Premature Ejaculation: Treatment and Management
As many as 1 in 3 men in the U.S. suffers from premature ejaculation (PE), a condition when a man has a rapid ejaculation and it causes distress to him or his partner.
The good news is that nearly all cases of PE have successful outcomes.
Communicate your issues
Meeting with a psychotherapist is an excellent way to identify if you have any underlying conditions, such as anxiety or depression, and will allow you to work through any feelings that might be contributing to your PE.
A therapist can teach you how to mentally work through any issues and steer you toward helpful support groups. Being able to share experiences with others who have the same issues can be therapeutic. You can discuss the treatments you’ve tried and what’s worked for you and get feedback from an empathetic audience.
Take matters into your own hands
Techniques exist that you—or you and your partner—can use to build up your resistance to premature ejaculation, giving you more control. There are two methods you can try right now: the Start-Stop method and the Pause-Squeeze method. A third method is to try Kegel exercises.
As the name suggests, when you’re having sex with your partner—or your partner is sexually stimulating you—wait until you feel as though you are about to ejaculate and…stop all stimulation. Take a few breaths, wait 30 seconds until the moment has passed, and start again. Try using the Start-Stop method three times, and then on the fourth time allow yourself to climax. Gradually build up to using the Start-Stop method five times or more before ejaculating.
Ideal for when you’re masturbating, the Pause-Squeeze method calls for stimulating yourself until you feel ready to ejaculate. Then stop and apply pressure to the frenulum, the elevated area on the shaft of the penis. You should apply this gentle pressure for five to 10 seconds until the urge to ejaculate passes. Now wait about 30 seconds and then begin masturbating again. The goal is to work up to five times before letting yourself ejaculate. This can also be practiced with a partner.
Both of these methods take some time to affect your control over premature ejaculation, but they often work. Studies have reported successful outcomes for 85 percent of sufferers within three months, all without the assistance of pharmacological interventions.
Not just for women, Kegel exercises strengthen the pelvic floor muscles. Practiced primarily by men who suffer from incontinence or who dribble after urination, Kegel exercises have also been shown to benefit men who ejaculate early. One small study found a high success rate after just a few weeks, and an ability to sustain the success after six months.
Kegel exercises basically consist of squeezing the pelvic floor muscles, which you would clench to stop urination midstream or hold in gas. The Mayo Clinic suggests holding the contraction for three seconds, resting for three seconds and repeating the process several times.
Many different types of medication therapies are available to treat PE, and obviously it’s critical to consult your healthcare provider before you embark on a pharmacological solution.
For some cases of premature ejaculation, a disruption of the level of serotonin—a neurotransmitter in the section of the brain that is associated with sexual activity—can directly affect the time it takes to ejaculate. A serotonin deficiency directly affects premature ejaculation.
Healthcare experts do not fully understand why someone develops low serotonin levels, but it is most certainly a combination of age, diet, exercise and stress.
A medical intervention to alleviate serotonin imbalances comes in the form of antidepressants called selective serotonin reuptake inhibitors (SSRI), such as Zoloft or Paxil. Studies have shown that SSRIs are successful for many patients.
Please note, however, that these drugs are available by prescription only, so you need to have a discussion with your primary doctor, especially so you are aware of the possible side effects: suicidal ideations, anxiety, sexual dysfunctions (inability to obtain an erection) and depression.
SSRIs can be taken daily and usually start working within four to six weeks. This form of treatment is usually combined with behavioral therapies.
A simple solution may be to wear a condom during intercourse and let the additional layer of material around the penis lower the sensations that cause ejaculation. If that isn’t enough, look for a condom that boasts “extra strength,” which probably means the condom is made of a thicker material.
Condoms are available that include a numbing gel in the tip, but there is no way to regulate how much of the numbing agent is present. And you must be careful when using this kind of condom, to ensure the numbing agent doesn’t get passed on to your partner.
Topical numbing agents, such as a lidocaine cream or spray, can be used to decrease sensitivity. It is generally placed on the tip of the penis—where it is most sensitive—30 minutes before sexual activity. Again, this solution can cause numbness or decreased sensitivity in your partner if it is not used correctly.
You should also be aware these delay sprays, creams and gels can sometimes cause skin irritation, stinging, burning and redness where applied.
After ejaculation and a refractory period, the second session of sexual activity can last longer. For some men, ejaculating (through self-stimulation) before sexual activity can increase the duration of their subsequent performance.
Prevention of PE
Any male can be affected by PE at any age, and for a lot of disparate reasons, so preventive measures are not so easy to suggest. However, there are some considerations you might like to include in your daily choices.
Practicing safe sex and sticking to a healthy diet are always good ideas, as is avoiding excessive alcohol use and substances that are not prescribed by your doctor. Always discuss everything with your sexual partner. Finally, listen closely to your doctor’s instructions for maintaining a healthy lifestyle that decreases your risk of medical issues that impact sexual performance, and try to follow them.