Premature Ejaculation can be very frustrating for men or couples who are experiencing it. In order to treat premature ejaculation, we must first determine the causes, if any, and explore treatments appropriate for each patient. Premature ejaculation has many contributing factors. For that matter, there are many aspects of our life that are likely contributing to premature ejaculation without our even realizing it.
It is important to understand that as mammals, humans are not designed to have extended coitus. The act of procreation is a very vulnerable position and activity for mammals. In nature (and from an evolutionary standpoint), it is important that males deposit sperm in the female as quickly as possible so that they do not become prey. Because humans linked procreative activity with emotional connection, our desire now is to make the sexual experience last as long as we wish. It is important to remind ourselves that we are engaging in behavior that is contrary to normal mammalian activity.
Two Types of Premature Ejaculation
The medical community categorizes premature ejaculation (PE) into two types. For some men PE has been a lifelong problem; it’s just the way they are wired. This is called Primary Premature Ejaculation. Just as some men are short or tall, brown hair or red hair, quick reflexes or clumsy, genetics can play a significant role in our sexual function. And while the clumsy guy can practice and become less clumsy, he is never going to be as coordinated as some men. It is the same thing with primary premature ejaculation. We can optimize how long this man can last, but it is unrealistic to expect that the man with primary premature ejaculation is going to learn to last 30 minutes without significant medical intervention.
Other men develop premature ejaculation for a number of reasons. This is called Secondary Premature Ejaculation. For these men, they have gone through most of their lives without ever paying much attention to how long they lasted because they always felt in control of reaching a climax and it was never an issue. But oftentimes there are changes (whether the man realizes it or not) which can create difficulties with ejaculation control. These changes can be gradual or sudden in nature.
It is very common to hear sex therapists or medical professionals blame men for having premature ejaculation due to bad masturbation habits. I’m not sure why our culture loves to shame masturbation, but when professionals talk like this, they are indicating their own biases and their own discomfort with normal sexual activity. While masturbation activities can be counterproductive, they are rarely the cause of premature ejaculation.
Part of our job in the clinic is to explore and become good detectives to figure out what changes have occurred that have triggered PE. Once we understand possible changes, we can try to address them or treat them. Treatments can include medication as well as sex therapy and education. We will go into these treatments in a different blog. The two-pronged approach we take when it comes to dealing with premature ejaculation is medical intervention to increase ejaculation control. At the same time, we want to engage in sex education so that the sexual activity patients are engaging in, supports the goals and desires of the couple. For example, we encourage couples to change up the sequence of events which are part of their sexual routine. I might encourage a couple to have an extended sexual experience with a lot of erotic play and massage and exploration while recognizing that intercourse will quickly lead to a climax.
Another example of sex education is recognizing the erroneous belief that a climax signals the end of sexual activity. This is a habit that is supported in the porn industry. Every sex scene involving a man ends with an ejaculation! In real life this does not need to be the case. Just because there is an ejaculation does not need to indicate that sexual activity is going to stop. It may mean intercourse may stop, but that doesn’t mean sex has to stop.
If you or your partner are struggling with climaxing earlier than desired, or if avoiding climax has become a focus during sex, then it is time to seek help. Be sure to find a sexual medicine specialist who is well-versed in the field of premature ejaculation. There is no need to suffer when help is readily available!