Coping with premature ejaculation

Heather Little-White, PhD, Contributor

Jamie, an 18-year-old reader of Outlook, is frustrated that he is not able to engage in sustained sexual intercourse because he ejaculates as early as two minutes in to the act. Jamie is not alone in his distress, as several men experience this dilemma.

Premature ejaculation (PE) is defined as 'coming within six thrusts' or 'coming within two minutes', definitions which suit Jamie's frustration. In general, it is coming before you want to, and you feel you are not able to control it. Of course, there is no cause for concern if it happens occasionally (www.selfgrowth.com). According to the Mayo Clinic, the primary sign of premature ejaculation is ejaculation that occurs before both partners wish, causing concern or distress in the relationship. PE may occur in all sexual expressions, including masturbation.

Primary

Premature ejaculation may take two forms, either as lifelong (primary) or acquired (secondary). The International Society for Sexual Medicine characterises lifelong premature ejaculation as:

Ejaculation that always or nearly always occurs within one minute or less of vaginal penetration. It is the inability to control ejaculation more than 50 per cent of the time.

The inability to delay ejaculation on all or nearly all vaginal penetrations.

Negative personal consequences, such as distress, frustration or the avoidance of sexual intimacy.

Secondary

The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, defines secondary premature ejaculation as:

Persistent or recurrent ejaculation with minimal stimulation before, on, or shortly after penetration, and before you wish it, causing personal distress or relationship problems.

Developing after having previous, satisfying sexual relationships without ejaculatory problems.

Men are often baffled as to what could affect their sexual pleasure. Some men who have had this difficulty most of their sex life are unable to discern 'the point inevitability', that sensation that occurs just moments before ejaculation. Men who do not suffer from PE are able to feel the sensation and can stop or change stimulation until that moment of urgency has subsided.

Causes

The causes of PE are complex and may be biological or psychological, or a combination of both.

Biological

Inflamation or infection of the urinary tract or prostate, or ill-health and stress-related conditions, may cause premature ejaculation. A man's nervous system may be predisposed to early ejaculation because of abnormal levels of brain chemicals, coupled with abnormal hormone levels. Medications that influence chemical messengers in the brain may result in premature ejaculation. The reflex activity of the ejaculatory system may be impaired and certain thyroid problems may cause problems.

Difficulty in getting and maintaining an erection may increase your risk of PE as there is the fear of losing the erection so sexual intercourse may be hurried. There is the possibility that the desire to ejaculate could be an inherited trait. Occasionally, surgery or trauma may damage the nervous system.

Psychological

Starting to engage in sex at an early age may cause premature ejaculation later in life. Early sex could establish a pattern which may be difficult to change in life. Situations include hurried sex to avoid being caught and having guilty feelings about having to rush. Anxiety about sexual performance or other issues is a major factor that may cause PE. Poor interpersonal dynamics in a relationship may also contribute to the problem.

Seeking help

It is important to talk with your family doctor if you ejaculate sooner than you and your partner wish during most sexual encounters. You will definitely need professional treatment to help you achieve and sustain satisfaction in your sex life. Do not be afraid to ask questions about PE's causes, treatment and what improvement is reasonable to accept. You should also honestly answer questions your doctor may pose in assessing your problem.

Your doctor may refer you to do certain tests, like blood and male hormone (testosterone) tests, and to see a urologist who specialises in sexual dysfunction and/or to see a psychologist to make a professional diagnosis.

Treatment

Options for treating PE include medications, sexual therapy and psychotherapy. Medications may include antidepressants, which have the side effect of delaying orgasm. You may not have to take the antidepressants every day but a low dose several hours before intercourse may improve the condition. You may have to try several antidepressants, on your doctor's advice, as you could experience decreased libido, nausea and dry mouth as other side effects. Topical anaesthetic creams with lidocaine or prilocaine, applied a short time before intercourse, will dull the sensation on the penis to help delay ejaculation. The cream should be wiped off before penetration when your penis has lost enough sensation to prevent premature ejaculation.

Sexual therapy

This may involve simple procedures to delay your ejaculation. Masturbating an hour or so before intercourse may help, or your doctor may recommend the squeeze technique for you and your partner. The procedure starts with stimulation of the penis until you feel almost ready to ejaculate. At this point, your partner squeezes the end of the penis for several seconds until the urge to ejaculate passes. You should wait for 30 seconds and go back to foreplay. Your partner should repeat the squeeze technique as you feel you are about to ejaculate. Repeated several times, it allows the man to penetrate his partner without ejaculating. Eventually the man learns the feeling of knowing how to delay the ejaculation so the squeeze technique may no longer be necessary.

Counselling

Counselling can help to heal issues in a relationship, especially if communication is poor between partners and there is little understanding of the differences in male and female functioning. There should be a willingness between partners to try new approaches to sexual satisfaction which would decrease performance anxiety. Although females want their partners to last longer, they should not blame each other for any sexual dissatisfaction they may experience. Instead, they should try to approach the problem in a loving way, offering to help each other with the problem and boosting self-confidence. Females can help their partners relax by having them take a bath with aromatherapy oils while listening to relaxing music.

Named changed for privacy

Send comments/feedback to: heatherl@cwjamaica.com.