Straight shooting: overcoming premature ejaculation

by Elaine Gottlieb

If all your sexual experiences are "quickies" because you ejaculate too soon after becoming aroused, you're not alone. Premature ejaculation is the most common male sexual dysfunction, affecting an estimated 30%, or 50 million American men, both straight and gay. But rest assured there are simple, very effective treatments.

It's defined by the American Psychiatric Association as "persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it." The key factor is control a man with premature ejaculation lacks the ability to reasonably control his responses.

A man with erectile dysfunction knows right away that there's something expected of him that he can't do. But a man who ejaculates quickly may not be aware he has a problem. "I think most men would prefer sex to last longer than an interlude. But they may not know until they hear from an outside partner...that they are not lasting as long as they could or as long as other men do," says Dr. Adam Keller Ashton, clinical assistant professor of Psychiatry at the State University of New York at Buffalo and a member of the Society of Sex Therapy and Research.

How long does the typical man "last?" Studies done in the United States report that the typical length of time to ejaculation ranges from five to nine minutes. So a man who lasts less than a minute is significantly different from the norm.

Researchers haven't uncovered any definitive physical or psychological explanations for premature ejaculation. Physical causes are extremely rare but can include unusual nerve sensitivity in the penis, prostate or urethra infections, or an overly tight uncircumcised foreskin. Premature ejaculation is usually a lifelong problem, not something that comes on suddenly. It is most common in young men, and many don't outgrow it.

Sociological factors do play a role, though. In the U.S. for example, many of our early sexual experiences are in circumstances that force us to rush sex to avoid being caught. Those early experiences don't usually lend themselves to extended sexplay either, as any of us who bear the scars of gearshifts and uncomfortable back seats can verify.

Anxiety can also aggravate premature ejaculation, but it's unclear whether it's a cause or an effect. But once you become concerned about premature ejaculation, it can lead to performance anxiety. The more anxious you become, the less control you have, which then creates more anxiety, trapping you in a vicious cycle. Many men report that premature ejaculation is a bigger problem at the beginning of a relationship when sexual excitement and insecurity are at their peak. As your relationship matures, you may find that your problems with premature ejaculation become less troublesome.

While not as devastating as impotence, premature ejaculation can take a toll on your self-esteem. You may fear being rejected by partners so that you avoid involvements altogether.

"Men can be fragile at times. Premature ejaculation isn't something you can tell your buddies about. I've never heard anyone talk about it. No one's supposed to have problems in bed. So much about being a powerful successful man is built on sexual prowess. Of course it affects a man's feelings about himself," says Dr. Ashton.

Fortunately there are highly effective treatments for premature ejaculation, some of which have a 90%-100% success rate, an outcome rare in medicine. The traditional treatment is behavioral therapy, with exercises designed to help you gain control over ejaculation. The theory underlying this approach is that lack of ejaculatory control stems from being out of touch with your excitement level. The strategies men traditionally use to delay orgasm replaying baseball scores or doing math tables just distract you from an awareness of your physical sensations and compound the problem.

Stop-start technique. The predominant behavioral exercise is the stop-start technique, in which you either masturbate or engage in intercourse until you approach "ejaculation inevitability." You then wait to regain control and start again. If you practice this exercise regularly, you will eventually increase your time to ejaculation. Dr. Ron Friedman, director of the Human Sexuality Program at the Beth Israel Deaconess Medical Center in Boston, reports that one of his patients, a professional man in his 30s, was able to go from ejaculating in one minute to lasting 15 minutes, something he had never thought possible. As you can imagine, it made an enormous difference in his confidence.

Dr. Friedman always has his patients first practice the stop-start exercise by masturbating so they don't have to worry about performance, and then try it with a partner later on. Dr. Ashton, on the other hand, believes that the technique must be used with a partner to be effective. Whatever the approach, studies show that 97% of men who perform the exercises faithfully will achieve a slower time to ejaculation.

Dr. Ashton doesn't recommend the traditional "squeeze" technique for delaying ejaculation, which involves squeezing the head of the penis close to the time of ejaculation. He feels that it can be too stimulating and may actually have the opposite effect.

When Viagra burst on the scene last spring, many men with premature ejaculation thought that it might be the cure for them. But Viagra only treats impotence or erectile dysfunction. However, there are treatments for premature ejaculation that are as effective as Viagra has been in treating impotence.

With the advent of the popular SSRI antidepressants such as Prozac, Paxil, and Zoloft, doctors discovered an unusual side effect. They slowed ejaculation. While this caused problems for men with normal ejaculation, men with premature ejaculation suddenly reported improvements in their sex life.

When Dr. Ashton offers his patients the options of exercises and psychotherapy sessions or taking medication, most choose to take medication. Dr. Friedman considers medication an alternative choice for patients who are anxious, depressed, or need quick results.

Any of the SSRIs are effective in treating premature ejaculation, as is Clomipramine, a tricyclic antidepressant. The doses used depend on individual needs and vary from a fraction of the usual dose to the highest recommended dose. The drugs are also effective if taken only when you plan to have sex.

The main drawback of medication is that in most men, symptoms return when you stop taking it. Whereas once a man masters the behavioral techniques, the change is more lasting.

With such easy, successful treatment available, it is unfortunate that more men with premature ejaculation don't seek help. Many men are still embarrassed to ask for help. But Dr. Ashton says they are quickly put at ease by a professional who is comfortable talking about sexual issues. \"When I tell them that I can help them get a few more minutes, they light up. Generally, I can give people an extra 3-5 minutes; if a man is only lasting 90 seconds, the extra minutes are a significant quality-of-life enhancement. They're usually very satisfied patients. What more could people want? The treatment is manageable and provides them with long-term success,\" he says.