Premature ejaculation is the most common of all male sexual complaints. Most men are loath to talk about it, but it can be effectively treated.
But if you asked a group of those men who are ‘getting enough’ what their problem is, you’ll probably hear ‘shooting my load off too early’.
Indeed, premature ejaculation, sometimes abbreviated by medical specialists to PE, is the most common sexual complaint amongst men and couples.
It’s a consistent problem for about one in three men, although two in three men may be affected at some time in their lives. It’s less common in older men, and most common in adolescents (because stimulation, erection and ejaculation rely on a complex pathway of nerves and blood vessels; these pathways become less responsive with age).
Little good comes of PE. It may lead to criticism of a man from his partner, often causing anxiety, loss of self-esteem, erectile dysfunction (impotence) and diminished libido. It doesn’t do much for the partner either, leading to diminished orgasm and in some cases inability to achieve orgasm at all.
But what is PE exactly? The definitions are a bit vague. It’s usually defined along the lines of ‘ejaculation happening sooner than the man or his partner would want’. But that means different things to different people.
So this month, the International Society for Sexual Medicine (ISSM), after consulting the world’s leading sexual health experts, came up with an evidence-based definition of premature ejaculation.
Here’s how they define it: “Premature ejaculation is a male sexual dysfunction characterised by ejaculation which always or nearly always occurs prior to or within about one minute of vaginal penetration; and, inability to delay ejaculation on all or nearly all vaginal penetrations; and, negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intimacy.”
They also point out that this definition can encompass sex that doesn’t necessarily involve vaginal penetration, but some other form of sexual stimulation.
When to seek help?
The ISSM says this definition is important, because it gives a man (and his partner) a clearer idea of when something is wrong, and when to seek help.
Going by this definition, a man may not need help; there may be nothing wrong. According to this definition PE is where early ejaculation “always or nearly always occurs”. In other words, PE is only a problem if it happens repeatedly.
In fact most men occasionally reach orgasm sooner than they’d like. It’s normal for a man to ejaculate quickly the first time he has sex, for example. It is also normal in those men who haven’t ejaculated for a long time.
But if it does happen frequently, what then?
Sex therapists say PE is usually caused by a man’s circumstances or mental state, and is not due to any physical problem. These circumstances might be:
- performance anxiety (the main cause), especially anxiety related to beginning a new relationship;
- conflict within an existing relationship (leading to fear of rejection or sexual failure);
- generalised anxiety or stress;
- a childhood anxiety about sex, a religious belief, or a fear of contracting disease or experiencing some physical harm.
The treatment for PE due to these causes is counselling and behavioural therapy from an experienced sex therapist, counsellor, or GP. These techniques help most men with PE. But they rely on a man being open and honest with his partner and with the therapist, and may include:
- techniques in which a man distracts himself in the early stages of arousal, to prolong ejaculation;
- the ‘stop-and-start’ technique, in which the man’s partner stimulates his penis until he feels he is about to ejaculate, then stops, waits for 20 or 30 seconds and then begins again;
- the ‘squeeze’ technique, which involves withdrawing the penis (or stopping foreplay) prior to orgasm and squeezing the end of the penis, where the head joins the shaft, for several seconds until the urge to ejaculate passes;
- psychotherapy directed at correcting underlying anxieties.
Sometimes PE doesn’t have a psychological cause, but is due to underlying disease, says a group of medical specialists writing in this month’s Medical Journal of Australia.
Some men have a condition known as primary (lifelong) premature ejaculation. For them, PE is a continual problem, regardless of their circumstances and who they’re with.
These men have increased sensitivity in the nerve, brain and blood vessel pathways that control orgasm and ejaculation. The pathways are hyperactive and easily triggered following sexual stimulation. The cause isn’t known, but it’s thought to have a genetic basis, as it tends to run in families.
Counselling and sex therapy doesn’t usually help these men. They often have relationship problems – but these are the effects of their condition, not the cause of it.
Drug treatment will help in about 75 per cent of cases. The most effective medications are the SSRI antidepressants, which increase levels of serotonin. Paroxetine (brand name Aropax) and sertraline (Zoloft) work best. Serotonin elevates mood (which is why these drugs are used as antidepressants), but also has the effect of inhibiting ejaculation. But the drugs take up to five hours to work and so need to be given in small doses on a daily basis – they don’t work if taken just before planned sexual activity.
Topical anaesthetics such as lignocaine cream or ointment applied to the penis 20 to 30 minutes before sex (and removed just before sex begins) have also been shown to work.
Other (non-drug) approaches include using condoms (they reduce sensitivity of the head of the penis and delay ejaculation), and masturbation prior to sex – ejaculation is usually delayed if it follows an earlier ejaculation.
The important thing, whatever the cause, is that a man recognises the problem and seeks help, rather than letting resentment and anxiety bubble away. This week is International Men’s Health Week – a good a time as any.