Ask a Sex Therapist: How to Stop Premature Ejaculation?

by Cay L. Crow

Man in bed without clothes on covered up by blanks looking at his crotch in surprise

Can I Have Great Sex Despite Rapid Ejaculation?

Advice from an AASECT-Certified Sex Therapist for those concerned about ejaculating rapidly:

First of all, you can have rapid ejaculation and have great sex!

So many men self-diagnose premature ejaculation (PE). One of the first things I do with each

client is, go over the diagnostic criteria. Many who self-diagnose believe that their partners

want them to last longer but this turns out to be a projection on the guy’s part. When I ask the

partner to come in, the partner often surprises the guy by saying the sex they are having is

great!

Is Premature Ejaculation Really A Problem?

The reality is that the male reproductive system is designed to ejaculate quickly and frequently.

Your body is functioning exactly as it is supposed to. It only becomes a problem when you or

your partner wants penetrative sex to last longer.

What Is Premature Ejaculation?

According to the International Society for Sexual Medicine, the definition of premature

ejaculation now includes a time minimum. A guy has PE if he ejaculates in less than minute, he

has little or no control of ejaculation, and he feels distressed about it. To put this in perspective,

one study of 500 couples from five countries who timed intercourse reported that most men

lasted between 2- 9 minutes. Few men lasted longer than 18 minutes. Half of the men lasted

for less than 6 minutes.

Can Circumcision or Condoms Help Premature Ejaculation?

Condom use and circumcision did not impact ejaculatory control in this study.

One study attempted to understand the difference between men with ejaculatory control and

those with PE. Sexual response to erotic films was the same. However, when stimulation with

male sex toys were added to the mix, 60% of those with PE ejaculated. The researchers

concluded that men with Premature Ejaculation might be neurologically wired to come quickly.

Another study demonstrated that the rapid heart rate common during sexual arousal continues

throughout sex for men with PE. Usually, men experience a slowing of the heart rate once they have

an erection.

Is It Really Important to Last Longer in Bed?

Are you focusing too much on how long you last as an indication of your skill as a lover?

Your partner wants to connect with all of you, not just your penis. When you focus too much

on how long you last, you could miss those subtle moments when the connection happens.

Men with PE often focus on their penis and ignore other body sensations such as secondary

erogenous zones. I often ask couples to do Sensate Focus exercises to expand their definition

of sensuality and eroticism. Sensate Focus is great for teaching mindfulness and introducing

relaxation into a situation that has been fraught with anxiety. I also encourage couples dealing

with PE to expand their definition of sex to include activities that do not require an erection.

While thinking about baseball statistics might seem to help temporarily with ejaculatory

control, it takes you out of the glorious sexual moment right in front of you. It is better to stay

in the game with your partner than be in the stands as a sportscaster, narrating your own

performance. Otherwise, you are a spectator to your own sexual pleasure.

Can A Man Control His Ejaculation?

Too many partners, especially partners who don’t have a penis, assume that a man can control

his ejaculation if he really tries. This is simply not true. Shaming a guy will not motivate him to

do anything about the situation including a talk with his partner about it. In fact, PE can actually

develop in a relationship where the partner tells the man overtly or subtly that he isn’t good

enough. This cycle of dread will put quite a damper on sex, and it could create a context in

which the man has difficulty with erections. The partner’s involvement and support are essential

to addressing PE.

The research demonstrates little or no evidence that PE is the result of a medical or

psychological issue. Acquired PE has been noted in 50-75% of men with hyperthyroidism but

there is no correlation between lifelong PE and hyperthyroidism.

Does Premature Ejaculation Improve With Time?

In men with lifelong PE, ejaculation control does not improve with age. These are cases where

creative adaptations in the bedroom are in order. For example, the couple does everything but

the most stimulating activity for the guy until he is ready to ejaculate.

How to Stop Premature Ejaculation?

One of the most effective tools I have found for PE is the timely use of the perineal press. The

perineum is also known as the taint or gooch, the area between the scrotum and the anus.

Firm pressure to this area during arousal helps relax the prostate which is behind the

compelling need to ejaculate. At the same time, open your mouth and exhale like you are

cleaning your sunglasses. This helps relax the pelvic floor muscles which tense up as ejaculation

approaches. Do not use the perineal press once you are past the point of inevitability when

ejaculation is imminent. Try using the perineal press during masturbation to see if it works for

you then introduce it to your partner.

Should I Use Medicines to Cure Premature Ejaculation?

Modern medicine has few products to offer for PE. 90% of men who start taking drugs for PE

discontinue them because they don’t work or because of the side effects. Promescent is a

numbing spray applied to the penis. There are condoms with benzocaine gel on the inside to

numb the penis. Many of the drugs used to treat PE were never approved for that purpose and

most of the studies done on their efficacy are done by the drug companies. Your doctor might

offer you a low dose of an SSRI like Prozac, Paxil, or Zoloft or Clomipramine (Anafranil) since

these medications have sexual side effects. You may experience ejaculatory control but you

could also experience a loss of sexual desire or arousal issues, not to mention other side effects.

Trials of Dapoxetine (Priligy) did not impress the FDA enough for approval although it is used in

other countries. The majority of men who tried it stopped using it within a year. On the

horizon, a drug called Silodosin might be promising. Boner drugs like Viagra, Levitra, Cialis, and

Stendra do not directly impact PE but can help with erection-related issues. For example, a guy

with PE can take a boner drug, ejaculate and then get a reliable second erection which may last

longer. Try samples of each drug first before committing to a prescription.

Overall, the best approach to PE is layering multiple interventions that are effective for you.

An AASECT Certified Sex Therapist in your area could also be a great resource. AASECT

Cay L. Crow, LPC, AASECT-Certified Sex Therapist


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