Premature Ejaculation

Premature ejaculation is a problem which plagues up to 36 million men if it is defined as ejaculation within five minutes. It is important to recognize, however, that premature ejaculation is a subjective diagnosis and totally depends on the satisfaction of the partners.

You don’t have a premature ejaculation problem unless you FREQUENTLY ejaculate before or shortly after beginning intercourse.

There are a great number of misconceptions and myths about premature ejaculation. The following are NOT typically causes of premature ejaculation:

  1. Men are too excited to focus on bodily sensation
  2. Some men’s first experience with intercourse was in a tense situation where hurrying was beneficial, like in a car, and then learned a bad habit.
  3. Being so concerned about performance they didn’t pay attention to their own sensations.
  4. Guilt about enjoying sex or pleasure of any kind.
  5. Worrying about maintaining erections.
  6. Unresolved relationship issues.
  7. General life stress.

Through the years many physical causes were linked to premature ejaculation. However, there are very few medical reasons that have been documented as causing premature ejaculation.

In the early 1990’s, research indicated that the pelvic muscles, specifically the muscles that surround the erectile bodies in the penis, are in a hyperactive state in men with premature ejaculation.

Further, it is known that during the ejaculation process there is increased activity of these same muscle groups. Consequently, it is likely that men who have premature ejaculation have hyperactive muscles that are already on their way toward the threshold to producing ejaculations.

Over the past few years that we have been evaluating and treating men with impotence and premature ejaculation at the Male Health Center (in excess of 3,000 men), we have noticed that men with premature ejaculation have increased sensitivity to vibration in the penis when compared to men without premature ejaculation. It is likely that premature ejaculation, at least in some men, may be due to a combination of hypersensitivity of the penis and hyperspasticity of the pelvic muscles.

Currently, the Male Health Center approach to premature ejaculation consists of a history and a physical examination specifically geared to determine the amount of sensitivity of the penis and detect any neurological problem. In the vast majority of cases, the patient’s problem relates to hypersensitivity of the penis.

Treating premature ejaculation
As to treating premature ejaculation, here are a list of things that DON’T work:

  • long-term psychoanalysis
  • getting drunk
  • using one or more condoms
  • concentrating on something other than sex while having sex
  • biting one’s cheek as a distraction
  • frequent masturbation
  • creams that numb the penis
  • testosterone injections
  • tranquilizers

There are legitimate ways, to treat premature ejaculation:

1. The squeeze method
Developed by Masters and Johnson, this method has the partner stimulate the man’s penis until he is close to ejaculation. At the point when he is about to ejaculate, the partner squeezes the penis hard enough to make him partially lose his erection. By circling the hand just below the head of the penis, a squeeze will prevent ejaculation. The goal of this technique is to teach the man to become aware of the sensations leading up to orgasm, and then begin to control and delay his orgasm on his own. This technique progresses from manual stimulation to motionless intercourse to intercourse with both moving. Masters and Johnson reported that 98 percent of couples who learned and used these techniques had success treating premature ejaculation.

2. The stop-start method
Stop-start involves the partner stimulating the man’s penis, except that when the man instructs, the partner stops stimulating the man’s penis before ejaculation becomes inevitable. Then as he feels he regains control, he instructs the partner to begin stimulating his penis again. This procedure is repeated three times before allowing the man to ejaculate on the fourth time. The couple repeats this exercise three times a week, until the man has good control, then they progress to stop-start with lubrication, and then intercourse with the woman on top and the man not moving. He again instructs her to stop moving when he senses he is losing control. The couple progresses over subsequent times to the having the man move, then side by side intercourse. Instead of stopping and starting, the couple may progress to merely slowing down to enable the man to regain control of his urge to ejaculate. The therapists counseling patients using this stop-start technique report a 90 percent success rate in delaying ejaculation.
Dr. Helen Kaplan described in her book, Premature Ejaculation other exercises that she claimed when performed and practiced regularly prolonged in at least 70-80% of men the time to ejaculation.

While exercise methods are effective, they both rely on the cooperation of the man’s partner, which in some cases may be a problem. For that reason, the Male Health Center also recommends some additional methods for helping the man get control of the sensations leading up to orgasm.

3. Biofeedback therapy
Biofeedback treatment enables a man to become aware of the muscles that control ejaculation and relax them. For a period of time, the Male Health Center used biofeedback (where control of the bodily functions is mastered) through the use of a rectal plug and home teaching monitor. While men were able to delay ejaculation with this technique, male patients were reluctant to stimulate themselves with something in the rectum. No surprise.

4. Drug Therapy
Recently there have been reports in the urology literature of successful treatment of premature ejaculation through the use of low dose antidepressants including Anafronil, Prozac, and Zoloft.

One of the known side effects of these medications when used for depression is significantly delayed ejaculation. In the studies, extremely low doses of the antidepressant medication have prolonged ejaculation by at least 5-10 minutes with very few side effects.

Currently these medications are the most popular treatment alternative selected by our patients. The medication is given approximately four hours before intercourse and will result in a significant delay of ejaculation.

Few patients have described any side effects with this treatment. On certain occasions, the medication is given on a daily basis. It should be pointed out that this medication is not approved by the FDA for treatment of premature ejaculation. When combining the medication with the exercised in Dr. Kaplan’s book, a man can begin to take control over his ejaculation time.

5. Counseling
Although premature ejaculation is a common and frustrating problem, the Male Health Center has had great success in treating the problem. Frequently, marital and relationship issues may be an underlying cause of premature ejaculation. These issues should also be addressed to improve the success of the therapy.