Premature Ejaculation continued
Inflammation of the urethral tube and also of the prostate are also possible physical causes of premature ejaculation. The man who suddenly develops too-rapid ejaculation after years of normal performance, should visit his doctor with the shortest possible delay. There will be a number of accompanying symptoms, but they are usually so slight that only the trained doctor will spot them. The most common symptom of urethritis is a burning sensation when urinating and a frequent desire to do urinate. Prostatitis in younger men can be caused by bacteria which have moved up the urethra to the prostate. The symptoms are urgency and a frequent desire to urinate, cloudy urine, which may or may not have some blood in it at the beginning and end of urination, diminished sexual desire, incomplete erection or premature ejaculation. The infection can come from sinuses, tonsils and abscessed teeth, and these are sometimes the cause of prostatitis and the accompanying premature ejaculation or too rapid ejaculation in men past their forties. Any man in middle-age who develops premature ejaculation should consult his doctor without delay. Prostatitis is easily cleared up by the administration of antibiotics, but the possible cause should be checked so that the return of the complaint can be avoided. With the cure of the prostatitis, the ejaculation trouble will also disappear. So we come to the psychological causes of too rapid ejaculation... ...which are present in the large majority of cases. First of all, there is anxiety or fear of various kinds. Let's take anxiety about sexual performance first. This is generally the cause of premature ejaculation in young men, and often takes the form that a man believes if he does not make his partner reach orgasm with his penis in her vagina, he will be reckoned by her, and anyone else who may get to hear of it, a failure as a lover. This is a tremendous threat to his male concept of masculinity in general and his own self-esteem in particular. He gets so anxious about it that he loses what little ejaculatory control he may have had in the first place. The main factor that will resolve his anxiety is his self-acknowledgment that he is inexperienced in sexual techniques. If he can convince himself that when he has had more practice he will be all right, more often than not the anxiety is removed and he learns to delay ejaculation. But many men do not seem to have this faith in themselves, and so they are dragged into the bad old vicious circle - the fear of coming too soon makes them come too soon. This is what has happened in all three cases quoted in the emails, but in the first and third there are additional factors. "...the more I try, the less likely it seems that I shall ever succeed." This extra factor lies in the phrase, 'the more I try'. The man who tries too hard is actually preventing himself from succeeding. In his too great eagerness to overcome premature ejaculation and last longer in bed, he gets himself so anxious that the psychological control he might have is weakened to the point of being non-existent. If only, instead of trying, he would remain calm, forget about his problem, make love to his girl and go into her when she is ready, he could delay his orgasm seconds longer the first time, half a minute longer the next, a minute the next, and so progressing to minutes and eventually full control. The middle-aged man in the second email has got himself in the same kind of vicious circle. In his case, the additional factor is a probable prostatitis which he has neglected because the symptoms haven't really bothered him. If he has the prostatitis cleared up, he may still find himself coming too soon, unless he can really be convinced that the complaint was the cause of his too rapid ejaculation. If he can be convinced of it, however, he may be back to normal as far as his ejaculation is concerned as soon as the last symptoms disappear; if not, he will be in the same boat as all other premature ejaculators. Other anxieties include fear of catching STD - this can be the cause in young men who shop around for their sex. The answer here is to use condoms. Once, however, they have got into the habit of ejaculating too soon, they have put themselves on a cycle of negative reinforcement and will have difficulty in getting off, even after they have a long term relationship and the reason for their fear no longer exists. Then there is the fear of unwanted pregnancy. Coitus interruptus (withdrawal), used when couples are too lazy or ignorant to do anything about fitting themselves up with a reliable contraceptive, is a good way of inducing early or rapid ejaculation, which makes their lovemaking all that more risky if they do not want an unwanted child. Fixing themselves up with a reliable contraceptive could go a long way to helping them overcome their difficulty, but unless they will recognize the fear - and its removal - as the all important factor, they, too, will have joined the vicious circle brigade. Another cause is just plain fear, sparked off by, of all people, the partner. I think I would not be over-exaggerating if I said that 99.9 per