What is it?
| Premature ejaculation is one of the most common sexual
problems. |
Premature ejaculation (PE) means coming too quickly, and it's
one of the most common sexual problems.
In our survey of several thousand British males, approximately
10 per cent of them said that they often or sometimes had this
trouble.
We found that it's commoner in younger men – which is not
surprising, as there's a distinct tendency for it to improve with age. Men
generally get better control as they grow older.
However, a 2004 survey in Europe showed that many middle-aged
men still have this problem. Fortunately, good treatments are
available.
In 2010/11, a new treatment became available in Britain and
several other countries – details below.
Definitions
It’s almost impossible to get an accurate definition of
premature ejaculation: what some couples consider a satisfactory length of
intercourse would be very inadequate for others.
At the 2006 Congress of the European Society for Sexual
Medicine, an American research paper reported:
- the average lasting time of men with PE was 1.8
minutes
- 'normal' men lasted an average of 7.3 minutes.
But there were males who claimed to have premature ejaculation,
yet who could last up to 25 minutes. This clearly shows people have wildly
differing ideas about what is normal!
At the same Congress, Professor Waldinger reported that 2.5 per
cent of men couldn't last 90 seconds inside the vagina. Those males undoubtedly
have PE.
From our own clinical experience, there are plenty of couples
who would regard intercourse that lasts under 20 minutes as less than
satisfactory, and would feel that any ejaculation in under 10 minutes or so is
decidedly premature.
As a working definition, if either you or your partner feels
that orgasm is happening too soon, there probably is some degree of
PE.
Does it matter?
In most cases premature ejaculation does matter, because it
makes people unhappy and frustrated. And in severe cases PE can threaten or
even ruin a marriage – simply because it spoils the sex lives of both partners.
Sometimes, the condition is so bad the man can't have sex
because he ejaculates before he can get into the vagina. This can be
devastating for a man's self-confidence. And it can be hugely frustrating and
annoying for his partner – especially if she wants to get
pregnant.
However, most men merely find PE a considerable irritation. It's
a condition that makes them come very soon after they enter their partner –
say, after only a minute or two, so neither party gets a lot of
satisfaction.
What causes it?
For many years, sex experts have tended to say that premature
ejaculation is caused by early conditioning.
In other words, the man's early, rushed (and perhaps furtive)
sexual experiences had to be quick so as to avoid detection. The idea is that
this conditions him to climax as quickly as possible.
However, our own surveys have found that many men with PE did
not have rushed early sexual experiences – though others say they
did.
It's worth noting that from an evolutionary point of view, it's
probable that males who climaxed quickly were more likely to have children. In
other words, if you were a caveman who came very fast, you'd stand more chance
of impregnating your woman and enlarging your tribe.
Some men seem to be highly triggered right from the start of
their sex lives, and we have encountered instances where their fathers were
much the same. Therefore, we feel that the tendency to reach orgasm quickly may
possibly be inherited rather than learned.
Finally, there's no question that
anxiety or 'nerves'
play a part in many cases of PE. If you're nervous, you're likely to come too
quickly.
This is why many males have discovered for themselves that a
small amount of alcohol eases their nerves and makes them less likely to climax
prematurely. But we wouldn't recommend
alcohol as a
treatment.
So, what can be done for PE?
Treatment for mild cases
If you have mild PE – for instance, you can last five minutes
but would like to last 10 – there's probably no point in going to a
doctor.
Why? Because you should be able to improve matters by simple
distraction techniques.
This means turning your mind to something else when you sense
that climax is near. For example, you can think about something totally
unconcerned with sex or pinch yourself.
Local anaesthetic gel
Some men try to treat themselves with a local
anaesthetic gel
that's applied to the shaft of the penis shortly before
intercourse.
This product is advertised to the public as a good way to
'damp down' sexual sensation in the penis.
We do not advise using this gel because the local anaesthetic
can 'dull' the sex sensation for your partner.
It can also cause a distressing skin reaction in either
partner, with intense itching, redness and soreness.
'Long love' condoms
German scientists have come up with a slightly different
approach that won't cause vaginal irritation.
It's called the 'long love condom’ and it contains a local
anaesthetic (benzocaine or lidocaine) inside it.
Long love
condoms are now being
sold in many countries, under a variety of brand names.
A few male patients have told us they do last longer with
these condoms, but the man is still at risk of a sensitivity reaction to the
local anaesthetic.
Treatment for more severe cases
If PE is causing you significant problems, it is best to consult
an expert for treatment.
The Masters-Johnson method
This method cures the vast majority of men, provided that
both partners are keen to co-operate (which isn't always the case).
It's based on a special 'penis grip' developed by the American
therapists Masters and Johnson. They employed it in a 're-education' course
lasting weeks or months.
The finger-grip abolishes the desire to climax, so if, under
careful instruction, the couple use it over a period of weeks, they can usually
re-train the man so he can last much longer. But please note that cure can't be
achieved overnight.
What does it involve?
- At each training session, your partner places her hand so
that her thumb is on one side of the man's erect penis (the nearer side to her
when she is facing him).
- Her index and middle fingers are on the other
side.
- The index finger is just above the ridge of the glans (the
'head'), while the middle finger is just below the ridge.
- When the man feels that he's near to a climax, he tells his
partner.
- She then squeezes his shaft firmly between her thumb and
the other two fingers. (Don't worry: it's painless!)
The programme and the grip can work for male couples as well
as for heterosexual ones.
Does it work?
We have seen many men with PE who couldn't last for 30
seconds, but who were able to last as long as half an hour after careful
training over a period of months.
However, unless this is done as part of an organised
programme, it probably won't work. We often hear from guys who tried to do it
themselves, and achieved nothing.
