Premature Ejaculation: Learn Control

Premature ejaculation may be the most common sexual problem for men. It is probably more common among younger men and men with less sexual experience, but can also appear later in men in established relationships. Ejaculation is said to be premature if it happens too quickly, the man doesn’t feel able to slow it down, and he feels badly about it. This can then negatively affect the couple’s sex life and overall relationship happiness, but fortunately can respond quite well to treatment.

 

Causes

Just as good sex results from a combination of physical, psychological, and relationship factors, so too is premature ejaculation potentially influenced by all of these, so we need to look at all three in order to figure out what is going on.

Physical Diabetes and cardiovascular disease have both been associated with premature ejaculation, as has withdrawal from opiates and alcohol.

Psychological Depression, anxiety, anger at one’s partner, low self-esteem, and sexual guilt can all make premature ejaculation more likely, as can being out of tune with one’s level of sexual arousal. Ironically, some men struggle with both premature ejaculation and also erectile difficulties—they increase stimulation to ensure they get a good erection but then orgasm too quickly or they try to distract themselves from the sensations so as to not orgasm too quickly but then lose their erection. Satisfying sex usually entails finding somewhere in between.

Relationship Sexual and non-sexual relationship factors can also impact the man’s sexual functioning. Power struggles, poor communication, fear of commitment or intimacy, and feeling pressured to perform can all reduce the man’s ejaculatory control. In addition, if the man believes that his wife does not enjoy sex (which may not actually be true) or if she experiences discomfort during sex, he may try to get it over with as quickly as possible.

 

Medical Treatment

If you suspect that medical conditions or medications are impacting your erectile abilities, then speak with your treatment providers and, if necessary, explore your options. You may find it helpful to include your partner in this discussion, both to provide potentially useful information as well as to weigh in on treatment options.

There are currently no medications approved for the treatment of premature ejaculation, but the SSRI antidepressants are sometimes used. Numbing creams are available to reduce sensation and thereby slow down orgasm, but they are usually far from ideal. If the premature ejaculation is the result of over-stimulation from fears of losing one’s erection, then erection medications can be helpful. If you find that a treatment is not working as expected, then talk with your treatment providers to see if refinements can be made.

 

Psychological Treatment

However the premature ejaculation started, once a couple has been struggling with it for a while, it can cast a dark shadow on their sex life. A sex therapist can help you disentangle these negative effects, as well as normalize the various solutions that you tried. This may also involve working on non-sexual matters that are intruding on your sex life.

Through the process of talking about this, you may work on communicating more about what each of you want from your sex life and agree on what options you would like to try together, at this time. Be direct about what you do and don’t like, what you’re willing to do for your partner, and what you are not interested in doing. It will probably be helpful to explore your assumptions about each other and whether they are getting in the way (e.g., women usually just put up with sex). This greater awareness of your own and your partner’s sexual desires makes it easier to feel confident in your sexual encounters which tends to reduce concerns about performance.

Some men develop rapid ejaculation if they feel that their partner isn’t enjoying sex, just wants to get it over with, or finds it painful. If there is truth to this worry, then it is worth exploring whether more foreplay, some quality lube, or different positions might make sex more enjoyable for her. If the discomfort remains or is too pronounced, then a medical examination should be considered.

Once some of these other matters are addressed, a sex therapist can also teach you and your partner how to do the start-stop technique which involves progressing through a series of exercises at home that teach you greater and greater awareness of your arousal level, response to stimulation, and ultimately control over your orgasm. These relatively simple exercises have been found to be quite effective.

Finally, a sex therapist can help you learn how to ensure that the sexual encounter is satisfying for both partners even if you do ejaculate before you intended to. A flexible approach takes the pressure off of both of you and makes the whole thing more enjoyable.

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