Our expert says:
Premature- [or Rapid]- Ejaculation means that the man is unable to CONTROL and delay ejaculation as long as he wishes in most acts of sexual intercourse.
This condition is not related to a particular length of time, nor his partner’s response, but depends on the absence of control of ejaculation.
It does not usually occur during masturbation, but is specific to sexual intercourse, and it is not influenced by circumcision.
Rapid ejaculation [RE] is the most common form of sexual dysfunction in men, and the most amenable to treatment.
Most young men ejaculate quickly in their initial sexual encounters and after intense, prolonged stimulation are usually highly aroused before entry and unable to delay ejaculation once penetration occurs. Such high levels of erotic sensations make it difficult for them to develop voluntary control. This may set up a pattern for the future, but it is only a problem if it does not resolve as they get older.
The problem may also become established by pressured, hasty initial sex acts associated with fear of discovery, or lack of privacy, or encouragement to hurry to finish by the partner. On the other hand, some men are unaware of their partner’s need for prolonged foreplay to enable her to become aroused before entry. Generally women take longer to become aroused and to reach orgasm than men do, and some women have difficulty reaching orgasm during intercourse unless they have direct clitoral stimulation.
Ejaculation may occur:
· at the very onset of sexual contact
· before entry
· even before obtaining a full erection
· during or immediately after entry after maintaining an erection for some time
· after one or two thrusts after entry.
Some men feel comfortable about stimulating their partner after they have ejaculated, and this diminishes the problem for both, but many men feel awkward and embarrassed about what they consider to be ‘their fault’ or inadequacy, and so avoid further contact. After a while his partner may feel cheated and frustrated, and become angry, and she may humiliate him, and this can cause a rift between them and affect their relationship. Therefore treatment should be sought before this type of vicious cycle becomes established.
In the past, treatment involved attempts at diminishing sexual sensations like the use of sedatives or the use of condoms, or avoiding direct stimulation, or focusing thoughts unrelated to the sex act, or masturbation prior to intercourse. This type of treatment often resulted in loss of erection and did not necessarily result in voluntary control.
It is best if both partners are involved in treatment. It helps her to understand that it is not ‘his fault’ and that she can help him to gain control. She should not feel that she is ‘being used’, or that her needs are being ignored, and realize that she too will benefit once he gains control of ejaculation.
In situations where men have become so embarrassed that they are reluctant to form relationships, they can learn to achieve control on their own by using the squeeze and stop /start techniques described below, while stimulating themselves. Once the man has acquired control, and then has a partner she should be involved so that he learns to accept erotic stimulation and control in relation to her.
Treatments include: the squeeze and stop/start techniques, anesthetic creams, anti- depressant medication and counseling.
Squeeze & stop/start technique:
This treatment is based on the fact that orgasm in the man has two phases:
at first semen passes from the seminal vesicles and prostate gland into the prostatic urethra [the tube that passes from the bladder through the prostate gland], - this gives the man the feeling of fullness at the base of his penis – called the ‘moment of inevitability’ or point of no return [that he is about to ejaculate]. This feeling lasts for 2-4 seconds and is then followed by loss of voluntary control as the muscles contract and eject the fluid – ejaculation.
The purpose of these exercises is to gain control of ejaculation. Concentrate on feeling and expressing sensations. This will help to reduce performance anxiety, ‘spectatoring’ and goalorientation and will increase communication. The exercise helps both partners to recognize the “moment of inevitability” and to gain control over the ejaculatory reflex, and focuses attention on erotic stimulation. The manshould control the level of stimulation by guiding his partner with his hand on hers..Intercourse should not take place during the exercise period In a relaxed situation the man lies on his back and his partner starts to stimulate him slowly.He indicates to her to stop [verbally or by gesture] when he reaches the moment of inevitability. She then places her thumb on the lower surface of where the shaft of the penis and the glans [tip] meet, and her index finger on the top surface of the penis, and her middle finger on the top of the glans, and applies firm pressure [short of pain] for about 20 seconds. This will make him lose the urge to ejaculate. He may also lose some of the erection whichwill be regained by further stimulation. EXERCISES: The woman stimulates her partner to the ‘point of inevitability’ and then delays ejaculation as follows 1. Stimulate- squeeze 3 times - then bring him to climax. 2. Repeat this exercise on one other occasion. 3Once control has been acquired in this way, they progress to replace the squeeze by the stop/start technique, as the squeeze technique cannot be used during intercourse. Stop/ start means that when he recognizes the moment of inevitability he indicates this, and she stops stimulating him Once he loses the urge to ejaculate she starts stimulation again. 3. Stimulate- squeeze-start- stop - start- squeeze - then bring him to climax. 4. Repeat this exercise on one other occasion. 5. Stimulate- stop – start - squeeze – start – stop - bring him to climax. 6. Repeat this exercise on one other occasion. 7. Stimulate – stop – start – stop – start – stop - bring him to climax 8. Repeat this exercise using KY jelly or baby oil to enhance sensuous feelings. He can stimulate his partner to orgasm manually/ orally if she desires after each exercise.Once he has confidence that he can indicate the moment of inevitability and that his partner responds effectively and they are both confident that they can control and delay ejaculation, they can incorporate these exercises into sexual intercourse. SEXUAL INTERCOURSE: After gentle stimulation his partner sits astride him in the woman-above position. She stays still while he focuses on what he is feeling. When he is in control he signals to her to move gently, and he indicates to her to stop when he reaches the moment of inevitability.She then keeps absolutely still until he is in control. This is the same effect as the “stop” above. When he is in control by using his hands or verbally shows her that she can move. This is repeated 3 or 4 times until he feels in control, and then they can start to thrust as they both feel inclined until he ejaculates. In this way both partners share the gaining of control. Once control has been mastered, the need for ‘conscious’ control diminishes as confidence is gained. Regular intercourse reduces early ejaculation. Once control of ejaculation has been achieved, intercourse can take place in any position both partners choose, and the man/woman herself can continue stimulation of her clitoris while they ‘stop’, so that she continues to be aroused.Voluntary control is usually gained in 2-6 weeks depending on the severity of the problem and the degree of mutual co-operation, and men are usually able to extend sexual intercourse as long as they desire--- the main thing being that they feel in control.If the problem recurs perhaps under stress, start with basic exercises again.
Anti-depressant medication: one of the side effects of some of these treatments is to delay ejaculation, and using these tablets is an extremely effective way of controlling the delay of ejaculation. This can only be prescribed by medical practitioners.
Anesthetic cream: can be applied to the penis covered by a condom, for 15 minutes prior to entry, during foreplay. Remove the condom, and wipe the penis [so that the partner is not affected]
Pharmacotherapy [Cilalis, Levitra or Viagra]: some studies have reported success and increased confidence in controlling ejaculation as well as satisfaction with sex life. This can be combined with the anti-depressant medication or anesthetic cream
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