Steady under Pressure: how to address premature ejaculation

By |2019-05-31T16:40:12+00:00May 30th, 2019|Categories: Featured, Men's Health, Sexual Performance|Tags: , , |Comments Off on Steady under Pressure: how to address premature ejaculation

Suffering from a short sex life? You aren’t alone. Millions of men suffer from premature ejaculation, though it’s an issue that’s often swept under the rug. While estimates vary, most literature states that between  20-30% of men have experienced  the issue at some point in their lives.

What is premature ejaculation?

Premature ejaculation is a condition in which a man ejaculates sooner than he or his partner want. Occasional issues with climax are likely not a cause for concern, but consistently short duration of sex and an inability to delay ejaculation are problems about which you should consider speaking with your doctor.

How short is too short? Doctors have had a difficult time pinning down a definition around what constitutes true PE. They consider the amount of stress it causes for the individual or in the relationship, the ability to control ejaculation and how quickly ejaculation occurs. Most medical guidelines define premature ejaculation as ejaculation regularly occurring within one minute of vaginal penetration.  Most men experience variable time to ejaculation and average between 5-6 minutes (in case you were wondering).

So, how can you tell if you have an ejaculatory disorder? Here are a few questions to ask yourself, and discuss with your doctor, if you think you might have PE:

  1. How long are you able to last following penetration?
  2. Is the duration from penetration to ejaculation consistent or variable? Can you last longer sometimes?
  3. How much control do you have over your ability to ejaculate?
  4. Has time to ejaculation always been short or has it changed over time or with different partners?
  5. Would you and and/or your partner be more satisfied if you could last longer?

Doctors treat lifelong, episodic and variable PE differently. Discussing the details can help the doctor determine underlying cause and provide good solutions to help improve sexual function and decrease stress and anxiety related to sexual encounters.

What causes premature ejaculation?

The male reproductive system is a bit more complex than most people give it credit for. The ejaculation process is a carefully orchestrated sequence of triggers that carry sperm from the epididymis to the prostate where it is joined with semen and eventually shot out of the body.

Ejaculatory dysfunction can occur if there are issues anywhere along the line. Often, it occurs when a man has a sensitive penis or becomes overly stimulated during a sexual experience. It can also be caused or aggravated by performance anxiety, stress, or relational problems. An enlarged prostate or other reproductive tract problems can also contribute to ejaculatory dysfunction.

Is premature ejaculation curable?

Most men are able to improve time to ejaculation and better enjoy their sex lives through open and honest conversations with their doctors and partners. It takes two to tango so involving your partner in your planning can help reduce stress, improve intimacy and your relationship.

Step 1: Talk to your doctor

Doctors will often review your medical and sexual history as a first step toward identifying the best treatment. A quick physical exam is also commonly performed to look for any other issues in the reproductive system that could be contributing to ejaculatory function.  Doctors often recommend several different treatment methods at once as they’re often most effective when used together.

Here are the most common treatments:

PE Medications and supplements

Most medications (topical or oral) are designed to reduce response to physical stimulation of the nerves. Some work locally on the penis itself, reducing sensitivity directly, while others slow the speed at which the signal travels to the brain or the brain’s response time.

Topical medications: A first-line treatment option is topical medication that alters penis sensitivity temporarily. Applied before intercourse, this medication uses the numbing agent, lidocaine, to help delay ejaculation. If you decide to use a topical treatment, be sure to apply it 10-15 minutes before sex to ensure it has enough time to begin working.

Oral medications: Doctors prescribe several different types of oral medications that may be effective in treating PE including various classes of antidepressants, chronic pain meds, drugs that are used to treat issues of the urinary tract and even certain ED medications to improve time to ejaculation. Having an honest conversation with your doctor and getting a full medical check-up can help identify the root issue of ejaculatory dysfunction and identify the best treatment options.

Caffeine: Though the method of action is not well understood, doctors may recommend a cup of coffee or other caffeinated beverage about 2 hours prior to intercourse. Some studies have shown that the caffeine boost can significantly increase duration. It’s worth a try, especially for some afternoon delight.

Folic Acid: Folic acid supplementation has been found to support sperm production, erectile function and ejaculatory function. A daily multi-vitamin, a prenatal or a diet rich in folate may help spice things up between the sheets in more than one way.

Over-the-counter supplements: Many over-the-counter supplements and herbs claim to improve sexual performance. Many of these claims are unstudied or unsubstantiated. If you are looking at some sort of dietary supplement, take time to read the ingredients and do your homework to make sure the product is safe and healthy. If you have questions or concerns, feel free to bring them to your doctor who can serve as a sounding board.

