Premature Ejaculation (PE), also known as early ejaculation, is a very common condition in men that can be very frustrating for couples and can even threaten relationships. It has been estimated that up to one-third of men struggle with this condition on a regular basis.
The clinical definition is an ejaculation that occurs sooner than 2 minutes after vaginal penetration AND includes one of the following:
- an inability to control the ejaculation when desired
- causes stress in a relationship
The average normal ejaculation time from penetration has been found to be a little over 6 minutes. While the clinical definition is practical for studies the most helpful definition in reality is any ejaculation that is sooner than you or your partner would like. For instance, one couple may be completely satisfied with 5 minutes of penetration, whereas another couple may need 20 minutes to be satisfied.
What causes premature ejaculation?
The causes of the condition vary widely and are often multiple in origins. Some men have what’s called primary PE, meaning that they have struggled with the condition since the onset of their sexual lives; others have secondary PE with onset later in life.
It’s often found that premature ejaculation (PE) may be situational, either occurring only with certain partners or at certain times. Whenever it occurs, it can be distressing to men. The most important aspect of PE, regardless of when it started, is psychological. Unfortunately, this can be the most difficult component to treat. Some psychological contributors to PE include anxiety and being hyper-aroused. In both cases the nervous system is in a heightened state, and in both cases, calming the nervous system will help increase the orgasm threshold and allow an increased time until orgasm. In general, most of the non-pharmacologic approaches will have very mild effects individually, but when combining several of these, the benefits are cumulative and thus will have a more appreciable effect in helping you to last longer.
Hormone dysregulation (i.e. low testosterone) is a major factor contributing to premature ejaculation. In fact, many men have had suboptimal testosterone since puberty, which predisposes them to premature ejaculation.
With modern medicine we are now learning that testosterone increases amount of serotonin in the brain. Low serotonin is associated with premature ejaculation. This is why long term use of SSRI-type anti-depressants (Selective Serotonin Reuptake Inhibitors which slow down the breakdown/recycling of serotonin) can be helpful for some guys. Unfortunately SSRI medications have a long list of side effects including decreased sex drive and fatigue, making them a less desirable option for treating PE. In addition, one reason serotonin is low in the first place is likely from low testosterone or another hormone imbalance such as thyroid dysregulation.
Internet porn and masturbation can also cause premature ejaculation. According to some studies, porn consumption increases your dopamine production which can cause faster ejaculations. Plus, many men masturbate simply to “get off” in the shortest time possible. This trains your body to ejaculate more quickly when you’re in any sexual situation. Pornography also causes many people to have unrealistic expectations of what sex is supposed to be like. Think about this: A 5 minute film isn’t going to sell well. Thus, adult films are made to be an entertaining length. Unfortunately, various tricks including Trimix and other medications (see below) and cutting/editing film techniques creates what appears to be an unrealistically long lasting sexual encounter between the actors.
There are several angles from which to approach the treatment of PE, and often the best results require a combination of several different treatments. Having many options to choose from also helps provide customized treatments that will work for individual patients.
In general, treatments for four main aspects of PE should be incorporated; Pharmaceuticals, Nutritional Supplements, Psychology, and Techniques.
Breathing: Breathing can help calm an excited/anxious nervous system.
Anxiety: Breathing can help with relaxing the nervous system. Just like during meditation, which often incorporates mindful breathing to quiet the brain, slow, steady, deep breaths during sex can help to calm the nervous system, including the nerves in the penis. DON’T hold your breath or take shallow, fast breaths. These have the opposite effect.
Hyper-arousal: Focusing on the breath has the additional benefit of distracting your thoughts. By thinking about your breathing more, you’re thinking less about sex, which can decrease arousal and allow you to last longer. In addition, beliefs in sex can affect arousal. If it’s a “big deal” you’re more likely to be hyper aroused than if it’s a “normal” part of life (which it is). Having sex more often can help normalize it and reduce your hyper-arousal to a normal level.
A simple exercise to do while masturbation is as follows:
1) Put one hand on your belly and feel your belly rise and fall as you breathe deeply and slowly
2) Consciously keep your pelvic muscles as relaxed as possible.
3) If you get close to orgasm, slow down or stop until sensitivity decreases. Allow yourself at least 15 minutes to do this practice.
PC Muscle Relaxation: The PC or Pelvic muscles described below play an important role in ejaculation. They help to propel semen through and out of the penis. By consciously keeping them relaxed, ejaculation can be delayed until you’re ready. This does take practice, just like any other muscle control, but the above exercise incorporates this practice.
PC Muscle Contraction: Just like the PC muscle can be contracted to prevent urination, it can be contracted to prevent ejaculation. Just before the “point of no return” is reached, squeezing this muscle as firmly as possible can prevent ejaculation, even if orgasm (ejaculation and orgasm are actually separate phenomena that happen to occur simultaneously) occurs. If you hold back ejaculation, you’ll be more likely to maintain your erection and be able to continue. Sensitivity is also reduced for a time allowing one to continue intercourse until the sensitivity is regained. Sometimes, however, the untrained PC muscle is not strong enough to hold back. As such, this technique also requires practice. You can find detailed exercises online, but the best and simplest is the Kegel. Kegel can be incorporated into the exercise above.
