Whoops! Too soon again?
Premature ejaculation (PE) happens when a man orgasms and ejaculates before he is ready to. We all know that sex is a situation where coming early is unlikely to impress, but although it can be embarrassing, most men will experience it at least once, and as many as one in five men have reported experiencing it on a regular basis. It only becomes a medical problem if it is happening frequently enough to negatively affect your sex life.
There are two types of premature ejaculation: primary and secondary. Primary PE is typically life-long, beginning with your first sexual experiences. It is usually due to psychological factors, such as trauma or negative attitudes towards sex growing up. Secondary PE is more likely to be temporary and is usually developed later in life. The causes of secondary PE can vary, from relationship problems to physical causes like diabetes or high blood pressure. Both types may require some sort of medical treatment at some point.
So what counts as 'premature'?
Although some men may feel pressure to last longer, a study of 500 couples found that the average time until ejaculation was only 5.4 minutes. Generally speaking, premature ejaculation is classified as sex that lasts less than one to two minutes. However, the ‘right time’ is subjective and if you feel you don't have enough control over your ejaculation, there are many different methods that can help you last longer in bed and improve your sexual performance.
The stop-start technique is a simple method that can be practiced during sexual intercourse or while masturbating. Just before you are about to ejaculate, stop stimulating the penis, only starting again when the urge to ejaculate passes. You can repeat this as many times as you would like. This allows you to regain control and increases the time it takes to reach orgasm.
You can also practice this technique on your own a few times a week, bringing yourself to the point where you are almost ready to finish before letting your arousal level come back down a few times. This can give you more control and a better understanding over what different stages of the arousal process feel like.
This method is similar to the stop-start technique. During sexual activity, once you feel you are about to ejaculate, either you or your partner can squeeze the head of the penis about thirty seconds, or until you no longer feel the urge to ejaculate. Your thumb and forefinger should squeeze at the point where the head meets the shaft of the penis. This inhibits the ejaculatory reflex and brings down your arousal level. As with the stop-start method, you can repeat this process as necessary to lengthen the experience.
Both the stop-start and squeeze techniques can help you to be more mindful of what different arousal levels feel like, allowing you to more easily delay ejaculation.
Although the humble condom has long been derided for the way it reduces sensation, in the case of premature ejaculation, that can be a benefit. Even better - thicker, specialised condoms are available to better decrease sensitivity, increasing the time it takes to orgasm. Some may even contain benzocaine or lidocaine to numb the area, further delaying ejaculation. They also provide the benefit of protecting you against STIs.
Weak muscles can also lead to premature ejaculation - but you don't need to go to the gym to exercise these muscles! Your pelvic floor is made up of a group of muscles that stretch from your pubic bone to your tailbone, supporting your bladder and bowels. If you have a weak pelvic floor, simple exercises can help strengthen them and improve your sexual function.
To locate your pelvic floor muscles, try squeezing your muscles together as if you are trying to stop urination midstream. Pelvic floor exercises, also known as kegels, are done by contracting these muscles. You can do these standing up, sitting, or laying down, depending on what feels easiest for you.
To perform pelvic floor exercises:
These exercises can be done from anywhere, but setting aside a regular time and place to practice these, such as when showering, after waking up, or before going to bed, can help you remember to do them.
If psychological causes, such as stress or relationship problems, are to blame, you may benefit from seeing a therapist. Relationship tension can be felt in the bedroom and make you less able to perform. Talking these issues out can help reduce sexual problems. Premature ejaculation can also be a cyclical issue - if it has happened once or twice already, you may get performance anxiety over it happening again.
Specialised therapy, such as sex therapy, is also a good option. Sex therapists specialise in treating sexual dysfunction and will be able to talk you through different treatment methods.
Topical creams and sprays can also be used to delay ejaculation. Some are available over-the-counter, while others, such as Emla cream, are only available on prescription. These use anaesthetics such as lidocaine or prilocaine to numb the area, decreasing sensitivity and delaying ejaculation.
You can apply the cream to the head of the penis about 20 minutes before sexual activity, making sure to wash it off before intercourse to prevent irritation to your partner.
Selective serotonin reuptake inhibitors, or SSRIs, are a class of antidepressants that are used to treat anxiety and depression, but a common side effect is delayed orgasm. Paroxetine, sertraline, and fluoxetine are antidepressants that are prescribed for this purpose, although they usually need a few weeks to take effect.
Dapoxetine, another antidepressant, has been specifically created to treat premature ejaculation. It acts faster than the other SSRIs, and you can take it 1-3 hours before sexual activity. Most men find that they are able to last two to three times longer while on this medication. Dapoxetine can be purchased under the brand name Priligy.
Although they are usually used to treat erectile dysfunction, phosphodiesterase-5 (PDE-5) inhibitors may also help with premature ejaculation. Medications commonly prescribed off-label for this use include sildenafil (Viagra) and tadalafil (Cialis). PDE-5 inhibitors may work better when combined with SSRI treatment.
Recent guidelines recommend treating erectile dysfunction first in men who experience both premature ejaculation and erectile dysfunction. This recommendation is not based on evidence and there is limited data about the efficacy and safety of dapoxetine/sildenafil combination therapy for these patients.
In addition to the above, there are other ways you can avoid an early finale, such as going slower, taking breaks, breathing techniques, or even distracting yourself. Thinking about something boring or taking a deep exhale before you feel you are about to ejaculate can help to delay ejaculation.
Many men find that masturbation before sex can help to delay orgasm. It's thought that this works due to a time after orgasm where many men may find it difficult to orgasm again, called the refractory period. Although there is currently not much evidence to support this technique, it is a risk-free method you can practice to see if it works for you.
If your symptoms persist after trying these methods, you should speak to your GP or a urologist to rule out any medical conditions. Certain conditions, such as thyroid disorders or an enlarged prostate, can also lead to ejaculation problems. If your premature ejaculation is caused by a medical condition, the root cause will need to be addressed before other treatments can be employed.
Above all, it's important to communicate openly and honestly with your partner. Communicating about your relationship and trying different methods can improve both your relationship and your sex life.
You can learn more about premature ejaculation and treatments here.
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