As a note, some medications indicated for PE may interfere with fertility, so it is important to have a complete conversation with your doctor about your personal and life goals as well as your medical history to understand what treatment options could be most effective in your situation.

Counseling

Often paired with drug therapy, counseling is another great way to address intimate health issues like premature ejaculation. Speaking with a mental health professional can help reduce performance anxiety and provide effective ways to cope with stress. It also offers a safe place to address feelings of inadequacy or frustration that are common in patients with premature ejaculation. Therapy can improve your life outlook, self-esteem, and relational health, all of which are key to a confident sex life. If you’re uncomfortable speaking with someone in person, consider online therapy to discuss your health issues privately.

Masturbation

Self-stimulation can provide a unique opportunity to practice manually delaying your ejaculation. While masturbating, try paying attention to what you feel right before ejaculation and use that insight to learn how to control the feeling. It can inform when you should slow down or change your behavior to lengthen your sex duration. Once you’re able to halt your orgasm during masturbation, you should be able to achieve it with a partner. Keep in mind, however, that this form of sexual control is a learned habit made over weeks of practice, not a quick fix. If you’d like some guidance, there is an app made by leading sex therapists that can walk you through some exercises to help gain control and track your progress.

The Stop-and-Start method

There are also techniques to employ in the middle of sex to avoid premature ejaculation, such as the “stop-and-start” method. This practice requires you or your partner to stimulate your penis until you are close to ejaculation. Then, stop the stimulation for about 30 seconds until you can get back in control of your response. Continue this process at least three times before allowing yourself to ejaculate. Taking these breaks should lengthen the amount of time you’re able to have sex and improve your, and your partner’s, experience.

Pelvic floor strengthening

Kegel exercises can strengthen the pelvic floor and positively affect sexual function in men such as ejaculation timing. To begin Kegel exercises, be sure you identify where your pelvic floor muscles are: they are the ones you use to stop urination prematurely. Then, tighten your muscles for three seconds, release, and then tighten again. Ideally, you should repeat this process in a set of ten, three times a day for the best impact on your sex life. If this seems tricky to get the hang of, there are companies developing kegel exercisers to help men perform exercises correctly.

Alternative Treatments

Both acupuncture (don’t worry, the needles won’t go “there) and yoga have shown some efficacy (though studies are limited) in improving ejaculatory function. Though there is limited understanding into the method of action, researchers propose that yoga may serve to strengthen the pelvic floor and acupuncture may interact with the nervous system (as it is also used as a form of pain management). Both are associated with other positive health outcomes and, like folic acid, may be worth a shot just for the health benefits.

Surgical Corrections

In extreme cases, there are surgical options to discuss with a urologist who specializes in sexual function. Some men will undergo circumcision to reduce sensitivity, which has been shown to be effective in many cases. There are other experimental procedures in development that are promising for some special cases.

References

Premature Ejaculation.Family Doctor, American Academy of Family Physicians, 11 Oct. 2018.

Diseases & Conditions: Premature ejaculation.” Mayo Clinic, MayoClinic, 16 May 2018.

Thomas, Lisa. “Struggling with Premature Ejaculation? Keys to Control.” Psychology Today, 7Feb. 2018.

Serefpglu EC, et al.  Premature ejaculation: Do we have effective therapy? Translational Andrology and Urology. 2013;2:45.

Martin C, Nolen H, Podolnick J, Wang R. “Current and emerging therapies in premature ejaculation: Where we are coming from, where we are going”. Int J Urol. 2017 Jan;24(1):40-50. doi: 10.1111/iju.13202. Epub 2016 Oct 5.

Chung E, Gilbert B, Perera M, Roberts MJ. “Premature ejaculation: A clinical review for the general physician.” Aust Fam Physician. 2015 Oct;44(10):737-43.

Hisasue S “The drug treatment of premature ejaculation. Transl Androl Urol. 2016 Aug;5(4):482-6. doi: 10.21037/tau.2016.06.10.

McMahon CG, Jannini EA, Serefoglu EC, Hellstrom WJ. The pathophysiology of acquired premature ejaculation. Transl Androl Urol. 2016 Aug;5(4):434-49. doi: 10.21037/tau.2016.07.06.

 

 

 

 

 

 

 

 

 


Sara SDx

Sara SDx

Editor of Don't Cook your Balls, Co-Founder of TrakFertility.com, Health Coach and Men's Health Advocate. Passionate about sperm, men's health and helping people build their families.
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