a combination of anxiety management and retraining. I advise similar breath control techniques as those used in meditation or yoga. This relaxes the body and lessens the “fight and flight” response.
Retraining includes the use of Seman’s “Stop Start” technique. Using masturbation, initially alone, and then by the partner, the “point of no return” is reached. At this point stimulation is stopped until it feels “safe” to continue. After 3 “stops,” stimulation to orgasm is allowed. The length of time people last gets longer and the pauses shorter with practice. The “Squeeze Technique” should be regarded as an “ emergency stop.” With imminent orgasm the penis is grasped firmly at the base of the glans between finger and thumb. This will stop the orgasm but may also cause the erection to collapse.
“Sensate Focus” was originally developed by “Masters & Johnson,” sex therapists in the 1950’s. It is used to treat all types of psychological sexual problems and is an excellent way of re-establishing a flagging sexual relationship. Couples are seen by the therapist every few weeks and need to do “homework” between sessions. Initially non-sexual touching, massage, body mapping and communication are stressed. The couple then progress to non-penetrative sex or “outercourse.” Men with PE can often enjoy reasonable control at this stage and the “Stop/Start” technique can be employed.
Eventually penetration is allowed, initially with no movement and combined with relaxation techniques to increase control.
Local anaesthetic creams and sprays are marketed for PME. They are designed to reduce sensitivity. They are occasionally helpful but can cause numbness of the penis and vagina. A new spray (Tempe) is said to avoid this and to be quite effective.
PE is the commonest male sexual dysfunction. It can devastate a relationship and lead to frustration and depression. There are a number of techniques and treatments that can be helpful. It is definitely worth overcoming your embarrassment and seeking help!