Our Greatest Wealth Is Health

Andrew Siegel MD  3/7/15

(Thank you Pixabay for above image)

Be sure that you do not sail too fast and leave your mistress behind.

—Ovid

What Is Premature Ejaculation?

Premature ejaculation (PE) is a condition in which sexual climax occurs before, upon, or shortly after vaginal penetration, prior to one’s desire to do so, with minimal voluntary control. It is the most common form of male sexual dysfunction.   “Rapid” ejaculation may be a kinder term than “premature” ejaculation.

The key features are:

• Brief time to ejaculation (often less than one minute)
• Lack of control over ejaculation
• Sexual dissatisfaction, distress and frustration of sufferer and partner.

How Long Should It Take To Climax?

In a study of over 1500 men, The Journal of Sexual Medicine reported that the average time between penetration and ejaculation for a premature ejaculator was 1.8 minutes, compared to 7.3 minutes for non-premature ejaculators.

Another study of 500 couples across five countries reported results ranging from 33 seconds to 44 minutes with the median being 5.4 minutes.

What Causes PE?

PE can be psychological and/or biological and can occur because of over-sensitive genital skin, hyperactive reflexes, extreme arousal or infrequent sexual activity. Other factors are genetics, guilt, fear, performance anxiety, inflammation and/or infection of the prostate or urethra and also can be related to the use of alcohol or other substances.

PE occurs in up to 30% of men, involving all ages, ethnicities, and socio-economic groups. PE can cause embarrassment, frustration and loss of self-confidence and can be devastating to a relationship. It is very typical among men during their earliest sexual experiences.

Who Knew? “Coming Attractions.” One can always use the excuse that being “fast and furious” occurred because of the tremendous attraction and turn-on of your smoking hot partner. However, this trump card can only be played once or twice before it gets very old.  

PE can be lifelong or acquired and sometimes occurs on a situational basis. Lifelong PE is thought to have a strong biological component. Acquired PE can be biological, based on inflammation/infection of the reproductive tract or psychological, based upon situational stressors. PE can sometimes be related to ED, with the rapid ejaculation brought on by the desire to climax before losing the erection.

Emphasis on ejaculation as the focal point of sexual intercourse tends to increase the performance anxiety that can initiate the problem. Once PE has occurred and established itself, fear of and mental preoccupation with the issue can actually induce the unwanted rapid ejaculation, creating a vicious cycle.

How Does One Overcome PE?

Diversionary Thoughts: Non-erotic mental diversionary tactics (concentrating on thoughts other than ejaculating) may prevent PE. Baseball, work, counting backwards, etc., are examples of such thoughts, but these are rarely effective and diminish the pleasure of sexual intimacy.

Down Tempo: This requires one to develop a mindfulness of the sensation immediately before ejaculation. By slowing the pace of pelvic thrusting and varying the angle and depth of penetration before the “point of no return” has passed, the feeling of imminent ejaculation may dissipate.

Pause-Start Method: If slowing the tempo is not sufficient to prevent the PE, one may need to stop thrusting completely while maintaining penetration in order for the ejaculatory “urgency” to go away. Once the sensation to ejaculate subsides, pelvic thrusting may be resumed.

Squeeze Technique: Originated by Masters and Johnson, as imminent ejaculation approaches, the penis is withdrawn and the head of the penis is squeezed until the feeling of ejaculation passes, after which intercourse is resumed. Although effective, it requires sexual interruption, is cumbersome and demands a very cooperative partner.

Pelvic Floor Muscle Training: Contracting one’s pelvic floor muscles is a less cumbersome alternative to the Master and Johnson technique. Instead of the clunky and obvious squeeze technique, a more subtle and discreet method is to slow the pace of intercourse, pause the pelvic thrusting and do a sustained pelvic muscle contraction. This is an internal “squeeze” without the external hand squeeze and can achieve the same goal, short-circuiting the premature ejaculation. With sufficient practice and the achievement of “muscle memory,” this process can become easier and the problem of PE improved, particularly with commitment to a pelvic floor muscle training program.

Decreasing Sensitivity: One method of doing so is by using thick condoms. Alternatively, local anesthetics in the form of topical creams, gels, and sprays can desensitize the penis. These include Lidocaine cream or gel, Lidocaine and Prilocaine (EMLA cream) or Lidocaine spray (Promescent) that are applied before intercourse. Another desensitization technique is increasing the frequency of ejaculation since PE tends to be more pronounced after longer periods of sexual abstinence. By masturbating prior to engaging in sexual intercourse, the PE may be controlled.

Erection Pills: Viagra, Levitra, Cialis and Stendra, which are commonly used for ED, can have a role in the treatment of men with acquired PE that is due to ED.

SSRI Anti-depressants: These selective serotonin reuptake inhibitors can substantially delay ejaculation. One is generally started on a low dose, with an increase in dosage as necessary. Once an effective dosage is achieved, the medication can be used on a situational basis, several hours prior to sexual intercourse.

Counseling: Since PE can be on a psychological basis, it may be beneficial to seek the counsel of a sexual therapist. This can be done in conjunction with some of the aforementioned techniques to hasten the resolution of the PE.

Bottom Line:   Although not life-threatening, PE is a common and distressing quality of life problem that is sometimes relationship-threatening.  The good news is that there are a number of effective treatment options available, so one need not suffer with the problem.   

Wishing you the best in health,

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the inbox of your email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health:available in e-book (Amazon Kindle, Apple iBooks, B & N Nook, Kobo) and paperback: http://www.MalePelvicFitness.com

Private Gym Male Pelvic Floor Muscle Training  Program: http://www.PrivateGym.com -available on Amazon as well as Private Gym website

The Private Gym is a comprehensive, interactive, follow-along exercise program that provides the resources to strengthen the pelvic floor muscles that are vital to sexual and urinary health. The program builds upon the foundational work of Dr. Arnold Kegel, who popularized exercises for women to increase pelvic muscle strength and tone. This FDA registered program is effective, safe and easy-to-use. The “Basic Training” program strengthens the pelvic floor muscles with a series of progressive “Kegel” exercises and the “Complete Program” provides maximal opportunity for gains through its patented resistance equipment.

Tags: Andrew Siegel MD, Arnold Kegel MD, counseling, ejaculation, erection, erection medications, lidocaine, male pelvic fitness, Masters and Johnson, pelvic floor muscle training, pelvic floor muscles, penis, premature ejaculation, Private Gym, Promescent, rapid ejaculation, squeeze technique, SSRI medication

This entry was posted on March 7, 2015 at 8:55 AM and is filed under health and wellness. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.