When it comes to men’s sex lives, we hear a lot about erectile dysfunction (ED). But another condition—premature ejaculation (PE)—affects even more men.
New research: While PE has traditionally been considered a man’s problem, a recent study found that it can also distress his sex partner—almost one-quarter of women reported that the issue had led to a relationship breakup, largely because the men were so focused on their own sexual performance that they neglected their partners.
Studies show that most men ejaculate after about five minutes of sexual intercourse.
When it’s a problem: Even though most men occasionally finish more quickly than they would like—after a long period of abstinence, for example, or from the excitement of being with a new partner—it’s called premature ejaculation only under certain circumstances. This includes when the man usually ejaculates within one minute of penetration (or before penetration occurs)…the man is unable to delay even when he tries…and/or he is frustrated by the inability to last longer and it causes distress.
As long as men and their partners are satisfied with their sex lives, there’s nothing to worry about. But, because of PE, many men struggle with a sense of failure and inadequacy.
Few men will admit to sexual problems, even to their doctors…and doctors often don’t ask. But if you have PE and are bothered by it, tell your doctor. PE can always be treated. Some men just need help coping with anxiety. Others have unrealistic expectations. Some men have a lifelong problem with PE, while others develop it later in life. PE can also be caused by medical issues, including a hormone imbalance (such as hyperthyroidism), infection/inflammation of the prostate gland, genetic factors or even ED. (With ED, men fear losing the erection and ejaculate prematurely.)
Also: Some men as they age may have delayed ejaculations. They may be unable to ejaculate during intercourse or for several hours or days afterward. Side effects from medication, especially for depression, can increase time between ejaculations as well.
WHAT HELPS
If your doctor has ruled out any physical causes for PE, there are simple steps you can take that may improve or reverse PE. You may want to try these strategies before considering medication…
• Wear a condom. Even if you don’t need condoms for contraception or disease prevention, they reduce sensation for some men who are hypersensitive and can help you last longer.
• Pause and squeeze. This form of behavioral training can help men recognize the feelings of impending ejaculation before it’s too late to stop. It doesn’t work for all men, but it’s worth a try.
What to do: During sex (or masturbation), stop the stimulating movements before you’re ready to ejaculate. Squeeze the top of the penis where the head meets the shaft to stop the urge to ejaculate. Keep squeezing for several seconds.
Wait about 30 seconds, then resume the activity—and stop-squeeze again when you feel you’re getting close. Keep doing it until you’re ready to finish. Your partner can also do it as part of foreplay. With practice, you can develop the “habit” of lasting longer.
• Try a topical anesthetic. You can apply over-the-counter numbing sprays or creams (such as Promescent) to the penis. They have topical anesthetics that reduce sensation and delay ejaculation.
Don’t overdo it when using these products. Reducing sensation can make it more difficult to sustain an erection. Also, some of the numbing agent can be transferred to your partner, which reduces her sensations. But a topical anesthetic does work for some men.
• Try different positions. Some sexual positions are more stimulating than others. In general, the man-on-top position produces the most friction and stimulation. You might last longer with other positions—say, with the woman on top. In this position, you can use your hands and pelvis to guide her body into angles and movements that are less stimulating to the most sensitive parts of your penis.
• Psychotherapy may also help improve sexual skills, increase self-confidence and improve self-esteem—all of which can ease PE.
Some men can learn to delay ejaculation with the behavioral and sexual techniques mentioned earlier, but it may take time and practice. The reality is, many men find medication to be more effective. Your urologist or internist can help you decide which is best for you.
• Antidepressants. The selective serotonin reuptake inhibitor (SSRI) antidepressants, such as sertraline (Zoloft) and paroxetine (Paxil), aren’t FDA-approved for PE, but doctors often prescribe them “off-label” for this condition.
These drugs’ sexual side effects, including reduced libido and delayed ejaculation, can help men with PE. Studies have shown that men who take these drugs can last anywhere from about four to eight times longer.
The doses prescribed for PE are lower than those used for depression, so other side effects (such as mouth dryness and sometimes nausea) are usually minor and tend to disappear within a few weeks.
• PDE-5 inhibitors, such as sildenafil (Viagra) and tadalafil (Cialis), do more than help with erections. They also appear to help men with PE. These medications increase levels of nitric oxide, a blood gas that dilates blood vessels and increases blood flow to the penis. At high levels, nitric oxide inhibits ejaculation. A man with a firmer, more reliable erection also tends to be more confident and less likely to rush through sex.
Some men find that taking both a PDE-5 inhibitor and an SSRI antidepressant works best. One study found that men who used both medications increased their intercourse time to more than three minutes from less than one minute. However, PDE-5 inhibitors can cause headaches, nausea and other side effects and should not be taken with medications that contain nitrates, alpha-blockers or cimetidine (Tagamet).
