When sex ends before it even starts, there’s a problem. The numbers are surprising. About 30% of men suffer from premature ejaculation, according to an extensive review published in the Journal of Sexual Medicine. The problem is especially common among young men up to the age of 40, and it causes them to have feelings of failure, shame, and guilt.
On the other side of the mattress, things are also not bright. The partners of these men may experience frustration and anger. In a recent survey of 1,040 women, 14% of women said they would end a relationship because of premature ejaculation and 70% said that they expect their partner to seek treatment for their sexual issues.
Dr. Zvi Zuckerman is the former Director of the Andrology and Sex Counseling Unit at the Rabin Medical center. He is also one of the creators of the Between Us Clinic’s Premature Ejaculation Program – an online program that teaches men how to overcome premature ejaculation.
We asked Dr. Zuckerman to help shed some light on this widespread but rarely talked about sexual dysfunction.
How can men know if they have full-blown premature ejaculation or just “normal” performance issues?
The International Society of Sexual Medicine defines premature ejaculation as:
Ejaculation that always or nearly always occurs within about 1 minuteof vaginal penetration also leads to negative personal consequences, such as distress, worry, frustration, and/or the avoidance of sexual intimacy
But, according to Dr. Zuckerman, although the formal definition is pretty straightforward, self-diagnosis is still not that easy. “If you ask couples with premature ejaculation issues how long it takes for ejaculation to happen, usually they will overestimate and report 5 minutes when usually it occurs within 1 minute.”
Dutch researcher Marcel Waldinger used to observe intercourse with a stopwatch to time the moment of penetration until ejaculation. He discovered that 90% of the men who suffer from premature ejaculation ejaculate within a minute and that the problem has a prominent genetic component. In about 91% of the cases, the patients have first-degree relatives with the same issue.”
In real life, though, most men don’t time their orgasms with a stopwatch, and even fewer will talk about this issue with first-degree relatives. This means that many men think they aren’t that good in bed when in fact, they have a sexual dysfunction that can be treated.
“Men develop ‘patent’ for delaying ejaculation, such as drinking alcohol before sexual activity or thinking about soccer or the overdraft in the bank during intercourse. Some tighten the muscles of the lower pelvis or stop and ‘rest” after every single movement. Some try to ejaculate twice when they have sex. The first time is very quick, and then they wait for a second erection in the hopes that it will happen within a reasonable period – let’s say up to 30 minutes – and hope that they will last longer this time. But as the man ages, it takes more time to have a second erection. Therefore, some men seek treatment only at an older age, when a second erection is no longer possible or when they also struggle with erection issues.”
Is there a typical case of a man with premature ejaculation?
“No, there isn’t one typical, but there are common scenarios. For example, there are couples in which the husband and wife lack sexual experience,” says Dr. Zuckerman. “Soon after getting together, they have children, and only a few years later, after the wife has had the chance to talk with her friends or get some basic sexual education online, she starts to comprehend that sex can be different. She begins to develop feelings of frustration and anger, and the stress rises. Some wives send their partners to treatment without showing any wish to participate.”
Dr. Zuckerman explains that there are four main types of premature ejaculation that look different.
“Lifelong premature ejaculation occurs in a man who has suffered from premature ejaculation throughout his life. Premature ejaculation happened in the first sexual activity and has continued ever since.
Acquired premature ejaculation is premature ejaculation that suddenly appears in a man who used to enjoy ‘normal’ ejaculatory control. Acquired premature ejaculation can be caused by stress or anxiety in a new relationship or by seemingly unrelated issues such as work, finances, children, etc. Occasionally, premature ejaculation can appear due to a decrease in serotonin.
Subjective premature ejaculation is when a man thinks he has premature ejaculation, although his ejaculatory control is normal. Despite the fact that a doctor or sex therapist determines that the man has no problem, he still believes he does and wants to last longer during sex. Subjective premature ejaculation is characterized by a man having intrusive thoughts regarding a premature ejaculation that doesn’t exist.
Variable premature ejaculation is a condition in which a man ejaculates prematurely only in certain situations or cases. This can occur only with a certain partner or due to specific conditions unrelated to the partner.”
Most people are only familiar with life-long premature ejaculation, and they brush off acquired and variable premature ejaculation as nothing but a simple case of pre-sex nerves. But when the problem continues, feelings of distress and even depression start to rise. Many of these men never understand that they suffer from a real sexual dysfunction, and they are left untreated, and that’s a real shame.
How can men treat premature ejaculation?
Luckily, once you have identified an issue, several treatment options can help you overcome this problem. “Regarding treatment, there are few options. Behavioral treatment has existed for dozens of years and helps improve control of the ejaculation reflex in up to 90% of patients. While it is recommended to pursue this treatment with a partner, you can also reach good results by yourself. Behavioral treatment is based on gradual exercises, which you do according to guidance from a professional. Treatment can be carried out in 10 sessions with a sex therapist or, alternatively, from your home with the online program we have developed, the PE Program. It is based on a smart online system that creates a personally tailored plan for treating PE, which adjusts to the patient’s feedback – just as a sex therapist would in a ’regular‘ clinic.
Another treatment is using a spray or ointment to decrease sensation in certain areas of the penis, which enables a few minutes of control. Yet, finding the right dosage is a delicate process. Not applying enough will be ineffective, while applying too much will cause numbness of the penis (occasionally resulting in erectile dysfunction). Additionally, incorrect use could end up desensitizing your partner’s genitals as well, thus decreasing their enjoyment.
You and your partner may also suffer from a loss of spontaneity in your sex lives, as the sprays or ointments must be applied 20 minutes prior to intercourse to a flaccid penis.
A third option is selective serotonin reuptake inhibitor (SSRI) medication, which has a side effect of delayed ejaculation. You take the medicine every day or 6 hours before having sex. And yet, these might have undesired side effects, such as headache, nausea, dry mouth, drowsiness, and reduced libido.
In addition, the timing of the ejaculation is dictated by the medicine. For example, sometimes the man would like to ejaculate slowly, but at other times – for example, after the partner is satisfied – he would like to hasten the ejaculation. However, this wouldn’t be possible due to the effect of the drug.
Unfortunately, no medicine currently is indicated to manage premature ejaculation with no side effects”.
To sum things up
Premature ejaculation is a difficult condition to live with for both the man and his partner. But once you’ve learned to recognize and come to terms with your sexual dysfunction, help is available. If you’re worried that you might have a problem, don’t neglect it, and don’t get discouraged. You deserve better!
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