Change positions: Changing positions interrupts intercourse and can allow the sensitivity of the penis to be reduced for a short time. Different positions can also result in more or less sensitivity. For example, the traditional missionary position tends to result in greater penile sensitivity while female on top positions can help a man last longer. Other positions can be explored and much information is available online.
Edging Techniques: Edging techniques can be a powerful way to retrain your ejaculatory mechanism to take longer. Edging is beyond the scope of this article but there is loads of information on it on the internet, both for self-training and with your partner to prolong your foreplay.
NLP: Neurolinguistic programming is famous for improving many psychological conditions including the psychological aspects of PE. NLP is beyond the scope of this article, but you should know that it is a powerful tool. Much more can be learned about NLP via a simple google search.
5HTP: The supplement 5-Hydroxytryptophan (5HTP) is an important precursor to the production of serotonin in the brain. Providing the precursor to serotonin results in increased production of serotonin, a neurotransmitter with many functions. A deficiency in serotonin has been associated with premature ejaculation, and many men have experienced improvements in PE by supplementing 5HTP. It is available over-the-counter from most supplement and health food stores. It also can have the effect of improving mood and the ability to relax.
The pharmaceutical approach is what Innovative Men’s Clinic excels at. It has two main benefits: It takes the worry out of things allowing the man to forget about the problem (which itself can reduce anxiety as mentioned in the previous section) and it is very simple to do (unlike some of the techniques discussed later that require some discipline and work).
Dextromethorphan 50mg/Acetaminophen 325mg/Sildenafil 50mg:
Dextromethorphan is a cough suppressant (the DM in Robitussin). A side effect of taking cough suppressants with dextromathorphan is a delay or inability to ejaculate. However, when premature ejaculation is an issue, it can be used to “delay” ejaculation to a more desirable duration.
Acetaminophen is an OTC pain relieving medication (the medication found in Tylenol) that can slightly reduce the sensitivity of the nerves in the penis. By itself, acetaminophen is not likely to result in drastic improvements in PE but when combined with dextromethorphan and other items listed in this article, desirable results can be achieved. Acetaminophen is Absolutely Contraindicated with Alcoholic Beverages! Taking Acetaminophen with alcohol in your system can cause significant damage to your liver.
If ED is an accompanying problem, Dextromethorphan and Acetaminophen can be combined with Sildenafil, the drug found in Viagra. It can also be combined with Tadalafil (Cialis), Vardenafil (Levitra), Avanafil (Stendra), or any other PDE5i medication. It is an arousal-dependent medication that can improve the firmness and duration of an erection. This has two main benefits; More confidence in your erection (and thus your performance) and a quicker recovery time after ejaculation, should you still be interested in continuing your sexual activity. When combined with Dextromethorphan and Acetaminophen, several issues are addressed at once.
Micro-injection Trimix for Premature Ejaculation:
The microinjection is applied completely painlessly just prior to sexual intercourse. Trim acts locally at the penis by opening up the blood vessels and thus allowing you to maintain an erection even after ejaculating.
The ability to maintain the erection after ejaculation reduces anxiety associated with sexual intercourse and the subconscious fear that can cause men to under-perform. Over time patients typically become less concerned with their PE. You may begin to prolong your ejaculation time more easily due to the decreased performance anxiety because even if you do ejaculate early you’ll still have an erection.
Eventually this approach gives you the ability to manage your ejaculation time on your own. It also helps you to practice the other methods listed below without having to worry about failing. We have been using this unique approach with patients for several years and have found remarkable and reliable results. It is very safe when done correctly, and the physicians at Innovative provide thorough instructions to all their patients who wish to use this technique.
How to Deal With Premature Ejaculation:
Part of the problem is that there are unrealistic expectations in modern society. The easy access to internet porn has many men to believe that they need to last for an hour or more. The truth is women should be able to orgasm in a short time too. We’re genetically programmed to be able to get the deed done quickly before a threat or other interruption occurs. The whole point, from an evolutionary perspective at least, is to reproduce. If it takes too long, reproduction is less likely.
If we’re smart, we’ll spend more time in foreplay. For most women, sex is mostly in the mind. Sure, physical arousal plays a big role too, but if you take the time to really get her aroused, she should orgasm within minutes or even seconds of penetration. Even bringing her to orgasm before intercourse will help her be more satisfied, and many woman can have additional orgasms after penetration. In short, it’s well worth your time to be patient and focus on her arousal during foreplay with lots of massage, caressing, kissing, and of course, manual and/or oral stimulation. This way, if you do ejaculate in a very short time after penetration, it’s OK, because your partner will already be satisfied. While reproduction may be the evolutionary goal, modern humans are blessed with the ability to enjoy sex, and as such, enjoyment should be the goal, and there are many ways to do that other than through penetration alone.