Premature Ejaculation Summarized
Premature ejaculation, as most of us know, is the most common problem men have in relation to sexual activity. Indeed, as most of us can testify from personal experience, our first sexual experiences are almost certain to be notable only for the brief time before we ejaculate. Many men, by which I mean probably 4 out of 10 or so, learn to control their ejaculation as their experience of sexual activity increases, so that in a few years they can fully satisfy their sexual partner. But for the majority of men, control of ejaculation seems to be elusive: my experience as a sex therapist suggests to me that between half and three quarters of men lack ejaculatory control the majority of the time. Of course how you define this is an open question; but let us suppose that if intercourse lasts for two minutes or less from the moment of penetration, that is an experience which would qualify as premature ejaculation (PE). In terms of a formal definition of PE from the medical establishment, there are two criteria which are important: the first is that ejaculation occurs before either partner wishes it, and the second is that it causes distress or interpersonal difficulty. Now, I don't think the second criterion is well-defined, because a man who ejaculates after two minutes of thrusting may not be unduly distressed by this, but may still wish that intercourse could last longer. Anyway, perhaps this is a bit irrelevant, because you know if you want intercourse to last longer, and you know if you ejaculate too soon. One of the features of premature ejaculation is that the man's orgasm and ejaculation may take him by surprise. I think more than anything it is this lack of control which is the most difficult thing about premature ejaculation. Certainly for a woman, there is great pride in having a man who, as a lover, is able to control his ejaculation, and who does not take his own pleasure before he has fulfilled the implicit agreement between him and his partner to satisfy her first. Emotionally, the consequences can be guilt, shame and anxiety, not to mention a general lowering of sexual self-esteem for the man. Instead of being a source of sexual pleasure and satisfaction that bonds the couple, intercourse can be something that relieve sexual tension but also increases dissatisfaction and disharmony within the relationship. In particular, if a woman decides that her man cannot be bothered to increase his staying power, there may well be difficulties ahead.... because feeling attractive and cherished by her partner are key elements of woman's sexual self-esteem, and when he ejaculates prematurely it's fairly obvious that he's not necessarily taking her needs into account. (And at this point I do also want to make the observation that it is entirely possible for a couple to be satisfied with intercourse that lasts for two minutes. That, obviously, is where the element of personal and relationship harmony and satisfaction comes into play in the definition of premature ejaculation.) So what are the causes of Premature Ejaculation? It's a hard question to answer. There have been many attempts to do so, with explanations of this phenomenon ranging from the biological, such as oversensitivity of the penis, to the psychosocial and interpersonal – for example, the suggestion that premature ejaculation is a representation of man's anxiety about sex, or his fear about being absorbed by a woman, either physically or psychologically, or even that premature ejaculation is a reflection of his anger because of resentment in the relationship. However, there is another point of view which is worth considering: that is, premature ejaculation might actually be the normal and natural condition of the human male during intercourse. There would have been a clear biological advantage during our evolution in favor of rapid ejaculation: any animal that took time over mating was likely to be preyed upon. So, it could therefore be that what we have to do as males is move away from the idea that rapid ejaculation is "bad" to a concept of longer intercourse, and this requires us to train ourselves in how to last longer in bed in sex. One of the problems that we face in this discussion is that men and their partners often talk about premature ejaculation – or rapid ejaculation, if you prefer – in a very negative way, one that doesn't actually reflect the reality of their sexual interaction. For example, as a sexual therapist I would always consider the relationship dynamics as part of the treatment process. Suppose that a man was in relationship with a woman who had difficulty with intimacy, or who was not fully at ease with sex. There is no question that her lack of arousal – if applicable – and her anxiety around intimacy, would communicate themselves to the man. That in itself is not a recipe for long-lasting or successful intercourse. I'm not saying that every time a man comes too soon for his or his partner's satisfaction it's about relationship issues, but I suspect that it's a lot more common than we imagine. Indeed, there are some therapists who have suggested that premature ejaculation is always an emotional issue. Derek Polonsky has summarized the main points of premature ejaculation.First of all, it's very common – the majority of men are not satisfied with their staying power, with their self-control during intercourse, and they think that most men perform better than they do in bed. Because of this, men often have a focus on their performance, which can roughly be represented as "am I going to last long enough this time?" Yet such self-focus takes one away from the enjoyment of intercourse and into a place of self-reflection and "spectatoring" - both of which are unlikely to enhance man's sexual experience. Indeed, it's this disconnection from the activity, this self-observation, which is one of the major problems of sexual dysfunction. To be fully absorbed in intercourse and intimacy with your partner, you need to lose - at least to some degree - your self-awareness, so that your attention is completely focused on your physical and emotional arousal. So far the majority of men, the important issue in controlling premature ejaculation seems to be learning how to stay below the level of arousal at which they would ejaculate without having to maintain conscious focus on doing so. And it is possible to achieve this objective, by training the nervous system to accept high levels of stimulation without ejaculation; technically, this is known as raising the threshold of the ejaculatory reflex. Polonsky also makes the point that many partners believe that their man is actually being selfish, that he is only interested in his own ejaculation, and that he does not care about their satisfaction. In general, nothing could be further from the truth: in addition, a man who ejaculates rapidly is not likely to be experiencing the most intense orgasm that he can, because intense orgasms result from prolonged foreplay and sexual stimulation before climax. It's also noticeable that couples who have a premature ejaculation issue rarely communicate fully and comprehensively about it, which could be some kind of indication about the more general state of communication in their relationship. However, the simple message is that communication is essential if you happen to be in a relationship where either you or your partner suffers from premature ejaculation. (It's worth noting in passing that the word "suffers" is pejorative, a reflection of the cultural attitude to this syndrome. "Experiences" would be a better word.) One reason why communication is a good idea is that it actually releases some degree of emotional tension and pressure, both of which contribute to the sexual arousal that makes men come too quickly. Another factor here is the absence of good information about sexual performance from men. It's a complete myth that women like prolonged thrusting; in fact most women would prefer the opposite, although they do value the closeness and intimacy of penetration. Finally, another point made by Polonsky is crucial: practice in a relaxed open way is essential, and to gain control the more often you have sex, the better. So in the face of all of this, how can treatment for premature ejaculation be effective?Premature ejaculation treatment includes therapy for men and partners, analysis of couple dynamics, cognitive and behavioral approaches, and psychosocial therapies like sensate focus. The essence is a human approach to giving pleasure: tender touch, the passionate caress, and all the other strokes that humans are so well-equipped to do, can be much more satisfying to a woman than a longer time span between penetration and ejaculation. Often, a therapist offering treatment for PE may offer practical guidance in the relationship with a partner, and guide a man through techniques. Often men behave in way that almost certainly increases anxiety and isolation and reduces ejaculatory control will be poor. An internal script for men where sexual arousal is usually controlled by the man - who knows exactly what will please his partner - is a daunting prospect for a man with poor ejaculatory control, and the therapist can offer a new model which slows things down, allows a man to get to know and totally trust a new partner, and open up communication about concerns about the man's sexual performance. The more usual pattern is for the man to struggle on his own with ejaculatory control, and for his partner to feel guilty or confused. But if she has had sexual experiences with several men, she can act as a resource and interrupt the spiral of self-doubt and anxiety. References: 1. Polonsky, D. C., Premature Ejaculation. In Principles and Practice of Sex Therapy. Third Edition, New York, The Guilford Press, 2000 |