Understanding and treating premature ejaculation

What is premature ejaculation?

The International Society for Sexual Medicine (ISSM) defines PE as follows. 

• Ejaculation that always or almost always occurs within one minute of penetration, or a significant reduction in the time to ejaculation to about three minutes or less. 
• Inability to slow ejaculation in all or almost all vaginal intercourses. 
• Negative personal consequences such as stress, frustration or avoidance of sexual intimacy. 

This definition allows us to understand PE better and to differentiate it from normal variations in sexual performance.  

What causes premature ejaculation?

Premature ejaculation can have various causes and is often a combination of biological and psychological factors. 

1. Psychological causes: Stress, anxiety, depression and relationship problems can all contribute to PE. Negative early sexual experiences may also play a role. 
2. Biological causes: Low serotonin levels in the brain, hormonal abnormalities, and infection of the prostate or urethra. 
3. Medication: Some medicines, such as tamsulosin for prostate problems, can contribute to premature ejaculation. 

Treatment options

1. Cognitive behavioural therapy: The two commonly used behavioural methods to delay ejaculation are the stop-start technique and the squeeze technique. 
   a. Start-stop technique: In this technique, you learn to be aware of your body and recognise the phase of sexual arousal that occurs before orgasm. It involves stimulating the penis until just before orgasm and then stopping until the urge to ejaculate goes away. This technique is repeated several times until ejaculation. Over time, it will get easier to control yourself. 
   b. Squeeze technique: In the squeeze technique, the penis is also stimulated until just before orgasm. Then the head of the penis is squeezed gently to decrease the level of arousal. 
   c. Breathing technique: Learn to control your breathing when you reach mid-level excitement to slow down ejaculation speed. Taking slow, deep breaths helps calm the state of tension that the body goes into during sexual excitement. 
2. Pelvic floor exercises: These exercises can help to strengthen the muscles in the pelvic area surrounding the penis, giving you more control. Regular pelvic floor exercises can be effective in managing premature ejaculation and improving sexual health. 
   a. How do you do these exercises? 
   - Know which muscles to work on: You want to strengthen the muscles you use to stop the flow of urine when you pee. 
   - Practise regularly: Tighten your pelvic floor muscles for three seconds, then relax for three seconds. Repeat this 10 times, three times a day. 
   - Go longer: As your muscles get stronger, try to tighten for 10 seconds at a time, then relax for a count of 10.  
   b. Benefits: 
   - More control: Improved muscle control can give you greater control of your ejaculatory reflex. 
   - Self-confidence: More control can boost your confidence. 
   - No side effects: These exercises are safe and can be done anywhere. 
3. Medication: Selective serotonin reuptake inhibitors (SSRIs), such as Priligy, can help delay ejaculation by increasing serotonin levels in the brain. However, side effects such as loss of libido and erectile dysfunction may occur. 
4. Psychological therapy: Talking to a therapist can help to address any underlying psychological causes of PE. This can be especially helpful if PE is accompanied by anxiety or depression, or if you are experiencing relationship issues. 
5. Combining therapies: There is evidence that combining behavioural therapy, medication and psychological therapy is often the most effective for improving PE. This approach covers both physical and psychological causes, increasing the chances of success. 

What can you do?

In addition to this, there are also techniques you can try yourself to gain more control over ejaculation. 

• Self-distraction: Some people find that if they think of something else during sex they can last longer, although some claim that this can lead to less firm erections. 
• Use a condom: Using a condom can make the penis less sensitive. 
• Masturbate before having sex: This can help to delay ejaculation when you are aroused and have sex a second time. 
• Talk with your partner: Communicating openly with your partner can take the pressure of things as you work towards finding a solution.  

The importance of a holistic approach

Treating PE often requires a holistic approach, addressing multiple aspects of your health and well-being. By working with your partner and a professional, you can develop a treatment plan that works for you. It's important to set realistic goals and be patient, as finding the right treatment can take time. 

Conclusion

Premature ejaculation is a common yet treatable condition. The main thing is to be open about what you are experiencing and to seek help. With the right approach, it is possible to have a gratifying sex life and reduce the negative effects of premature ejaculation for you and your partner. Remember, you are not alone. There are effective treatments for PE available.