Premature
ejaculation
Related
pages:
Premature ejaculation is
one of the most common sexual
complaints in men.
Estimates of the number of men experiencing
premature ejaculation
range from 20% to 75%. However, there is no
general agreement
of what premature ejaculation actually is,
what causes it, or how it can be cured. Fortunately
there are treatment approaches which can be
used by all men with a high degree of
success.
Definition of
premature ejaculation
There is no commonly agreed
definition of premature ejaculation. However,
if a man can't control when he ejaculates, and he
does so sooner than he or his partner wants,
then that's pretty clearly something you can
call "premature".
As
you see, we are already deeply into the
subjective area. One man may last two
minutes between penetration and ejaculation
and regard that as a very short time, so
short in fact that he believes he is a poor
lover with little control; but another man may
think two minutes is perfectly acceptable
and see himself as a very good lover.
In fact,
only a weak correlation has been found
between the actual time between penetration
and ejaculation and whether a man describes
himself as coming too soon.
Therefore the definition of "premature" may all be
about the expectations a man and/or his partner
have rather than his actual ability to last
for two minutes or ten during sex. (One should also remember that
rapid ejaculation is the norm for all other
mammals. During sex both partners are
extremely vulnerable, which suggests evolution
would have favored more rapid ejaculation.
Ejaculatory control is something human males can
acquire with time, but according to this
view, it's not a natural
phenomenon: it must be learned.)
The
psychological factor in premature ejaculation
This brings us to the other
important part of premature ejaculation. Not
only does the man think he ejaculates too
quickly with no control, but this fact
distresses him: he feels shamed, humiliated
and sexually incompetent. Rapid ejaculation may therefore become a trigger
for internal criticism and negative
self-talk. This sets up a vicious
cycle: the negative feelings after sex eat
away at a man's self confidence, which may
make him more anxious about ejaculating too
early next time. More anxiety means more performance pressure, which makes it more
likely that he will ejaculate "too soon"
next time...and he does....!
The causes of premature -
or "rapid" - ejaculation
Sexual therapists have
not yet found any physical or medical reason
why a man comes too quickly, and they probably
never will. Some time ago
researchers thought that rapid
ejaculators were more sensitive and got
over-stimulated easily, but this theory
has now been disproven. And in any case,
rapid ejaculation isn't caused by just
one single factor.
The typical man
with a rapid ejaculation feels anxious
about his condition and his sexual
performance. He may experience a general
pressure to perform or to prove himself
rather than just to live life and enjoy it
in a relaxed way. This might mean
that deep inside he does not feel like he is
acceptable or good enough as he is (see
the psychology pages on life positions)
and that he has to work hard all the time to
become acceptable to other people
-
women in particular. And his quick ejaculation
may be a physical sign of this
sense of inadequacy and performance
pressure. It may become a symbol of everything that is
not acceptable about him. Clearly this will
make his sexual ability seem even more
important and the anxiety this produces will heighten his
tendency to ejaculate quickly even more.
For some men the connection
between stress and anxiety and rapid ejaculation is much more
obvious. Some men can react to a sexual
situation by getting very anxious which then
causes them to
ejaculate very quickly, sometimes even before they have taken
all their clothes off or penetrated their
partner. In these more severe
cases, the use of SSRI
anti-depressants may be a necessary part of
treatment (these drugs slow down ejaculation),
together with treatment programs which
change a man's behavior, and some sexual
psychotherapy.
Another factor which seems to
play a role in premature ejaculation is age. Younger men
are more prone to ejaculate quickly. Most men
ejaculate quickly during their
first sexual encounters, which suggests that
men generally start off as "premature" ejaculators, and
learn better control as they get more sexual
experience.
Of course,
having less sex leads to a more rapid
ejaculation. Infrequent sexual activity my
heighten problems with ejaculatory control, which may be
part of a vicious cycle of feeling bad after
sex, having less sex, getting tense
beforehand and then ejaculating quickly
again. Also, different sexual positions may
hasten or slow down a man's approach to
orgasm. For example, the
man-on-top or rear-entry sex positions tend to
make a man come more quickly. For more
information on this, see our
sex positions
pages.
Men who ejaculate quickly often have unrealistic
expectations about what they should be able
to do as lovers. The media
and the wider sexual culture in our society don't help here,
for there's a widespread image of sex as
intercourse-based, which means sex where the man is
in charge and is able to fully satisfy his
partner without ever asking what she would
like him to do! Clearly, this is completely
impossible and any man who feels he has to
achieve such a feat on a regular basis is
setting himself up for disappointment and
internal criticism. "Premature ejaculation" may simply become a physical
expression of the impossible task a man is
expecting of himself during sex.
Premature
ejaculation and a couple's relationship
Premature ejaculation can affect any man, whether he is in a
relationship or not. Young single men may
get so anxious about their sexual
performance that they avoid getting into a
committed relationship because they feel
their problem will really show up. However,
having regular sex with a safe and
supportive partner is probably the best
thing that can happen to a man with
anxieties about his ability to be a good
lover in general - and
the speed of his ejaculation in particular.
