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Please be advised there are two sections on this topic, one by Dr. Stanley Ducharme, a sex therapist, and one by Dr. Ricardo Munarriz, a sexual medicine physician. Stanley Ducharme, Ph. D. For men, erectile dysfunction and ejaculatory problems are the most common sexual difficulties. With the introduction of Viagra however, problems of erectile dysfunction are much less frequent and more easily treated.

BACKGROUND When does an ejaculation problem become a disorder? This is a subjective question and is based on the level of distress that is experienced by the man or his partner. The time from initiating sexual activity to ejaculation varies from one individual to another. This time period is called the ejaculatory latency.

Typically, ejaculatory disorders fall into two categories. These are: delayed ejaculation and early ejaculation. This column will explore some of the psychological factors and treatment options related to these two distinct male dysfunctions. In the vast majority of cases, the most effective therapeutic approach for ejaculatory dysfunction is a combination of biologic and psychologic therapy.

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In addition, they are not well understood by most medical doctors and urologists. It is not unusual for doctors to minimize the dysfunction and to dismiss it. For many men, finding the right professional, who has experience and realizes the seriousness of the problem may be one of the most difficult aspects in the treatment process.

Resolving the problem is most successful when both partners can work together as a team toward a successful solution. If the man is in a relationship, he needs the support and understanding of his partner. This helps to insure a successful treatment. Otherwise, the partner’s frustration and distress may contribute to the continuation of the problem.

In couples where ejaculation is an issue, the partner often internalizes this dysfunction as their mistake; the partner feels responsible ultimately intensifying the man’s stress and performance anxiety. Ejaculation problems may also contribute to a low libido and lack of interest in sexual activity. Without ejaculation, sex can become a source of frustration and devoid of satisfaction.

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In some cases, the woman may not be interested in sexual intimacy because of her frustration and anger at the situation. Ultimately in such cases, couples agree to avoid sexual contact rather than face the emotional pain of another sexual failure. For some men, there may be additional psychological issues that underlie an ejaculatory dysfunction.

The literature suggests that early ejaculation is the most common of any male sexual difficulties. It is certainly one of the most stressful. By definition, early ejaculation is an ejaculation that occurs before it is desired. Typically, the ejaculation has become inevitable either during foreplay or in the first moments following penetration.

As the young man becomes sexually active with a partner, these skills can then be transferred to his new sexual encounters. As the man becomes more sexually experienced, latency of ejaculation increases although not always to the satisfaction of the man and his partner. In addition to early sexual experiences, family attitudes toward sexuality as well as cultural and religious beliefs all play a role in sexual development and ejaculatory control.

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At other times, there may be no clear precipitating events to the onset of a early ejaculation pattern. Essentially, treatment for these cases is similar to younger men but psychological issues are probably even more critical to address. TREATMENT APPROACHES / CONCLUSIONS As mentioned, the most effective approach is a combination of psychological assistance and medical intervention.

Urologists and other medical doctors typically treat early ejaculation with a combination of medications and creams. Anti-depressant medications such as Paxil and Zoloft are often prescribed and are taken by the patient 2 hours prior to sexual activity. If this is not effective, the patient is further instructed to take the medication on a daily basis rather than before sexual activity.

In a therapeutic program, the first step is usually education. It is important that the couple have an understanding of the problem, it’s origins, the prognosis and the need to work together toward a satisfying solution. The partner must also understand that the man is not being selfish and that ejaculatory control is unsatisfying for him as well.

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The most important lesson to be learned by men and their partners is that there is hope and there are therapies that can help resolve the distress of ejaculatory difficulties. Often the first step, deciding to seek treatment and finding the proper professional is the most difficult. Ricardo Munarriz, M.D.

It is theorized that the central regulation is by dopamine and penile hypersensitivity, so treatment may be with Sildenafil and local anesthetic. If you have premature ejaculation there is a 91 % chance that a first degree relative (father, brother, son) will also have it. SSRI’s which are used for depression are a first line treatment as well.

This treatment works better for people whose rapid ejaculation is acquired. Since Sildenafil is more effective than SSRI’s, a combination of an anti-depressant, local anesthetic and Sildenafil is effective in 97% of the time. The anti-depressant with sildenafil is signficantly better than the SSRI alone. Although this is currently the preferred therapy, medical insurance typically covers 30 pills for SSRI’s and only 4 sildenafil tablets per month.

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There is research still needed in this area.

Not able to last as long as you’d like during sex? That can have several causes. You might be super-excited about a new partner or routine; you might just be off your game; you may just need to relax; or it may be that many forms of media depict unrealistic expectations of how long the average man actually lasts.

