Many aspects of sexual dysfunction remain shrouded in mystery even today, largely as a result of the hesitation felt by men who are suffering, to discuss the problem in the open, either with their peers or with the medical profession.
On the whole, most people will be aware, to some extent, that erectile dysfunction involves a man experiencing difficulty in achieving or maintaining an erection. People may also be aware that this becomes more common as a man gets older. What they may be less aware of is that premature ejaculation occurs in up to a third of men across the age groups making it the most common form of sexual dysfunction in men.
What causes premature ejaculation?
There is a theory that premature ejaculation may be influenced by evolutionary factors in that the man who ejaculates the most quickly has a better chance of spreading his genes; this is because he is less likely to be attacked by a competing male during intercourse when he is vulnerable.
A combination of physical, psychological and relationship factors can influence premature ejaculation so we need to consider all these areas in order to more fully understand erectile dysfunction:
- Physical factors – withdrawal from opiates and alcohol are connected with erectile dysfunction as are diabetes, thyroid problems, prostate problems and cardiovascular disease
- Psychological factors – depression, anxiety, stress and anger resulting from your relationship alongside low self esteem and sexual guilt can all contribute to erectile dysfunction; all of these issues have been shown to make the problem worse. When we are stressed or under pressure, the body produces the hormone cortisol. The effects of cortisol include preparing the body for fight and flight and so the nervous system becomes more excitable. Whilst this response is useful if you are under threat but it also has the effect of making premature ejaculation worse
- Relationship issues – factors connected to a relationship, be they sexual or non-sexual can impact a man’s sexual performance. Poor communication, fear of commitment, fear of intimacy and feeling pressured can all have the effect of reducing a man’s ejaculatory control. Another factor that may cause problems is if a man believes that his partner is not enjoying intimacy or is finding it physically uncomfortable in some way. This can have the effect of the man wanting the process to be over as soon as possible.
- Learned behaviour – for some men premature ejaculation can be an acquired habit learned as a result of masturbating too quickly, sometimes whilst watching pornography which in itself can speed the process up.
- Alcohol and recreational drugs – alcohol and drugs such as amphetamines and cocaine can not only cause erectile dysfunction but are also known to cause premature ejaculation.
- Medication – medication that is prescribed to treat Parkinson’s disease can cause premature ejaculation.
Treating premature ejaculation
Consulting your doctor is the first step in finding the best treatment for PE. The type of treatment will be dependent on the cause and whether your type of PE is lifelong or acquired. Behavioural treatments include:
Stop-start technique – this method involves being bright close to orgasm, either by yourself or your partner and at that point stop and rest. This process is repeated until ejaculation is permitted.
The squeeze technique – again, a man is brought to a point just prior to ejaculation at which point, the head of the penis is ‘squeezed’ for 10 – 20 seconds. After a period of another 30 seconds, the process is repeated. This way, the period leading up to ejaculation is considerably extended.
There are ways to help yourself to last longer in bed and they include:
- Masturbate 1 – 2 hours prior to having sexual intercourse. Take a deep breath quickly when you feel ejaculation approaching. This helps by shutting down the ejaculatory reflex. This is an automatic reflex that occurs when ejaculation takes place
- Have sex with your partner on top. This will enable your partner to pull away when ejaculation is close
- Use a thick condom, this will reduce sensation on the penis
- Take breaks whilst you are having sex. In addition to lengthening the process, it will kill the moment, enabling you to try to think about someone else
It is important to remember that while the male in a relationship may think that the problem is his, in actual fact the problem affects both partners in the relationship. Working together towards a solution can enable the relationship to grow.
It is normal for a sex therapist to be involved in this process and suggestions may include:
If there are issues within the relationship then it may be advisable for the couple to explore these issues. The therapist will be able to assist in solving any problems.
Another suggested method may be to encourage the couple to explore each other’s bodies but in a way that is not related to sex. The aim of this method is to retrain the brain and body whilst at the same time being an enjoyable and stress free experience.
There are techniques that are able to help people 'unlearn’ and so reverse some behaviours whilst at the same time enabling the person to learn better habits which are less likely to result in premature ejaculation. The ‘stop-start’ and ‘squeeze' techniques which are in this category are covered earlier in this article.
Reducing stress and anxiety
Keeping stress and anxiety levels down is a good first step. If PE is already a problem and you are experiencing added stress as a result of work, family, money problems or relationship problems then it is likely that PE will get worse; the PE then becomes entrenched in a vicious cycle as it causes more stress,
Ways to break that vicious circle stress cycle include:
- Regular exercise, aerobic exercise in particular is a good stress buster.
- Meditation techniques can be very effective in reducing stress and anxiety levels
- Reduce caffeine intake; caffeine can have the effect of increasing stress levels in the body
- Reduce alcohol as it is also a stimulant
- Have and give massage to your partner before intercourse can relax the situation and make matters less frantic
Treating PE with medication
There are several drugs that are used to treat depression but have also been found to be effective in the treatment of premature ejaculation. They are known as SSRI’s or selective serotonin reuptake inhibitors. SSRIs that have been used for this function include the following:
For some men, the effect is almost immediate but in most cases, it can take 2 – 3 weeks for the drug to reach its full effect. There are also side effects to these drugs which are usually mild and short lives. They include:
- Nausea and vomiting
- Excessive sweating
There is a particular SSRI medication that has been licensed for the treatment of erectile dysfunction in the UK known as dapoxetine; it is marketed as Priligy. The action of this drug is much more rapid than other SSRIs and as a result can be used on an ‘as and when’ basis, rather than having to take a drug on a daily basis.
The dosage is that it must be used no more than once per day between 1 and 3 hours before having sex. Side effects can include nausea, headaches and dizziness; it is also contraindicated in men with heart, kidney or liver problems. It is also contraindicated for use with some antidepressant medication.
Phosphodiesterase- 5 inhibitors (PDE5 inhibitors)
Lidocaine or prilocaine can be administered to the tip of the penis in an ointment or cream form. The effects of the medication can however be transferred to the walls of the vagina which is a disadvantage. It can be more acceptable if condoms are used in conjunction with the anaesthetic. This will further reduce the sensation felt by the penis as well as protecting the walls of the vagina.
Any subject relating to problems having sex can be embarrassing and so difficult to talk about; this includes communicating with a partner or even communicating with a GP. It is important to talk things over with both parties. Firstly, because your partner is closely involved with and so affected by the PE and secondly with your GP as they have heard it all before and will be able to help!
At the end of the day, when your self confidence and even your relationship are at stake, facing the embarrassment is surely a no-brainer!