According to an extensive review published in the International Journal of Impotence Research: the Journal of Sexual Medicine, about 30 per cent of men worldwide suffer from premature ejaculation. In short (no pun intended), it is the most common problem in the sexual function of men.
Despite this, those who suffer from it tend to feel isolated and threatened by an unsatisfied partner and therefore avoid discussing the matter. This is a mistake.
I am sorry about the silence of those suffering from premature ejaculation. Most of them don't realise that the problem can be resolved with a short and effective learning process, and it can usually be overcome within a few months.
In my experience as a doctor, I have found that the problem is often behavioral, not mental. Most men suffering from this issue are completely normal, that their mental issues are no different to those of the rest of society and therefore they do not suffer from psychiatric problems.
The causes of premature ejaculation
If a man doesn’t have a chronic illness, doesn’t take medicine on a regular basis, enjoys having erections and has a sexual appetite, there is no reason to assume that his premature ejaculation has a medical background. This is in contrast to loss of sexual appetite or impotency, which in many cases is caused by medical or organic issues.
Controlling ejaculation has to do with awareness of the stimulation sensation in the penis during sexual intercourse – before an orgasm. A lack of awareness about this sensation is likely the direct reason for premature ejaculation. When a young man masturbates or has sex for the first time, he is so stimulated that he reaches ejaculation without understanding what happened. This is a natural phenomenon. Over time, the man learns to identify the sensation related to the sexual stimulation before the orgasm.
Recognizing this sensation enables him to maintain a constant level of stimulation, to sustain the enjoyment, and to delay ejaculation to a later stage. This learning process was disturbed in men that suffer from premature ejaculation. They did not learn to identify the stable sexual stimulation sensation, and they cannot extend the stage called “the plateau” and control the ejaculation.
A typical case
"G" arrived at my clinic when the problem caused him to avoid relations with women. He matured relatively late and started going out with women during his 20s. At this age, both men and women expect to have sexual relations within a relatively limited number of dates. His first time was with a girl his age who was sexually experienced.
He didn’t dare tell her that he never had sex before. The first time, which was over relatively fast, she made a sarcastic remark. He found a random reason and cut off all relations. At this point he didn’t dare meet any other women and felt rather hostile toward such relations.
So, unfortunately, during his first sexual intercourse G. met a rather critical woman. When he finally came for treatment, we had to dismantle everything, the mental blocks that caused him to disconnect from the sexual stimulation and the strong erotic sensation prior to an orgasm. Only afterward did he learn to prolong his sexual relations, using exercises and relaxation. Now he has to find an emphatic and supporting partner.
The fixed and predetermined scenario
The scenario according to which premature ejaculation is caused looks something like this: during the first intercourse, the man ejaculates too quickly for some reason. During consecutive sexual encounters, stressful terms are used which do not enable him to overcome the previous erotic experience. The man enters a cycle of failures, and over a long period there are no suitable conditions in which to learn the erotic sensations of a prolonged sexual encounter. Thus the problematic issue of premature ejaculation is generated. Every modern sexologist knows how to identify the problem as an undesired habit that one has to deal with.
This is a common scenario when we talk about premature ejaculation that has been present since the first sexual encounter. There are also cases where premature ejaculation has started occurring in a man that enjoyed a normal sex life up to that point. This is referred to as acquired premature ejaculation.
Seeking medical treatment
There is a group of psychiatric medicines, mostly anti-depressants, of which one of the side effects is delaying ejaculation. One example is Anafranil (Clomipramine), a medicine from tricyclic antidepressant group, which is effective six hours after administration. Other antidepressants that have an effect on ejaculation belong to the SSRI (Selective Serotonin Reuptake Inhibitor) antidepressant group and also elevate the serotonin levels in the brain. Examples include Prozac and Seroxat. These medicines may have other side effects, such as headaches, dizziness, nausea, dry mouth, drowsiness, and reduced libido.
There is also the old treatment of using topical anesthetic products such as Lidocaine on the penis. But there is as yet no medicine which is indicated to premature ejaculation and which has no side effects.
The main downside of both of these solutions is that when you stop taking them the problem returns in its full capacity. For this reason, sex therapy is advised.
The essential element in treating premature ejaculation focuses on the sexual enjoyment instead of using distractions such as alcohol, two condoms or biting lips nervously. There are exercises which are intended to teach the man how to recognize the erotic sensation before ejaculation and how to use this awareness in order to delay the ejaculation.
There are exercises for couples or for a man by himself. In the couple exercises, the couple is asked to have intercourse in a program of six stages and exercises, including strong squeezing of the glans penis (squeeze technique), stimulation and breaks (the stop-start technique) maintained by the partner. The couple is asked to disconnect all phones and televisions and the partner should stimulate her man for a long period using her hand. Constant repetition of the exercises will teach the man to identify the moment before ejaculation and therefore control it.
When moving forward to the more applicable stage, the partners are requested to have full intercourse, in a position in which the woman is on top of the man. Afterward, and only if the man has acquired a few minutes of no ejaculation, the couple moves on to other positions. Men that prefer the missionary position can return to it only after they have learned to control their orgasm. The exercises which are done by the man alone are also grouped into a program with different masturbation exercises with different levels of intensity and include stimulation and breaks and also the strong squeezing of the glans penis. The protocol of these exercises has been used for over 45 years now and it is the only way to overcome premature ejaculation. When these exercises are conducted on a regular basis, there are high rates of success.
To find a sex therapist near you, visit the Sexual Health Australia website which an arrange a consultation. You can also learn to improve your ejaculatory control by using the PE Program, a smart online program, developed with the help of Dr. Zuckerman, that includes a home exercise program for self-treatment of premature ejaculation.