Premature ejaculation may be the most common sexual problem for men. It is probably more common among younger men and men with less sexual experience, but can also appear later in men in established relationships. Ejaculation is said to be premature if it happens too quickly, the man doesn’t feel able to slow it down, and he feels badly about it. This can then negatively affect the couple’s sex life and overall relationship happiness, but fortunately men can respond quite well to treatment.
Causes
Physical: Diabetes and cardiovascular disease have both been associated with premature ejaculation, as has withdrawal from opiates and alcohol.
Psychological: Depression, anxiety, anger at one’s partner, low self-esteem, and sexual guilt can all make premature ejaculation more likely, as can being out of tune with one’s level of sexual arousal. Ironically, some men struggle with both premature ejaculation and also erectile difficulties—they increase stimulation to ensure they get a good erection but then orgasm too quickly or they try to distract themselves from the sensations so as to not orgasm too quickly but then lose their erection. Satisfying sex usually entails finding somewhere in between.
Relationship: Sexual and non-sexual relationship factors can also impact the man’s sexual functioning. Power struggles, poor communication, fear of commitment or intimacy, and feeling pressured to perform can all reduce the man’s ejaculatory control. In addition, if the man believes that his female partner does not enjoy sex (which may not actually be true) or if she experiences discomfort during sex or he worries that she might, he may try to get it over with as quickly as possible.
Medical Treatment
If you suspect that medical conditions or medications are impacting your sex life, then speak with your treatment providers and, if necessary, explore your options. You may find it helpful to include your partner in this discussion, both to provide potentially useful information as well as to weigh in on treatment options.
There are currently no medications approved for the treatment of premature ejaculation, but the SSRI antidepressants are sometimes used off-label. Numbing creams are available to reduce sensation and thereby slow down orgasm, but they are usually far from ideal. If the premature ejaculation is the result of over-stimulation from fears of losing one’s erection, then erection medications can be helpful. If you find that a treatment is not working as expected, then talk with your treatment providers to see if refinements can be made.
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However the premature ejaculation started, once a couple has been struggling with it for a while, it can cast a dark shadow on their sex life. A sex therapist can help you disentangle these negative effects, as well as normalize the various solutions that you tried (including maybe avoiding sex entirely). This may also involve working on non-sexual matters that are intruding on your sex life.
Whether or not you see a therapist, you and your partner can work on communicating more about what each of you want from your sex life and agree on what options you would like to try together, at this time. Be direct about what you do and don’t like, what you would like from your partner, what you’re willing to do for your partner, and what you are not interested in doing. It will probably be helpful to explore your assumptions about each other and whether they are getting in the way (e.g., women usually just put up with sex). This greater awareness of your own and your partner’s sexual desires makes it easier to feel confident in your sexual encounters which tends to reduce concerns about performance.
Some men develop rapid ejaculation if they feel that their partner isn’t enjoying sex, just wants to get it over with, or finds it painful. If there is truth to this worry, then it is worth exploring whether more foreplay, some quality lube, or different positions might make sex more enjoyable for her. If the discomfort remains or is too pronounced, then a medical examination may be worthwhile.
Once you have had some of these conversations, if the difficulties remain, you and your partner can practice the start-stop technique which involves progressing through a series of exercises at home that teach you greater and greater awareness of your arousal level, response to stimulation, and ultimately control over your orgasm. These relatively simple exercises have been found to be quite effective and can be found easily online, so look around for one that feels like a good fit for you and your partner. An added bonus of these exercises is that they also help partners be more aware of not only their own level of arousal, but also their partner’s, and to thereby communicate better about it. This is no small thing, since good communication and coordination makes sex much better for both people. If you find yourselves still struggling, a sex therapist can help you make refinements.
Perhaps not surprisingly, some couples emerge from the adversity of premature ejaculation better off for it. One of the best lessons that you can both learn from this experience is to talk explicitly about and identify all the various ways that you can make your sexual encounters mutually satisfying, regardless of when you each orgasm. That way, both of you can have a good time, regardless of when one of you climaxes. After all, an erection is not necessarily a requirement for satisfying a woman sexually. Knowing that you have other options takes the pressure off of both of you, so the encounter can still be a success, even if one orgasm comes sooner than you would wish. As with so many other things in life, a flexible approach with multiple options tends to make the whole thing more enjoyable.
Ari Tuckman PsyD, MBA
Psychology Today