cent of all men have experienced too rapid ejaculation on one or two occasions throughout their lives. It usually happens when there has been a long abstinence from intercourse. The prospect of a good session of sex at last is so exciting that all psychological control is lost and the sexual nervous system becomes so stimulated that the slightest attempt at penis-vagina contact brings on immediate ejaculation. If it's with a regular partner, she will more likely than not be equally excited, and may be critical for the loss of control....such criticism can cause fear and anxiety about letting her down in her partner which may not be shrugged off so lightly....... If the man is young and hasn't the experience to ignore her criticism and to laugh off his failure with, 'There's always the next time,' when the next time comes he will be apprehensive about failing again, and ten to one his apprehension will make him fail. The second failure causes him to panic, and sets him going round in the vicious circle. There are other causes of anxiety, and they all produce the same pattern of premature ejaculation. There is one other cause, however, which I want to consider before going on to discuss ways and means of trying to treat premature ejaculation. Anger or resentment against or desire to "punish" the partner psychologically: usually the resentment or the desire is subconscious, but it's real enough to cause havoc in the sex-life of the couple. There are several causes of such resentment, probably the most common of which is the man's assessment of his partner's sexuality and sex-drive being stronger than his own. Or he may find that the relationship isn't all he thought it was going to be, resents being tied in a disappointing relationship and, putting the blame on his partner, never on himself, he decides either consciously or subconsciously to punish her. Or he may be jealous of one or more of her attributes which may have no connection whatsoever with their sex-life. He can show his resentment or desire to punish in one of two ways. Either he can ejaculate rapidly and prevent her from obtaining sexual satisfaction through intercourse; or he can so influence his sexual relations that he never ejaculates at all, however long he thrusts his penis in the vagina. This last condition, which is the opposite of premature ejaculation, is known as retarded ejaculation. It is not so common as premature ejaculation, but it is common enough. The man who uses retarded ejaculation to demonstrate his resentment against or desire to punish his partner is placing all the blame for his not being able to ejaculate on her. Unlike the partially impotent man, or the too-rapid ejaculator, the retarded ejaculator gets a very stiff erection which he can keep up for three-quarters of an hour or more. Even if he keeps up constant penis movement in the vagina all this time, or allows his partner to masturbate or fellate him, he cannot reach orgasm. The tension is there all the time, and creates more frustration than any other form of orgasm impairment. Most retarded ejaculators emphasize their resentment or desire to punish, by maintaining penis-vagina contact or partner masturbation or fellatio for half-an-hour or more, then in desperation withdraw and masturbate themselves, when they will invariably come off within a minute. By doing this they are, in effect, saying to their partners, 'You see, it must be your fault!' The too rapid ejaculator is doing much the same thing, though his approach is different. He is not saying, 'It's your fault'; he may be saying, 'You're not worth the trouble. I really can't be bothered to wait for you.' But both he and the retarded ejaculator may be subconsciously making their partners the victims of their emotional conflict. Can anything be done to help the too rapid ejaculator? Before I go into possible treatments, let me deal with one or two small but important points. For example, there are some men who claim to be too rapid ejaculators who certainly are not, like the man who told me he always came when he had made about a hundred thrusts, which took him about six minutes. It is important that men should know one of the basic sex-facts of life, namely, the average man who does not try to control his progress towards orgasm and who has not been manually or orally stimulated by his partner, will reach orgasm in two or three minutes if he starts to masturbate the very moment his penis has reached full erection, or if he puts his penis in the vagina immediately he has become fully erect. Any man who can maintain penis-vagina contact for two minutes without reaching orgasm and ejaculating does not really have a medical problem. Again, many premature or too rapid ejaculators would last longer if, when they make love, the partner parts her vaginal lips and guides his penis into her vagina. If the man is not helped in this way, but tries to gain entrance by pushing his penis in the direction of where he hopes the vagina entrance will be, he will, by doing so, rub his penis-tip against the vaginal lips and pubic bone, which is sexually stimulating. If the nerves in his glans are very sensitive he will ejaculate