Premature Ejaculation

Premature ejaculation is one of the most common forms of male sexual dysfunction. It affects most men at some point in their life.

How does ejaculation work?

Ejaculation is controlled by the central nervous system. When you become sexually stimulated, signals are sent to your spinal cord and brain. When a certain level of excitement is reached, signals are then sent from your brain to your reproductive organs. This causes semen to be released through the penis (ejaculation).  Ejaculation has 2 phases: emission and expulsion.

Phase 1: Emission

Emission is when semen moves from the prostate and seminal vesicles into the urethra.

Phase 2: Expulsion

Expulsion is when the muscles surrounding the urethra at the base of the penis contract forcing semen out of the penis. Usually, ejaculation and orgasm (climax) happen at the same time. In most cases your erection dissipates following this.

Causes:

Most cases of premature ejaculation do not have a clear cause, however with experience and age men usually learn to delay orgasm.  Some instances in which premature ejaculation may be more likely are:

·     With a new sexual partner

·     In certain sexual situations

·     If it has been a long time since the last ejaculation

Psychological factors can influence premature ejaculation:

  • Anxiety
  • Guilt
  • Depression

Certain medical causes can impact on premature ejaculation:

  • Hormonal
  • Injury
  • Side effects of medications

Symptoms:

Ejaculation either before or shortly after intercourse begins, before the man wishes it to occur and usually with minimal sexual stimulation.

Treatment:

In many instances premature ejaculation gets better on its own given some time.  Practicing of relaxation techniques or utilizing distraction methods may assist in delaying ejaculation, as can learning to identify and control sensations that precede ejaculation.  Techniques such as those listed below may assist also:

  • Utilizing a condom to reduce sensation
  • Trialing of different  sexual positions

The following is a further toolbox of techniques which may assist;

Deep breathing

This is a form of meditation that can assist in controlling the arousal and tension buildup which often leads to early ejaculation.  To use this technique you need to ensure you avoid shallow or short breaths which lead to an increase in heartbeat and can trigger premature ejaculation.  Practice breathing in for a full count of five, hold the breath for a count of three then exhale for a count of five – this needs to be practiced before using it in the bedroom.

The stop-start method

This begins as an exercise done on your own.  You should begin masturbation, bringing yourself close to orgasm then stop. After relaxing you should continue getting closer and closer to orgasm until you cannot control the feeling any more – by undertaking this exercise without distraction you can learn where your point of no return is before engaging in sexual stimulation with a partner.

The squeeze method

This requires you or your partner to firmly squeeze the end of the penis just prior to orgasm. Maintain the squeeze for around 30 seconds or until the urge to ejaculate passes. After the squeeze is released wait for another 30 seconds then return to masturbation/foreplay. The technique aborts the ejaculation reflex and delays orgasm.  The goal is to teach yourself to become aware of the sensations leading up to orgasm, and then begin to control and delay on your own.

Kegel exercises

If you have strong pelvic floor muscles then they can assist you to delay orgasm. This is done by contracting the muscle when you feel you are close to orgasm – This may lead to you being able to slow the reflex down.

The following is a guide to enable you to locate your pelvic floor and know what it feels like to engage these muscles, prior to commencing the pelvic floor exercise program. 

  • When emptying your bladder try to stop or slow the flow of urine once you have started. 
  • Try to lift and squeeze the ring of muscle around the anus as if you are trying to avoid passing wind. 
  • Use a mirror so that you can see your penis and scrotum.  When you engage the pelvic floor muscles you should see a visible lift of your scrotum and a drawing inwards of your penis.

Once you have successfully located your pelvic floor muscles you can begin the exercise program by lifting and squeezing without holding your breath - for a count of eight and then relax for a count of eight.

  • Repeat this exercise ten times.
  • Next squeeze and lift the pelvic floor without holding (squeeze, relax, squeeze, relax no breaks) – repeat this exercise eight to ten times and then relax.
  • This is one set of exercises.  You should attempt this at least once a day although you will need to ensure that it is undertaken in sitting, standing and lying to ensure that you reach the entire pelvic floor.

Local Anaesthetic Cream Applied to the Penis

The cream is applied to the glans about 20-30 minutes before intercourse to assist in lessening the sensitivity.  The penis must be washed clean of any remaining cream prior to intercourse as otherwise it may also cause vaginal numbness.

Oral Medications

Many medications may delay orgasm and may be used off-label upon consultation with your doctor. 

Serotonin Re-uptake Inhibitors

Even though you may not be depressed, the SSRI (selective serotonin re-uptake inhibitor) family of anti-depressants which includes medication such as Prozac may assist.  These can be taken several hours before sexual activity and since they are known to inhibit orgasm – they can assist you to control ejaculation.

Phosphodiesterase inhibitors

Such as Sildenafil (Viagra/Avigra/Silvasta), Tadalafil (Cialis) or Vardenafil (Levitra) may also help premature ejaculation.