Premature Ejaculation
We start with an email received by our online counseling service: I am 23 and have just got engaged to a wonderful girl. We make love on average twice during the week and two or three times over the week-end. It's a marvelous experience for me, or at least it would be absolutely marvelous but for one thing. I come too quickly, so that I am not able to help my girlfriend achieve orgasm during intercourse. I am beginning to feel very frustrated, because though I enjoy sex - she is marvelous at making love to me - and I always see that she reaches orgasm afterwards, there is something missing. In other words, I want to give her an orgasm while we are making love. She hasn't said anything, but I am sure she feels the same way. The more I try, the less likely it seems that I shall ever succeed. Please, what can I do? Another email: I wonder if you can help me. I am 30 and have been married for three years, and during all that time, except on very rare occasions I have never been able to hold back coming long enough during sex after penetration to get my wife to orgasm. Knowing this, I sometimes get her to orgasm with oral sex before I go into her; otherwise I have to bring my woman to orgasm either with my tongue or finger afterwards. Not being able to fuck properly makes me feel very inadequate sexually. The curious thing is that when I masturbate it takes me anything between two and ten minutes to come off. I must admit that I always masturbated fairly frequently from when I was about 12. In my middle teens, I probably did it once and sometimes twice every day. Do you think this has anything to do with it? I mean, have I damaged the nerves in my penis? But if I have, I can't understand why I take so long to ejaculate, and yet I scarcely get my penis in the soft warmth of her vagina when I ejaculate. You'd think that if it takes say five minutes vigorous rubbing it would take even longer moving my penis against the much smoother vagina, wouldn't you? I didn't have much experience of lovemaking before I married, probably not more than a dozen fucks. But it always happened then. I've read somewhere, that though it may take a little time to settle down sexually after getting married, regular lovemaking soon gives one control over ejaculation. This may be so, but don't you agree that three years, without any sign of improvement, is a long time? It isn't just me who's getting fed up; my wife is, too, and if I can't improve soon, I can see serious trouble ahead. So please, please help me if you can! -D. V. Another email: I am 56 and have been married 27 years. Until recently our lovemaking has always been satisfactory and very satisfying; not very adventurous, perhaps, but at least it has kept us happy. About eighteen months ago I suddenly began to come too soon. I wasn't very worried at first, because I believe most men ejaculate quickly and, for one reason or another, they experience premature ejaculation; for instance, if they've been away for a time and haven't made love, or when they've got more than ordinarily sexually aroused. However, when it kept happening, time after time, I did begin to be worried, and lately it has got worse and worse. Before this happened I could hold back five to ten minutes after I'd put it in, but now half a dozen thrusts and it's all over. My wife is understanding but underneath I sense an increasing frustration. Can you tell me why this should happen, and is there anything I can do about it? I hope to God there is, because it is spoiling our sex-lives. - F. T. These three emails are typical of the pleas we are constantly receiving from young men and men lately entered into middle age. Premature or rapid ejaculation is one of the two or three most common sexual afflictions which affect men. Usually, it is more common among young men, though it does attack men of all ages, and has an unwelcome habit of rearing its unwelcome head at mid-life when other sexual difficulties also develop. The medical term for coming too soon is premature ejaculation or rapid ejaculation. Although premature ejaculation may happen even before the penis can be put in the vagina, it generally takes place within two minutes of the penis being put in the vagina, or after twelve or fifteen thrusts of the pelvis. In both cases, the man's partner is deprived of her orgasm unless he stimulates her clitoris with his fingers or orally before or after he has ejaculated. This is not so satisfactory, nor is it as psychologically rewarding, as both partners enjoying an orgasm through sexual intercourse, not necessarily simultaneously, during the "penis in the vagina" phase of sexual activity. The basic factor with premature ejaculation is that almost inevitably the man's penis begins to go flaccid as soon as he has ejaculated, and he cannot normally be stimulated to erection again for ten minutes or a quarter of an hour, often because the glans is so sensitive after a man reaches orgasm that the slightest touch is intolerable. If premature ejaculation occurs and the woman can wait until her partner obtains a new erection, and lovemaking can begin all over again from scratch, in quite a large percentage of cases the man will not ejaculate too soon, and the woman will reach orgasm during penetration. There are some couples who are able to overcome their difficulties in this way, but not many. The average woman who is sexually aroused and needs only two or three minutes' stimulation to take her over the edge into orgasm, may fail to respond to sexual stimulation a second time. Her sensations of frustration seem to inhibit her from being able to make a fresh start after a longish pause. (This is not true of the woman who does reach orgasm and embarks on a new session of lovemaking as soon as her partner's penis is erect again.) There are also many men suffering from premature ejaculation who are so psychologically upset by their failure that they cannot achieve a second erection; while just about as many men, after their first orgasm, lose