Premature
ejaculation
Related
pages:
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.
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 27.12.06
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