Because premature ejaculation (PE) is such a common condition, people have been seeking treatments for millennia. Even the ancient Chinese were trying to deal with it. Fangzhongshu is a compendium of sexual skills and methods. Skills to control ejaculation are part of this ancient work. PE is hardly a modern invention! Yet modern health care is seemingly behind the curve in treating this ubiquitous condition.
As with anything, when it comes to medicine (and sexual medicine in particular), there is usually no silver bullet to solve our problems. The most successful method for treating PE is a multi-faceted approach which involves medical treatment, mental health treatment, and sexual education. While any single approach may eventually work, we have found a combination approach is more successful.
The typical man who comes to us for help with PE is usually in a bit of a crisis mode. Very often, couples ignore or avoid talking about their feelings around this topic. It is common that resentment builds until there is a boiling over point and men come to us with relationships in jeopardy. By the time men seek help, they are often in considerable emotional and mental distress.
The good news is that we can help men gain control fairly quickly through medical treatments. It may take trial and error to find the right medication at the right dose, but for the vast majority of men, we are able to stop the downward spiral and restore desired function. Once they are out of the crisis mode, we engage in therapy and education to treat underlying problems.
As we have said before, some men may simply be hard-wired to ejaculate quickly and for those men, they may need to use medication for years. For many men, however, teaching them how to moderate arousal and maintain the plateau stage of arousal is the key to controlling ejaculation. This means re-learning how to have sex and recognize sexual patterns which are interfering with ejaculation control.
For example, most men learn how to have sex from teenage friends and pornography. Their sexual routine is carefully controlled and almost always follows the very same course of action. For many couples, sex consists of making out, foreplay, maybe some oral sex, and then penetration. For many men the goal is then to give their partner an orgasm and then the man allows himself to orgasm – that’s the end of sex!
Unfortunately, this carefully prescribed routine is an unrealistic and pressure-filled performance. If anything goes wrong or if there is any variation in the routine, one or both partners tend to view the sexual experience as flawed, bad, or “it didn’t go right”. Men particularly feel they are to blame in this situation. Culturally, men have been taught that sex is their responsibility and if things go wrong, it’s their fault.
In the therapy phase of treatment, we learn to recognize the sexual routines, patterns and pressures that get in the way of pleasure-focused sex. Instead of performing, we teach men to play. This means unlearning old beliefs and relearning a new healthier approach to sexual expression. Most men will admit that they are somehow reenacting a porn scene when they have sex. This realization opens the door to a more fulfilling and rewarding playful sexual experience.
In addition, we teach the men skills to become aware of their arousal levels and how close they are to ejaculation. We teach them to modify arousal and sensory input to maintain the plateau level of arousal. Very often these exercises are masturbation exercises as well as partnered exercises where sex becomes less focused on genitals and more focused on intimacy.
Virtually every man who is struggling with uncontrolled ejaculation can be helped. Even if he is never able to learn to entirely control his ejaculation, he can learn how to change the focus of the sexual experience so that rapid ejaculation does not have a significant impact on pleasure or the relationship.