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Premature ejaculation - coming too soon!

Published:Tuesday | September 2, 2014 | 12:00 AM

PREMATURE EJACULATION (PE) is the medical term for a male sexual disorder in which, during sex, a man ejaculates earlier than he or his partner desires. PE is the commonest sexual disorder in men below 40 years of age, with as many as 70 per cent of men being affected to some degree at one time or another.

The PE sufferer ejaculates before he or his partner would like. Severity may range from ejaculation even before vaginal penetration to within one minute after penetration. This usually leaves the couple feeling unsatisfied. PE is not usually caused by any physical problem, but, in fact, is mostly the result of psychological issues like guilt, fear or anxiety. Interestingly, research in the US suggests that, on average for most men, ejaculation occurs within five minutes of vaginal penetration.

Lifelong premature ejaculation

With lifelong PE, the man has never had sex without also experiencing premature ejaculation. In this situation, a complex, deep-seated emotional disturbance is often present.

This behaviour may be a conditioned response resulting from teenage masturbation practices or from deep anxiety about sex coming from early traumatic experiences (incest, sexual assault, conflict with parents, religious guilt or other serious disturbances). In most cases of lifelong PE, referral to a psychiatrist, psychologist or sex therapist is indicated.

One psychological explanation for PE suggests that many men are conditioned as youngsters to reach climax quickly because of fear of discovery when masturbating or during early sexual experiences with others. This pattern of rapid sexual release becomes difficult to change later in marital or other relationships.

Acquired premature ejaculation

Acquired PE refers to PE that develops after not having had the problem before. This usually indicates that some form of performance anxiety is a major factor.

Performance pressure (fear of failure to satisfy his partner) can arise from other problems like erectile dysfunction (ED). Fear that an erection will not last may precipitate PE. In such cases, the man apologises for his early climax by claiming that extreme excitement by his partner caused the problem.

However, ED may not be the issue, and factors like a belittling attitude from his partner may be the real cause of the man's anxiety and subsequent PE.

Treatment: Because of the complexity and severity of the underlying psychological issues, evaluation and treatment by a sex therapist, psychologist, psychotherapist or psychiatrist may be necessary for some people. Many family physicians do not have the time or expertise to handle the deep psychological disturbance.

The practice of relaxation techniques may be helpful and there are several self-help strategies that a couple may try:

The 'stop and start' method: This technique involves the female partner sexually stimulating the man until he feels like he is about to reach an orgasm. She then stops the stimulation for about 30 seconds to allow the sensations to diminish and then start it again. This pattern is repeatedly practised to allow the man to learn to deliberately postpone ejaculation.

The 'squeeze' method: This technique involves sexual stimulation to the man until he recognises that he is about to ejaculate. At that point, the man or his partner gently squeezes near the end of the penis (where the glans meets the shaft) for several seconds while sexual stimulation is halted and then started again. The man or couple may repeat this pattern until ejaculation is desired.

Kegel exercises: Commonly recommended for women to strengthen the muscles of the pelvic floor, they have been reported to assist men to

develop greater control of ejaculation while at the same time helping to improve ED. Detailed instructions on Kegels exercise are outlined in my new book.

Another approach involves reducing penile sensitivity with local anaesthetic creams or condom use, in the hope that decreased sensations in the penis may delay ejaculation.

Medication: A variety of antidepressants drugs such as Imipramine, Prozac and others are often prescribed to treat PE. Apart from relieving depression and anxiety a side effect of these medicines is that they increase the time it takes to ejaculate. A natural alternative to them is the herb St John's Wort which has its own relaxant and antidepressant effects.

Recent research suggests that medicines used to treat ED by increasing blood flow to the penis (the Viagra group of drugs) may also help to relieve PE. These drugs work by increasing the levels of an important molecule called nitric oxide. A number of natural substances - the amino acids L-arginine and L-citrulline and the herb pycnogenol do a similar job. Herbalife International has this natural combination in tablet form.

I believe that better sex education at home and school during adolescence can decrease the incidence of premature ejaculation in young men. In older men, the early treatment of ED would help prevent acquired PE.

You may email Dr Vendryes at tonyvendryes@gmail.com or listen to An Ounce of Prevention on POWER106FM on Fridays at 8:15 pm. His new book, An Ounce of Prevention - Mainly for Men, deals with issues like the above and is available at local bookstores and on the Internet.