Another study got right down to it: Researchers asked 500 couples to press a stopwatch at penetration, then again at ejaculation for one month. Reported durations ranged from 33 seconds to 44 minutes. But the average for vaginal sex was three to seven minutes, with 5. 4 minutes the precise median (Waldinger, 2005).

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If you’re ejaculating too quickly for your or your partner’s satisfaction, there are several strategies you can try to last longer. In this technique, you begin sexual activity and continue until you feel almost ready to ejaculate. Then your partner squeezes the end of your penis at the point where the head (glans) joins the shaft.

Also known as “edging,” the stop-start method is something you can practice with a partner or as you masturbate. When you’re masturbating and feel like you’re about to come, pause until the urge to ejaculate passes. Then resume stimulating yourself. Over time, you’ll learn to recognize when you’re approaching “the point of no return” and be able to extend intercourse.

This can reduce sensation, which might make you last longer. Anesthetic creams are sold that have the same effect. Some companies sell over-the-counter, disposable, moist towelettes you apply to your penis before sexual activity; they can reduce sensation and help you last longer. Read everything you ever wanted to know about premature ejaculation here.

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It is described as an inability to delay ejaculation to a point that is mutually desirable for both partners. To understand premature ejaculation, one should first understand the process of erection. An erection develops when blood flows into the erectile chambers of the penis. These chambers, known as the corpora cavernosa, are elastic sleeves filled with blood vessels within the penis and are adjacent to the urethra, which is the urinary channel.

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Ejaculation takes place when a signal is sent from a control center in the brain which leads to contraction of muscles adjacent to the urethra which cause the semen to be ejaculated from the tip of the penis. After ejaculation, the erection subsides. The blood which had been trapped in the elastic sleeves is now released and the penis gradually returns to its non-erect state.

A variety of causes have been suggested for premature ejaculation. Some suggest it may be caused by stress or anxiety. Others suggest it is a learned response. An easy way to picture the process is to think of the control center in the brain as a thermostat. In some men, this thermostat is set too low.

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With that in mind, the different treatments are designed to lengthen the time to ejaculation by resetting the thermostat. There are a variety of treatment options available for premature ejaculation, which are listed below. Masters and Johnson first described a method to prolong the time to ejaculation which relies on behavior modification.

Each time, he brings himself closer to orgasm until he learns the point where it can no longer be controlled. By repeating this procedure a number of times on different occasions, a man can learn the “point of no return”. A man can practice this with his partner by engaging in sexual stimulation until he reaches the point just before ejaculation.

This step is repeated several times until a man feels comfortable postponing his ejaculation. Although this method is effective, it can take weeks or months to cause a change in the threshold for ejaculation. Although this works for some men, it can be difficult for others to achieve favorable improvement with this technique.

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As a man approaches climax, either he or his partner squeezes the tip of the penis just below the head of the penis as he approaches the point of climax. Pressure is held there until the sensation of impending orgasm diminishes. Thispressure can even be held until there is some reduction in erection.

Oversensitivity can be a cause for premature ejaculation. Some men find that the sensation of sex with a condom is less intense. By wearing a condom, they may reduce the amount of sensory input so that it takes a longer period of stimulation to reach climax. Another approach to decrease sensitivity requires the use of a topical anesthetic cream to desensitize the penis.

In addition, there can be times when the topical aesthetic cream is transmitted to the female partner which can cause her to have decreased sensitivity as well. There are several different medications which can delay ejaculation. They belong to a class of medications known as selective serotonin reuptake inhibitors (SSRIs) which are types of antidepressants.

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When these drugs are used to treat depression, men notice the side effect that it may cause them to take a longer period of time to reach ejaculation. The medications likely affect the “thermostat” in the brain which controls the signal for ejaculation. Although these drugs are not indicated for the treatment of premature ejaculation, they are frequently used with benefit in men who have premature ejaculation.

These medications can “reset the thermostat” so that a man can last longer before reaching ejaculation. These drugs may need to be taken anywhere from 1-12 hours before sexual activity. For a subset of men, one of these pills may need to be taken on a daily basis to provide benefit.

Men often note that if they climax quickly with their first erection they can last a longer time if they are able to get a second erection. With the second erection, it may take a longer period of time until they ejaculate. However, for many men, it may be difficult to obtain the second erection.

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Viagra is taken one hour before sexual activity. Once a man has his first erection and ejaculation, he may find Viagra makes it easier to obtain the second erection. In summary, premature ejaculation is a common problem for which a variety of treatments are available..

Topical anesthetics that help premature ejaculation can be purchased over-the-counter at most drugstores. Oral medication, The FDA has not specifically approved any oral medication as a treatment for premature ejaculation, but many drugs have been shown to help delay ejaculation. A doctor may prescribe oral medication as an “off-label” therapy, meaning the drugs are being prescribed to treat something they have not been approved to treat.