either before he gets in or immediately afterwards. Also, not many men know that if, after they have penetrated their partner, they tense the pelvic muscles and the muscles in the buttocks while moving the penis backwards and forwards in the vagina, this tensing of the muscles will bring them to orgasm much more quickly than if all their muscles are relaxed. There was a time when I could reach orgasm and ejaculate by tensing my buttock muscles and without using any direct penile stimulation. I have recently heard from two couples where the male partner has retarded ejaculation during sex but can reach orgasm and ejaculate during masturbation using this buttock clenching method (and indeed, any other method). When the penis is first put into the vagina, the pelvic and buttock muscles should be quite relaxed. The backwards and forwards movement will be a "swinging" movement, and not the thrusting movement it will be when the muscles are tensed. This swinging movement is just as stimulating for the woman as the thrusting movement is. The man who has taught himself to swing, and has also learned a little psychological control, should be able to keep up the swinging movements for five or ten minutes. Only when his partner tells him she is getting near orgasm, or after she has come, he can bring himself off literally in seconds of changing from swinging to thrusting and tensing his pelvic and buttock muscles. Almost without exception, the too rapid ejaculators I know thrust. A number have been 'cured' by learning to swing. Even the premature ejaculator can keep up swinging movements for a couple of minutes without coming, and the effect of this psychologically on the man who has always reaches orgasm within fifteen or thirty seconds because he thrusts, is often so great that, encouraged by his success, he can teach himself to prolong the swinging to five minutes or more. I think that even in cases of psychologically-induced premature ejaculation in which resentment or other emotional issues are the basic cause, ejaculation can be delayed by swinging. But the technique works best in those cases where high sensitivity of the glans nerves, or a too short frenulum, is the dominant factor. The man with psychologically induced premature ejaculation is usually best treated by psychotherapy which aims at uncovering and removing the psychological 'block'. This has been the invariable treatment in the past, but recently doctors working on these cases have been experimenting with a fair measure of success along predominantly physical lines, with the psychological part of the treatment being superficial - directed at explanation, education, reassurance, support and developing and maintaining motivation. This form of treatment involves both partners, and without the woman's full co-operation cannot be carried out. She joins the same psychological program as the man, but it is she who plays the major role in the physical treatment of the man. This physical treatment involves the woman inducing full erection in the man, and then masturbating him with her hand until he is almost at the threshold of the point-of-no-return. At this point, he tells her to stop; whereupon she presses the point in her partner's perineum which stops him ejaculating while she counts a slow five. By five the man's imminent-orgasm sensations will have faded away. She then masturbates him again until he tells her to stop, when she repeats the squeezing. In one training session this is carried out for four or five times. After a number of sessions of this treatment, the man can last a little longer than before the treatment. The next stage is then begun. In this, the man lies on his back, and the woman kneels astride him, facing him, with her knees on or slightly below his nipple line, and bending forward at about 45 degrees. She then puts the tip of his penis inside her vaginal entrance, and slowly slides her vagina back on the penis. She remains absolutely still until the man feels he may ejaculate. She then slips off his penis, takes hold of it and presses his perineum until the sensations have died away. The process is then repeated three or four times. This accustoms the man to the feel of intravaginal containment, i.e. the sense of the penis in the vagina. Several sessions of this procedure generally lengthen the time that the man can 'hold back' his ejaculation, and when this has been achieved, the woman can introduce movement. She should keep this up until the man is on the point of coming: then she stops moving, counts to five, withdraw, presses and waits. This further increases the man's ejaculatory control, until he should be able to make love with the swinging technique for two or three minutes before ejaculating. With new-found confidence, over a period, he should be able to control his progress to orgasm. One last word. We receive more than twenty emails a week from young men asking how they can overcome too rapid or premature ejaculation. Quite a large number of these attribute their condition to frequent masturbation during adolescence, but frequency of teenage masturbation has nothing whatsoever to do with later too rapid ejaculation. |