For men who
do ejaculate quickly, the whole issue may become even
more complicated when it impacts on
the couple's relationship (or vice versa).
Some couples have no problems at all with
sex even if the man does ejaculate prematurely
after penetration. This is probably because he feels OK about it,
his partner is OK with her (or his) own
sexuality, he does not feel responsible
for his partner's sexual satisfaction, and
they enjoy themselves sexually in many
ways.
However, in some relationships
a man's tendency to ejaculate too soon becomes a major
issue. In this case it is important to look
at the whole sexual relationship rather than
think of the length of sex as being just "his" issue. If
rapid ejaculation persists even when a man
practices skills of ejaculation control, there is a
good chance that it's serving both partners in some way,
perhaps as a
psychological defense.
If premature ejaculation and erectile dysfunction occur together, it
is necessary to deal with the erectile
dysfunction before the ejaculation
problems are treated.
Types of
premature ejaculation
Polonsky (2000)
categorizes
cases of premature ejaculation into 4 groups:
A) Simple:
In this scenario
the man will need some training in
ejaculation control and possibly
some support or coaching with his overall
sexual abilities. However, there are no or
few underlying psychological contributing
factors which lie behind (and tend to
maintain) his premature ejaculation.
B) Simple plus
relational:
Premature ejaculation is an issue within the
couple's relationship, but both partners are
willing to look at the issues involved and
support each other through the treatment
program. Both partners take some
responsibility for change. This may involve
practicing control techniques together,
talking more openly about sex, expanding
their sexual repertoire, or the man's
partner taking responsibility for his or her own
orgasm and being willing to engage with his
or her
own sexuality rather than expecting the man
to do so.
C) Complicated: In this
category are cases of premature ejaculation
which are linked to deep-seated issues
within a man's psyche. This may be
true for men beyond their 30s who have built
up negative expectations and feelings about
sexuality or themselves. In this case
a very quick ejaculation may function as a
defensive maneuver to avoid getting close to
someone else or finding out more about
oneself.
Additionally,
childhood experiences or parental attitudes
towards sex may play a major role for men in
this category. Simple treatment techniques
may not work for men in this category. Men
may need to do deeper psychological work on
themselves before a behavioral program
can be effective. Some sex therapists also
recommend anti-depressants, which may lift
a man's mood and self-confidence (and also
have a beneficial side-effect: a tendency to delay orgasm).
D) Complicated and
relational: Premature ejaculation becomes a
defense for both partners, and it may confirm
existing roles and dynamics within the
relationship. Here, difficulties with ejaculation
may simply be a smoke screen for other long-standing relational difficulties. Often
couples are not willing to engage with the
programs designed to treat it nor
to support each other
in a process of change. It seems as if
people are more interested in replaying roles
and problems from their past than meeting each other psychologically and
emotionally.
In this case, a premature ejaculation may
simply be a symbol for what is not working
within the relationship. Realistically, the
relationship would still struggle in the
same way even if the man lasted longer in
bed. Deeper issues need to be sorted first
before his staying power can be addressed. Couple
therapy or individual therapy may be the
only way forward.
Treatment of
premature ejaculation
Generally treatment for
premature ejaculation should
be easy. There are good
behavioral
programs available which
address premature ejaculation and teach
better ejaculatory
control. However, these programs need to
be practiced over a period of time and
repeated from time to time.
These treatment methods are a bit like going to the gym to
build up stamina! Obviously this needs to be an
ongoing thing. Without commitment, therefore, treatment
to gain ejaculatory control is often not
particularly successful or long lasting, especially if
other factors such as psychological issues
and relationship dynamics are added into the
equation.
But the great news is that treatment
techniques do work if practiced
consistently! No matter what the treatment,
the principle is the same: it's designed to
help men become more aware of how they feel
in their bodies as their arousal increases
and they move towards ejaculation. This
usually involves masturbatory
exercises and exercises with a partner.
Basically, the man masturbates himself to a
point just before he feels he is going to
ejaculate, then he
pauses to let his arousal subside before he
begins to stimulate himself again. This helps him recognize
the sensations he gets in his body prior to orgasm
and ejaculation, so he can slow down
or stop sexual activity as he gets near
orgasm.
Additionally, for some men
SSRI anti-depressants (selective serotonin
reuptake inhibitors) may help to delay ejaculation. If you are
considering taking anti-depressants please
talk to your doctor about it and weigh up
all the benefits and drawbacks.
Anti-depressants in themselves
may not solve your premature ejaculation,
but they may contribute to other
improvements you make in your internal and
external world.
Psychotherapy or
sexual therapy may be an important
option, whether you seek it out as an individual
or as a couple. When the causes of your quick
ejaculation are deep-rooted, psychotherapy
is essential - and the same is true when
it has more to do with
the relationship than the man himself.
Premature ejaculation is then
often a symptom of other things which need
to be addressed between you and your partner.
References:
Polonsky,
D. (2000) Premature ejaculation. In Leiblum
and Rosen, (Ed.) Principles and Practice of
Sex Therapy. 3rd edition, The Guilford
Press, New York, London
Written by Anna 27.12.2006
Revised by
Rod 19.07.2009
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