all desire for further stimulation. However, a number of young men in their twenties who have come to us for help, have been successful in overcoming their difficulty by masturbating before beginning to make love. Anyone wishing to try this should do it themselves in private, and they should begin lovemaking within five minutes of having masturbated, so that by the time they have stimulated the partner sufficiently for her to be ready to make love, they have lost their penile glans sensitivity and can readily be stimulated to erection. Unfortunately, this does not seem to work for those in older age-groups. This may be due to the fact that as a man gets older his sexual recovery process takes longer, and as he may have to wait more than half an hour before a new erection can be induced, he simply loses interest. With the possible exception of the highly sexed, who, even in their late forties and fifties and beyond, are capable of obtaining erection very quickly after frequent orgasms, there are not many middle-aged men whose sexual desire can be sustained for long after ejaculation. In passing, we have never yet met a highly sexed man who suffered from premature or too rapid ejaculation. What are the causes of premature ejaculation? Research into this problem has not produced clear answers, but the little we do know seems to indicate that apart from one or two physical reasons, premature ejaculation is mostly psychologically induced. Let me deal with the possible physical causes first. It does seem possible that there are a few men with hypersensitive orgasm-producing nerves in the glans and frenulum. When these men are uncircumcised, one would imagine that circumcision, by removing the protective foreskin, would help these vital nerves to become less sensitive. It would appear, however, that the nerves in the circumcised penis do not lose a significant degree of sensitivity. (It is a fact that there are only seconds difference between the average response times in uncircumcised and circumcised men's progress towards orgasm, the circumcised man being the very slightly slower.) There seems to be little help that one can offer these men, though some find local anesthetic cream has much improved their lovemaking ability. These creams contain anesthetic, e.g. lignocaine, a portion of which, about the size of a rather large pea, is rubbed into the head of the penis and frenulum, at least 30 minutes before foreplay. An aerosol spray has come on to the market which is easier to apply. The use of cream or the spray does not affect erection in any way. If a cream is used, and the penis is washed well before lovemaking starts, i.e. at the end of 30 minutes, the woman can use fellatio on the man's penis without experiencing an unpleasant taste. The aerosol spray is tasteless, in any case. While on the subject of anesthetic creams and sprays, I must make one or two remarks about their use. Many men find these creams useless. Like everything else to do with sex, hard and fast rules about the application of the creams and spray cannot be made to suit everyone. If the rule is to apply the cream to the glans 30 minutes before starting foreplay it is because with the majority of men it takes 30 minutes for the cream to desensitize the nerves. There may be some men, however, who require the application to be made an hour, or even longer, before the nerves are fully desensitized. Or, there may be some who require double the suggested amount of cream to be applied. It is essential, if the cream does not work as prescribed, that the user should experiment in order to discover his own personal requirements. There is one physiological cause of premature ejaculation which is difficult to treat. This is when the man has been born with a frenulum that is abnormally short. (The frenulum, by the way, is the little band of skin on the underside of the penis which joins the ordinary skin of the penile shaft to the glans. The frenulum is packed full with a mass of nerves which, if stimulated, bring on erection quickly, and if stimulation is continued, help to produce orgasm.) However rigid the penis is in erection, the skin of the shaft will always move a little, so that even the circumcised penis thrusting in the vagina will cause the skin of the shaft to be pushed down as the penis goes forward, and to pull on the frenulum. This pulling stimulates the frenulum nerves and helps to produce orgasm. If the man with the short frenulum is uncircumcised but his foreskin slips backwards and forwards easily, he will be even more susceptible to to rapid ejaculation than the circumcised man, because the action of the foreskin rolling back will exert an even greater pressure on the frenulum. Fortunately, the abnormally short frenulum is something of a rarity. In some cases the condition has been treated surgically by cutting so that the frenulum does not pull on the glans and excite the orgasm-producing nerves. However, since the frenulum cannot be cut without severing the nerves, the man is deprived of the service of these nerves. If it should happen that the glans nerves are not very sensitive, the penis deprived of the frenulum nerves will have difficulty in reaching orgasm. I know of one case when this operation was carried out and the man, instead of ejaculating too rapidly, was not able to ejaculate at all. In cases of premature ejaculation caused by short frenulums, stretching of the frenulum may be helpful. To do this, the man must induce a really strong erection. He then grasps the penis firmly just below the rim, and pulls the skin of the shaft down towards the pubic bone, stretching the frenulum until it begins to hurt a little. He holds the frenulum stretched until he feels he may ejaculate. He then releases his penis, waits for the imminent orgasm-sensations to subside, and then repeats the process. If this stretching is carried out for five or six minutes daily, after several days the frenulum remains permanently stretched, and the man no longer ejaculates too soon. |