Premature Ejaculation

Consistent orgasm between one and three minutes of sexual intercourse or sexual stimulation is considered premature. Bear in mind that research shows many 'normal' sexual encounters last five to six minutes.

It's important to remember that if it happens infrequently it is not a problem. Many men experience occasional premature ejaculation. It can be brought on by stress, alcohol or tiredness. If this turns into a regular occurrence, and you are unable to regain control, then medication, counseling and techniques can help get you back on track. Don't be embarrassed to speak to your doctor about the common condition.

Is premature ejaculation common?

Yes, premature ejaculation is common and it may even be under-reported due to the social stigma attached to a man who ejaculates too soon.

Issues with sex are common from erectile dysfunction through to premature ejaculation, delayed ejaculation, and size worries. The worries men have about their sex lives are wide-ranging and often detrimental to their self-confidence. It's worth remembering you are not alone if you are concerned about your sex life.

Physical and psychological reasons can cause premature ejaculation.

The physical reasons include:

• Infection of the prostate, urethra or other penile condition
• A problem with hormone levels
• A change in brain chemicals
• Erectile dysfunction which causes a man to speed up in case he loses his erection
• Sexual inexperience
• Inherited aspects

The psychological causes include:

• Anxiety and Stress including performance anxiety
• Sexual abuse
• Depression
• Low self confidence and a poor body image
• Poor communication with your partner

Primary and secondary symptoms of PE

The main symptom of premature ejaculation is a man's inability to prolong his orgasm more than a one to three minutes after penetrative sex. This may happen in all sexual encounters whether penetration occurs or not. Orgasming too soon can happen during masturbation or other body contact.

Other symptoms which can arise as a result of premature ejaculation are relationship difficulties, low self esteem, anxiety, depression and a tendency to avoid sex or relationships. In the long term it may lead to difficulties conceiving.

PE can be separated into two types, Lifelong/ primary premature ejaculation and acquired/ secondary premature ejaculation.

• Lifelong/Primary – when PE has occurred nearly or all of your life.
• Acquired/ Secondary - when PE develops after you have had sexual encounters without orgasming too soon.

Some men experience a mixture of normal ejaculation and premature ejaculation. This may not fit the diagnosis of premature ejaculation, but if it distresses you, seek your doctor's advice.

If you feel your life is being affected by rapid ejaculation then your doctor can help. There are treatments and supports to help you. To get a diagnosis you are likely to be assessed as having:

• Distress about your sexual performance
• Always or nearly always ejaculate within one minute of sex
• You are unable to delay or slow down your ejaculation

If these issues happen infrequently, you do not have premature ejaculation, however you may benefit from hearing your doctor tell you that it's perfectly normal to have premature ejaculation on occasion.

In some men PE appears one day for no reason you can fathom and causes distress and upset. It's not always easy to find your way back to delaying ejaculation.

The risk factors for premature ejaculation are:

Overtiredness - Ensure you get enough sleep, open a window and do something relaxing before bedtime. Avoid TV and computer screens an hour before you sleep as the light will stimulate your brain and keep you awake.

Stress – Working too hard and being anxious about a certain situation can cause PE. Try to find a good work/life balance and find a way to de-stress such as a hobby, exercise or other enjoyable distraction.

Performance anxiety – If you have experienced erection difficulties you may find this leads to PE. Speak to your doctor if you find you are unable or get or maintain an erection on a frequent basis.

There are many treatments ranging from control techniques to sprays, medications, and counseling. It's important to find out what is causing the PE before you start treatment. Sometimes you will need to try a number of treatments to find one that suits you.

Control techniques

Some experts recommend masturbating a few hours before anticipated sex so that you're not so sensitive. Other steps include avoiding intercourse and focusing on foreplay.

The pause-squeeze technique

When you feel orgasm approaching, squeeze the end of your penis at the area joining the head to the shaft, and hold until the urge fades away. You can repeat this as many times as necessary during sex. After time you will be able to identify the feeling needed to stop orgasm without the squeeze. You can practice this during masturbation too.

If squeezing hurts, simply stop stimulation and wait for the sensation to pass. This is the stop /start technique.

Pelvic floor exercises

Strengthening your pelvic floor may help control orgasm. Stop your urine midstream to identify the muscles and then squeeze and relax these on a regular basis. This is sometimes called 'working your kegels'. Aim for three sets of ten squeezes each day, and hold each squeeze for three seconds.

Condoms

Using a condom can help decrease your sensitivity to stimulation, particularly the thicker ones. You can buy these over-the-counter or online.

Anaesthetics spray and Creams

It's possible to buy sprays and creams that contain numbing ingredients such as benzocaine or lidocaine. Applied ten to fifteen minutes before sex and they may help control your orgasm by reducing sensation.

Although topical anaesthetic agents are effective and well-tolerated, they have potential side effects. For example, some men report a temporary loss of sensitivity and decreased sexual pleasure. Sometimes, female partners also have reported these effects.

Oral medications

Your doctor may suggest medication to delay orgasm. There are no specific medications used to treat PE, but side effects of certain drugs can delay orgasm. These include antidepressants, pain medications such as analgesics and erectile dysfunction medications called PDE-5 inhibitors.

Mental health and counselling

A therapist or counselor might be able to help you get to the bottom of your difficulties if they are psychological. A specialist sex therapist can help with traumatic experiences in the past, or teach you techniques to prevent PE. These sessions can help reduce anxiety about performance.

If the root cause is a relationship difficulty such as guilt, a lack of attraction or a loss of connection, then couples therapy may help.

It is important to include your partner in any treatment. They may feel hurt or pushed away by a lack of intimacy and blame themselves. Open and honest communication can improve a relationship and help you manage premature ejaculation.

Men who want to last longer in bed should try the techniques listed above to slow down their orgasm. It's also worth remembering that sex is not all about penetration. There are other ways to enjoy a sex life that will be appreciated by your partner. Oral sex, mutual masturbation, foreplay, role play and even hugging your partner all count as part of your sex life.

Try not to focus too much on the penetration aspect as this raises expectations and anxiety levels.
Do not pay attention to boasting stories or tales of a man lasting all night in bed. The average time for sexual intercourse last around five minutes. You can extend sexual pleasure by focusing on other aspects.