Rapid Ejaculation

The embarrassment of talking about rapid or premature ejaculation keeps many men from seeking medical help. However, premature ejaculation is a very common men’s health condition with a number of treatment options; the first step is simply discussing the condition with your physician.

Many men occasionally ejaculate prematurely, but when it occurs regularly, it may be diagnosed as premature ejaculation. The Diagnostic Statistical Manual of Mental Disorders (DSM IV) defines premature ejaculation as a recurrent ejaculation with minimal sexual stimulation before, on or shortly after penetration.

“Rapid or premature ejaculation is a condition where men ejaculate much sooner than they wish,” says Dr. Stacy Elliott, Chair of the Canadian Male Sexual Health Council and a Sexual Medicine Physician active in The Men’s Health Initiative of BC. “It’s defined by three things: one is that the time it takes to ejaculate is very short, probably under a minute. The second thing is that there isn’t a sense of control, and the third thing is it causes distress to either a man or his partner.”

There are both psychological and biological factors that can contribute to premature ejaculation, including:

• Anxiety or stress
• Feelings of guilt or shame around sexual intercourse
• Abnormal hormone levels or brain chemicals
• Prostate inflammation or infection

“The prevalence of premature ejaculation is about 30% across the board, across the ages,” says Dr. Elliott. “I look at it as a sort of very hyperactive reflex, and it’s normal. That’s the way that men are made, and how they’re defined as men: that you should ejaculate fast, so it’s not an abnormality. The problem is that it doesn’t work in your relationship, and you want to extend that time.”

There are a number of techniques a man and his partner can use to delay ejaculation during intercourse. Other treatments include topical anesthetic creams that contain lidocaine or prilocaine to dull the sensation on the penis, psychotherapy, and medication.

Patients need to understand that there is no “magic pill” to cure premature ejaculation. “No pill is going to get rid of this,” says Dr. Elliott. “You need to really spend the time to learn how to slow down that reflex through behavioural methods.”

There are lots of theories trying to explain what causes rapid ejaculation. After all, sex is a complicated process—there are physical, mental and social factors all working simultaneously. Like many men’s sexual health issues, guys didn’t used to talk about rapid ejaculation with their doctors or partners; today, new research is shedding light onto the physiology of ejaculation.

The pelvic nerves and the muscles of the pelvic floor interact in a complicated way when men ejaculate. Recently, studies have shown hypersensitivity of the penile sensory receptors, hyperactivity of the ejaculatory reflex, and lower thresholds to unblock the normal neural inhibition of ejaculation. This neuro-muscular complex responds to a mix of neurotransmitters like adrenalin, serotonin, nitric oxide, and the latest discovery, carbon monoxide. You think that’s complicated? Try this: a guy’s neurotransmitter levels at any given moment will also vary in accordance with his hormone level, not to mention his stress level, or his level of caffeine, alcohol, and who knows what else.

A recent report also identified a hereditary component to rapid ejaculation. That’s right. Your Dad, your Grandfather, your great Grandfather—you may have inherited more than you bargained for from the (ahem) family tree. How do we know all this? It’s simple: guys have started to talk about rapid ejaculation as a part of living healthy—and sexually fulfilling—lives.

Primary:  This is most common type. It starts early in life, often with first sexual experiences. It’s only a problem if it persists.

Secondary:  This is when rapid ejaculations begin later in their life. Secondary RE has been associated with some underlying medical conditions, like prostate problems, so it’s wise to see a doctor for a medical evaluation. Stress or relationship issues may also contribute.

The other possible cause of Secondary RE is erectile dysfunction (ED). This too should prompt a visit to a physician so that any underlying medical conditions like diabetes or vascular disease (to name just a few) can be uncovered if present, or ruled out.

When rapid ejaculation develops as a result of ED, it is generally accepted that the best plan is to treat the erectile dysfunction and the RE will probably clear up on its own.

First, forget about the shame and blame. Turn off that nagging voice in your head, and get smart about rapid ejaculation. It’s a medical condition, and it’s treatable.

Secondly, talk to your partner. If you’re intimate enough to be having sex, you’re intimate enough to talk about it before and afterwards. Talk, listen and ask questions… you’re on the same team.

The Stop-Start Technique

This is currently the most recommended form of physical therapy for rapid ejaculation. Basically, it’s a series of exercises that you undertake, with your partner if possible. The idea is to identify and communicate your level of excitement and arousal, then to learn to stop all movement and stimulation just before you reach the point of no-return or “ejaculatory inevitability”.