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    Psychological therapy, behavioral therapy and drugs are the main treatments for PE. You can talk with your health care provider to decide the best choice for you. More than one type of treatment may be used at the same time. Psychological therapy is a way to work through the feelings and emotions that may lead to problems with sexual relationships.

    It can also help couples learn to grow closer. Psychological therapy can help you become less nervous about sexual performance. It can also give you greater sexual confidence and understanding to help your partner’s satisfaction. This type of therapy can be used as the only treatment, or it may be used along with medical or behavioral therapy.

    The goal is to help you train your body away from PE. Some choices are the squeeze method and the stop-start method. Exercises work well, but they may not be a lasting answer. The Squeeze Method, With this method, you or your partner stimulates your penis until you are close to ejaculation.

    The goal is for you to become aware of the sensations leading to climax. The squeeze method may help you better control and delay climax on your own. The Stop-Start Method, In this method, you or your partner stimulates your penis until just before ejaculation. When you are about to climax, you or your partner stops until the urge to climax lets up.

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    This process is repeated 3 times. You ejaculate on the fourth time. You repeat this method 3 times a week until you have gained more control. No drugs have been approved in the U.S. to treat PE. Still, there are a number of drugs, numbing creams and numbing sprays that may slow ejaculation in men with PE.

    Drugs for PE can be taken each day or only before sex. Your health care provider will suggest when you should take a drug based on your activity level. The best time to take the drug is not clear. Most doctors suggest from 2 to 6 hours before sex. PE can return if you stop taking these drugs.

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    Numbing creams and sprays may be put on the head of the penis about 20 to 30 minutes before sex. If you leave the numbing cream/spray on your penis for longer than suggested, your erection may go away. Also, the numbing cream/spray should not be left on the exposed penis during vaginal sex because it may cause vaginal numbness.

    Wearing a condom can also help dull sensation.

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    However, it’s up to each couple to decide if they’re happy with the time taken – there’s no definition of how long sex should last. Occasional episodes of premature ejaculation are common and are not a cause for concern. However, if you’re finding that around half of your attempts at sex result in premature ejaculation, it might help to get treatment.

    Common physical causes include:Common psychological causes include:anxiety about sexual performance (particularly at the start of a new relationship, or when a man has had previous problems with sexual performance)It’s possible, but less common, for a man to have always experienced premature ejaculation since becoming sexually active. A number of possible causes for this are:conditioning – it’s possible that early sexual experiences can influence future sexual behaviour.

    They then let go and wait for another 30 seconds before resuming masturbation. This process is carried out several times before ejaculation is allowed to occur. The stop-go technique is similar, but your partner does not squeeze your penis. Once you feel more confident about delaying ejaculation, you and your partner can begin to have sex, stopping and starting as required.

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    Selective serotonin reuptake inhibitors (SSRIs) are designed to treat depression, but they also delay ejaculation. SSRIs used for this purpose include:Some men may experience an improvement as soon as treatment begins. However, you’ll usually need to take the medicine for 1 to 2 weeks before you notice the full effects.

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    They include:Read more about the side effects of SSRIs. An SSRI specifically designed to treat premature ejaculation, known as dapoxetine (Priligy), has now been licensed in the UK. Local NHS authorities can choose to prescribe it on the NHS.It acts much faster than the SSRIs mentioned above and can be used “on demand”.

    Your response to the treatment will then be reviewed after 4 weeks (or after 6), and again every 6 months. Dapoxetine is not suitable for all men diagnosed with premature ejaculation. For example, it is not recommended for some men with heart, kidney and liver problems. It can also interact with other medicines, such as other antidepressants.

    Research has found that they may also help with premature ejaculation. Because of changes in regulations, you no longer need a prescription to get sildenafil. But you will have to have a consultation with the pharmacist to make sure it’s safe for you to take it. Read more about sildenafil including information on how and when to take it.

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    For example, you may be able to ejaculate normally when masturbating, but not during sex. When ejaculation only occurs in certain situations, there’s usually a psychological cause. Sex therapy is a form of counselling that uses a combination of psychotherapy and structured changes in your sex life. This can help to increase your feeling of enjoyment during sex, and help make ejaculation easier.

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    Availability can vary widely depending on where you live. You can also pay privately. Prices per session are around £50 to £80. The College of Sexual and Relationship Therapists website provides information about private sex therapists and how to find a therapist in your local area. The relationship counselling service Relate also offers sex therapy at a number of its centres.

