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Premature ejaculation

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Premature ejaculation is one of the most common psychosexual complaints in men. Figures from different authors give the percentage of men suffering from premature ejaculation from 20% to 30% or even 75%. However, there is no consensus of what premature ejaculation actually is, what causes it, or how it can be cured. Fortunately there are treatment approaches which can be practiced by all men and which are reliable and effective when applied.


Definition of premature ejaculation

There is no commonly agreed definition of premature ejaculation. However, if a man can't control when he comes, and he comes sooner than he or his partner wants, then that's a pretty clear case of premature ejaculation.

As you can see we are already deeply into the subjective realm. What distresses one man as premature ejaculation may be completely OK with another guy and his partner. In fact, only a weak correlation has been found between the actual time between penetration and ejaculation and whether a man describes himself as having premature ejaculation. Therefore premature ejaculation may all be about the expectations a man or his partner have rather than his actual sexual performance. One should also remember that rapid ejaculation is the norm for all other mammals. During sex both partners are extremely vulnerable. Therefore, evolution did not prefer males who could control over their ejaculations so that they could last longer in bed. Control is something human males can acquire with time, but it's not a natural phenomenon. Control must be learned.


The psychological factor

This brings us to the other important part of premature ejaculation: not only does the man feel like he has no control over his ejaculation and it happens too quickly, but this fact distresses him. Most men with premature ejaculation feel anxious about ejaculating too quickly, and when they do, they feel shamed, humiliated and incompetent afterwards. Premature ejaculation may therefore become a trigger for internal criticism and even self-persecution. 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....!


Causes of premature ejaculation

Psychosexual therapists have up to now found no physical or medical cause for premature ejaculation, and they probably never will. Some time ago researchers favored the view that premature ejaculators were more sensitive and got over-stimulated easily, however this theory has now been disproven. And there isn't just one factor that causes premature ejaculation.

However, the typical man with premature ejaculation feels anxious about his condition and his sexual performance. He may experience a general pressure to perform or to prove himself rather than live and enjoy. 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 others in general and women in particular. Premature ejaculation may be a physical sign of this perceived 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 will heighten his tendency towards premature ejaculation.

For some men the connection between stress and anxiety is much more obvious. Some men can react to a sexual situation by getting very anxious and then ejaculating very rapidly, sometimes to the point of ejaculating before they have taken all their clothes off. In these more severe cases, the use of SSRI (selective serotonin reuptake inhibitors used as anti-depressants) may be necessary as well as behavioral and psychotherapeutic approaches to dealing with the issue.


What seems to contribute to premature ejaculation is age. Younger men are more prone to premature ejaculation. Most men ejaculate rapidly during their first sexual encounters, which suggests that most men may start off as "premature" ejaculators and some learn better control as they go along. Also, having less sex leads to quicker ejaculation. Infrequent sexual activity my heighten problems with 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 support longer penetration before ejaculation, whereas other positions hasten a guy's  ejaculation, such as the man-on-top or rear-entry positions. For more info on this, see our sex positions pages!


Men who ejaculate quickly often have unrealistic expectations about what their sexual performance should be like. The media and our sexual culture don't help here, for there's a widespread image of sex as intercourse-based, sex in which 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.


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 premature ejaculation.

For men with premature ejaculation the whole issue may become even more complicated due to the impact it has on the couple's relationship and vice versa. Some couples have no problems at all with sex even if the man does ejaculate rapidly after penetration. What seems to help in this respect is if 1) he feels OK about it, 2) the partner is OK with her or his own sexuality, 3) he does not feel responsible for his partner's sexual satisfaction, and 4) they enjoy themselves sexually in many ways.

However, in some relationships his premature ejaculation becomes a major issue. In this case it is important to look at the whole sexual relationship rather than think of premature ejaculation as being just his issue. If premature ejaculation persists even if he practices his skills and control there is a good chance that it's serving both partners in some way as a psychological defense.

If premature ejaculation and erectile dysfunction occur together, it is necessary to deal with the erectile dysfunction before the premature ejaculation is 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 behavioral control techniques and possibly some support or coaching with his overall sexual abilities. However, there are no or few underlying psychological contributing factors which help to maintain 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 behavioral 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 sexuality rather than expecting the man to do something for them.

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 premature 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 behavioral techniques may not work for men in this category. They may need to do more 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 tendency to delay orgasm).

D) Complicated and relational: Premature ejaculation becomes a defense for both partners, which may confirm existing roles and dynamics within the relationship. Here, premature ejaculation may simply be a smoke screen for other long standing relational difficulties. Often couples are not willing to engage with the behavioral programs designed to treat it nor to support each other in a process of change. It seems as if people are more invested in replaying roles and problems from their past rather than meeting each other psychologically and emotionally.

In this case, 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 without premature ejaculation and deeper issues need to be sorted first before the former can be addressed. Couples' therapy or individual therapy may be the only way forward.

The converse of premature ejaculation is retarded ejaculation, where a man cannot orgasm and ejaculate during intercourse. If this is a problem for you or your partner, the following website, which deals in great detail with the causes and cures of retarded ejaculation - also known as male orgasmic disorder - may be really helpful.


Treatment of premature ejaculation


Generally speaking, treatment for premature ejaculation should be easy. There are good behavioral programs available which teach ejaculatory control. However, these programs need to be practiced over a period of time as well as intermittently at later stages.

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 for premature ejaculation 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 behavioral 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. 

Basically, the man masturbates himself to a point just before he begins to come, then he pauses to let his arousal subside before he begins again. This helps him recognize the sensations he gets in his body prior to orgasm and ejaculation, and thereby helps him control his level of arousal by slowing down or stopping sexual activity.


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 psychosexual therapy may be an important option, whether you seek it out as an individual or as a couple. When the causes of premature ejaculation are deep-rooted, psychotherapy is essential - and the same is true when premature ejaculation 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.



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 27.12.06

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