The Masters and Johnson grip really needs to be demonstrated
to you personally by an expert. Most couples who try to learn it from the
Internet or a book get it wrong.
Our advice: see a professional. In the UK, try one of the
organisations listed at the end of this article.
Antidepressant drugs
In recent years, it has also proved possible to treat PE with
antidepressant drugs taken a few hours before intercourse. The group that are
mainly used for this purpose are the SSRIs (
selective serotonin
re-uptake inhibitors).
The use of these drugs may seem a little odd, but delaying
male climax is a well-known side-effect of certain antidepressants. For most
men, that side-effect is unwanted. But for guys with premature ejaculation,
it's highly desirable.
Antidepressants that are commonly used for this purpose
include
clomipramine
(Anafranil),
fluoxetine
(Prozac) and
sertraline
(Lustral).
But please be warned: these are powerful drugs that can last a
long time in the body, and have a considerable list of potential
side-effects.
Before opting for one of them, talk it over carefully with
your doctor.
In many countries antidepressants are now sold illegally in
bars and on the street as 'last-longer pills'. We really do not recommend
buying antidepressants in this casual fashion.
Antidepressants are prescription-only drugs, with a potential
for causing you harm. If you want to try them for premature ejaculation, make
an appointment to see your GP.
Drugs by nasal inhalation
At the end of 2008, there was a good deal of controversy in
Britain because a company started using large advertisement hoardings to
promote its treatment for PE: a nose spray.
In fact, the only point of the spray is to deliver a drug into
the bloodstream more quickly than could be achieved through taking it by mouth.
The drug which is mainly being used in these new nose sprays
is clomipramine – which, as we have mentioned above, is an antidepressant.
There have also been reports of sex clinics suggesting the use
of the major painkiller tramadol in a nose spray.
This does not strike us as a good idea, in view of the drug's
side-effects which include mental confusion and abdominal pain.
Tramadol is related to morphine, and
is widely misused by people with drug problems. It is habit-forming.
A special constriction device
In 2000, a clinical trial of a new technique for treating
premature ejaculation was published in the medical press.
It was developed at St George's Hospital, London, and involved
wearing a slightly constricting ring below the head of the penis for 30 minutes
each day. The theory was it would make the organ less sensitive.
Unfortunately, at the present time the inventors of the device
have not been able to publish any results of large scale trials.
Don't attempt any constriction techniques like this off your
own bat. Such a method should only be prescribed by an expert at a sexual
problem clinic. It may or may not turn out to be useful.
Release of a new medication
At a medical conference we attended in December 2004, it was
announced that a new anti-PE medication should be launched during 2005.
However, it was not until 2010 that it was finally released
for use in the UK – and even now it is available only on a very limited basis,
and NOT on the Health Service.
But in recent months it has become widely available in
Scandinavia, Australia and Malaysia.
The product is a tablet called dapoxetine. Its UK trade name
is Priligy.
Essentially, it is one of the 'SSRI' group of antidepressants
– which, as noted above, do have the ability to lengthen the time between
sexual arousal and climax. It is taken by mouth, in tablet form. The dose is
either 30mg or 60mg. Dosage depends mainly on your body weight.
Please understand that Priligy is NOT a pill which will
actually cure PE.
The idea is that you simply take it a couple of hours before
you intend to have intercourse. With luck, you will last a good deal longer
that day.
But of course, you will need to take another Priligy tablet
before your next sexual encounter.
Newspaper reports appearing in Britain in late 2010 suggested
that it helps 70 per cent of males.
Unfortunately, the trial results we've seen so far suggest
that in reality only about 45 per cent of men reported that the drug gave them
control that was 'fair, good or very good'.
Possible side-effects of dapoxetine include dizziness, dry
mouth, nausea,
insomnia,
headaches and
diarrhoea.
However, if you have bad PE, Priligy (which may be the first
of various such products) would probably be worth trying when it becomes
available in your part of the world.
In the UK in 2012, the situation is that Priligy is NOT
available from your GP or on the NHS. Some private doctors prescribe it. You
can obtain it via the internet, but you should have an online 'consultation'
with a doctor first.
At present, it is still extremely expensive. In the UK the
online price has come down to £47.85 for three tablets. Obviously, this works
out at about £16 every time you want to make love.
Cognitive behaviour treatment (stop-start technique)
In 2006, we attended a conference on sexual medicine in
Vienna. One of the speakers, Dr Mehmet Sungur, claimed good results for the
cognitive behaviour (CBT)
method of treatment for PE.
The CBT method focuses on addressing the kind of thinking that
has proved unhelpful.
For example, a man may believe that ‘real men’ must thrust
endlessly to give a woman pleasure. Such thinking is not only damaging to the
man, but wrong. Most women want penetration but also derive great pleasure from
love play – often preferring fondling and
oral sex to
intercourse.
The CBT method also aims to alter the man’s behaviour: he is
encouraged to
masturbate using the
stop-start technique to gain more control over his responses and his urge to
ejaculate quickly.
The stop-start technique
- The man is encouraged to masturbate alone.
- He is asked to set time aside to be private and to
masturbate with dry hands.
- The man is encouraged to masturbate almost to the point of
ejaculation and then stop.
- He should do this three times.
- On the fourth time, he is permitted to
ejaculate.
After he has achieved this measure of control, he can try
masturbating with a wet hand, which will feel more like the inside of a vagina.
He is encouraged to do the stop-start technique as before.
Obviously, this technique could possibly be adopted by a man
who does not seek treatment from a therapist.
But because there are often psychological difficulties as
well as behavioural and mechanical ones, most men will benefit more from
seeking treatment rather than using the stop-start technique on their
own.