Let all the excitement dissipate, and then start again, slowly. Repeat three times, slowly. Start. Stop. Start. Stop. Start. Stop. Start. Finally, after the third time, just relax, enjoy, and let it happen.

Start practicing three times a week, twenty to thirty minutes each time. You can begin with self-stimulation, and graduate over time to exercises with your partner. At first, practice with non-intercourse activities (take the Palmer Twins on a date, as the saying goes). Once you’re sure that you’re totally in control, you can move onto intercourse with a partner.

Don’t get discouraged; it’s going to take about 30 minutes, 3 times a week, for 3 months to see some progress. Your ejaculatory control will improve over time, but you’ve got to be patient. You might want to consult a sex therapist, a psychologist or a family doctor who deals with sexual problems while you are doing this program to deal with any doubts, resistance, or communication barriers.

Checking in with your partner about how “close” you are while have sex may seem a little strange at first, but it can actually lead to increased intimacy as you explore and communicate about your body in the moment.

Sensate Focus Exercises

In addition to the Start-Stop Technique, Sensate Focus Exercises can also be helpful. If the sessions are strained or anxious situations, then these exercises will help take away the pressure to perform. They employ touching, tickling, exploring and communicating techniques to help couples eliminate anxiety, and learn relaxed enjoyment. Sometimes it’s even fun to leave the clothes on and invoke a “No Intercourse” rule for a few weeks while you settle down and relax.

The Squeeze Technique

Self-help books and magazines used to suggest guys use the “squeeze technique” to keep themselves from ejaculating. The idea is to squeeze the tip of the penis just before ejaculation in order to prevent it from happening. Usually, this just results in a flaccid penis and a sticky hand. Plus, this technique doesn’t exactly lend itself to situations with… you know, a partner.

Kegel Exercises

Get with the program, dudes; women have been doing Kegel exercises for years. These involve the isometric tightening of the muscles of the pelvic floor for 10 seconds, repeated in sets of 15 as many times a day as you think of it (go ahead—try it right now). Basically, you’re toning these muscles in order to strengthen them… think of it as a trip to the gym for your penis.

SSRIs

A class of anti-depressants called SSRIs (Selective Serotonin Reuptake Inhibitors), like Prozac, Paxil, Zoloft, Celexa, etc., were noticed to have the side-effect of altering sexual function, including the delaying of ejaculation. The drug resets the threshold for initiating the ejaculation reflex. This can be used to advantage, to delay ejaculation, but it is not a cure, only a treatment. That means that, unlike the Stop–Start exercises, the problem usually returns whenever the treatment is discontinued. That is why the Stop–Start Technique is preferable as first-line treatment. Some doctors suggest daily treatment with the pills for two weeks, then just when necessary thereafter, at about 5pm on days of planned intercourse.

Men who ejaculate prematurely who don’t have a regular partner are caught between a rock and, er… a hard place. They’re often too embarrassed to find a partner, and without the help of a willing partner, it’s not easy to improve control. A pill, like an SSRI, will help them perform without prematurely ejaculating early in a relationship, but at some later point in time, they will still need to discuss the issue with their partner and embark on a mutually rewarding course of Stop–Start Therapy.

Note: Use of these SSRI drugs for treating rapid ejaculation is what is called off-label use. That means that the drug is not officially approved by the FDA for this use.

Viagra

Some experts advocate the use of sildenafil (Viagra) or a similar erection-enhancing method for treating rapid ejaculation. Without having to worry about losing his erection once he’s ejaculated, it is claimed, the man will be able to do the exercises without all the performance anxiety which often confounds the best of intentions. This method isn’t recommended it as an initial approach, but it is worth trying if exercises alone become problematic.

Conclusion

Ejaculation involves a complicated and coordinated interaction between the nerves and muscles of the pelvic floor, the urethra, the vas deferens, as well as various adjacent glands, ducts and vesicles. We’re only now beginning to identify and understand the neurotransmitters that regulate ejaculation, and how they work. Good drug treatments and (probably even better) gene therapies are hopefully not more than a few years away.

In the meantime, remember this: guys who live with rapid ejaculation for a long time have a tendency to develop a poor self-image. They doubt their masculinity and they tend to feel a general dissatisfaction with life. Controlling ejaculation is only part of the solution for these men. It’s important to realize that the Hollywood Stud and Sexual Superhero figures don’t exist in the real world.

Communicating openly and honestly with your partner and your physician is more important than trying to appear manly or tough. Let go of the myths, and take charge of your sexual health.