    During sex therapy, you’ll have the opportunity to discuss any emotional or psychological issues related to your sexuality and relationship, in a non-judgemental way. Activities may also be recommended for you to try at home while you’re having sex with your partner (you should never be asked to take part in any sexual activities during a session with the therapist).

    Retrograde ejaculation is caused by damage to the nerves or muscles that surround the neck of the bladder (the point where the urethra connects to the bladder). Usually when you ejaculate, semen is pushed out of your urethra. It is prevented from entering your bladder by the muscles around the neck of the bladder, which close tightly at the moment of orgasm.

    If you’re having problems with your sex life and are seeking treatment, it is usually recommended you involve your partner as much as possible. Communicating your concerns can often go a long way to helping to resolve them. And, in some cases, your partner may also have their own problems that are contributing towards problems with your sex life.

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    The use of topical EMLA-cream-only seems to be an effective treatment of premature ejaculation. Copyright © 2006 Elsevier Inc. All rights reserved..

    Medically reviewed by Last updated on Feb 15, 2022. Premature ejaculation occurs when a man reaches orgasm and ejaculates too quickly and without control. In other words, ejaculation occurs before a man wants it to happen. It may occur before or after beginning foreplay or intercourse. Some men experience a lot of personal distress because of this condition.

    When premature ejaculation happens so frequently that it interferes with the sexual pleasure of a man or his partner, it becomes a medical problem. Several factors may contribute to premature ejaculation. Psychological problems such as stress, depression and other factors that affect mental and emotional health can aggravate this condition.

    Working to relieve stress or other psychological issues may help the situation to improve. Other men have lasting difficulties with premature ejaculation, and require professional help. Some men respond to treatment promptly, while others struggle with this problem over a prolonged period. Effective treatment is available. There is no known way to prevent premature ejaculation.

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    Most commonly, the “squeeze technique” is used. If a man senses that he is about to experience premature orgasm, he interrupts sexual relations. Then the man or his partner squeezes the shaft of his penis between a thumb and two fingers. The man or his partner applies light pressure just below the head of the penis for about 20 seconds, lets go, and then sexual relations can be resumed.

    When this technique is successful, it enables the man to learn to delay ejaculation with the squeeze, and eventually, to gain control over ejaculation without the squeeze. Behavioral therapy helps 60% to 90% of men with premature ejaculation. However, it requires the cooperation of both partners. Also, premature ejaculation often returns, and additional behavioral therapy may be needed.

    Some men with premature ejaculation may benefit from drugs called phosphodiesterase inhibitors, such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis). A phosphodiesterase inhibitor can be used alone or in combination with an SSRI. One drug should be started at a time, preferably at a low dose. Some men with premature ejaculation also benefit from reducing the stimulation they experience during sex.

    Another option is to use one or more condoms. However, these techniques may interfere with the pleasure experienced during sex. The following list of medications are in some way related to or used in the treatment of this condition. Speak with your doctor if you consistently ejaculate before you want to.

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    On one occasion a volunteer was able to control ejaculation for 7 minutes and 40 seconds after taking Viagra. The researchers measured “vibrotactile stimulation ejaculatory latency time” in the man’s penis as their measurement of time to ejaculate. They actually measured vibration, not ejaculation, so their times were much higher than the couples would have reported if they had been operating a stopwatch.

    Men who took Viagra reported they felt more in control of their ejaculations. Men who took Viagra reported greater satisfaction from sex. Men who took Viagra reported they were able to get it up and go again on average in 3 minutes and 12 seconds after ejaculation when they were on Viagra.

    With that said Cialis does have it’s own list of potential side effect: Headache Upset stomach Back pain Stuffy nose Flushing Dizziness Another reason for taking Cialis instead of Viagra is that Cialis is a drug you can take once a day on a regular schedule, and Viagra is a medication you take when you think your partner is going to be in the mood.

    Levitra has to be taken right before sex and it can also be helpful in helping you maintain an erection after ejaculation. Levitra is a medication that works best if it is taken about 60 minutes before sex. One of the same researchers who studied Cialis as a muscle relaxant also did stopwatch tests of couples having sex after the man took Levitra.

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    Frank Sommer reported that the average time to climax with no treatment was less than 90 seconds. During the first 4-weeks of the study, each man was taught at home exercises and techniques to help better control ejaculation, such as: About half of the men found this sufficient enough to not proceed with the remainder of the study.

    It’s hard to determine the efficacy of Levitra on PE considering that other ejaculatory control methods were introduced into the study. However, men in the study reported that with Levitra they usually lasted long enough that both partners enjoyed sex more. A follow-up to this study found that men get good results with Levitra for premature ejaculation if they take it once a day, but it also works if they just take it an hour or less before they have sex and skip the pill on days they known they won’t be having sex.

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