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Friday, January 23, 2009

Premature ejaculation

What is it?Premature ejaculation (PE) means coming too quickly, and it's one of the commonest of all sexual problems. In our survey of several thousand British males, approximately 10 per cent of them said that they often or sometimes had this trouble.We found that it's commoner in younger men - which is not surprising, as there's a distinct tendency for it to improve with age. Men generally get better control as they grow older.However, a 2004 survey in Europe showed that many middle-aged men still have this problem. Fortunately, good treatments are available.DefinitionsIt’s almost impossible to get an accurate definition of premature ejaculation: what some couples consider a satisfactory length of intercourse would be very inadequate for others.At the 2006 Congress of the European Society for Sexual Medicine, an American research paper reported:
the average lasting time of men with PE was 1.8 minutes.
'normal' men lasted an average of 7.3 minutes.But there were males who claimed to have premature ejaculation, yet who could last up to 25 minutes. This clearly shows people have wildly differing ideas about what is normal.At the same Congress, Professor Waldinger reported that 2.5 per cent of men couldn't last 90 seconds inside the vagina. Those males undoubtedly have PE.From our own clinical experience, there are plenty of couples who would regard intercourse that lasts under 20 minutes as less than satisfactory, and would feel that any ejaculation in under 10 minutes or so is decidedly premature. As a working definition, if either you or your partner feel that orgasm is happening too soon, then there probably is some degree of PE.Does it matter? In most cases premature ejaculation does matter, because it makes people unhappy and frustrated. And in severe cases PE can threaten or even ruin a marriage - simply because it spoils the sex lives of both partners. Sometimes, the condition is so bad the man can't have sex because he ejaculates before he can get into the vagina. This can be devastating for a man's self-confidence. And it can be hugely frustrating and annoying for his partner – especially if she wants to get pregnant.However, most men merely find PE a considerable irritation. It's a condition that makes them come very soon after they enter their partner - say, after only a minute or two, so neither party gets a lot of satisfaction.What causes it?For many years, sex experts have tended to say that premature ejaculation is caused by early conditioning.In other words, the man's early, rushed (and perhaps furtive) sexual experiences had to be quick so as to avoid detection. The idea is that this conditions him to climax as quickly as possible.However, our own surveys have found that many men with PE did not have rushed early sexual experiences - though others say they did.It's worth noting that from an evolutionary point of view, it's probable that males who climaxed quickly were more likely to have children. In other words, if you were a caveman who came very fast, you'd stand more chance of impregnating your woman and enlarging your tribe.Some men seem to be highly triggered right from the start of their sex lives, and we have encountered instances where their fathers were much the same. Therefore, we feel that the tendency to reach orgasm quickly may possibly be inherited rather than learned.Finally, there's no question that anxiety or 'nerves' play a part in many cases of PE. If you're nervous, you're likely to come too quickly.This is why many males have discovered for themselves that a small amount of alcohol eases their nerves and makes them less likely to climax prematurely. But we wouldn't recommend alcohol as a treatment.So, what can be done for PE?Treatment for mild casesIf you have very mild PE – for instance, you can last five minutes but would like to last 10, there's probably no point in going to a doctor.Why? Because you should be able to improve matters by simple distraction techniques.This means turning your mind to something else when you sense that climax is near. For example, you can think about something totally unconcerned with sex or pinch yourself.
Local anaesthetic gelSome men try to treat themselves with a local anaesthetic gel that's applied to the shaft of the penis shortly before intercourse.This product is advertised to the public as a good way to 'damp down' sexual sensation in the penis.We do not advise using this gel because the local anaesthetic can 'dull' the sex sensation for your partner.It can also cause a distressing skin reaction in either partner, with intense itching, redness and soreness.
Long love condomsGerman scientists have come up with a slightly different approach that won't cause vaginal irritation.It's called the 'long love condom’ and it contains a local anaesthetic (benzocaine) inside it.Long love condoms are now being sold in many countries, under a variety of brand names.A few male patients have told us they do last longer with these condoms, but the man is still at risk of a sensitivity reaction to the benzocaine. Treatment for more severe casesIf PE is causing you significant problems, it is best to consult an expert for treatment.
The Masters-Johnson methodThis method cures the vast majority of men, provided that both partners are keen to co-operate (which isn't always the case). It is based on a special 'penis grip' developed by the American therapists Masters and Johnson.The finger-grip abolishes the desire to climax, so if, under careful instruction, the couple use it over a period of weeks, they can usually re-train the man so he can last much longer.
What does it involve?
Your partner places her hand so that her thumb is on one side of the man's erect penis (the nearer side to her when she is facing him).
Her index and middle fingers are on the other side.
The index finger is just above the ridge of the glans (the 'head'), while the middle finger is just below the ridge.
When the man feels that he's near to a climax, he tells his partner.
She then squeezes his shaft firmly between her thumb and the other two fingers. (Don't worry: it's painless!)The programme and the grip can work for male couples as well as for heterosexual ones.
Does it work? We have seen many men with PE who couldn't last for 30 seconds, but who were able to last as long as half an hour after careful training over a period of months. However, unless this is done as part of an organised programme, it probably won't work.The Masters and Johnson grip really needs to be demonstrated to you personally by an expert. Most couples who try to learn it from the Internet or a book get it wrong.Our advice: see a professional. In the UK, try one of the organisations listed at the end of this article.
Antidepressant drugsIn recent years, it has also proved possible to treat PE with antidepressant drugs taken a few hours before intercourse.This may seem a little odd, but delaying male climax is a well-known side-effect of certain antidepressants. For most men, that side-effect is unwanted. But for guys with premature ejaculation, it's desirable.Antidepressants that are commonly used for this purpose include clomipramine (Anafranil), fluoxetine (Prozac) and sertraline (Lustral).But please be warned: these are powerful drugs that last a long time in the body, and have a considerable list of potential side-effects.Before going on to one of them, talk it over carefully with your doctor.In many countries antidepressants are now sold illegally in bars and on the street as ‘last-longer pills’, with amitriptyline the most commonly available. We really do not recommend buying antidepressants in this casual fashion.Antidepressants are prescription-only drugs, with a potential for causing you harm. If you want to try them for premature ejaculation, make an appointment to see your GP.
Drugs by nasal inhalationAt the end of 2008, there was a good deal of controversy in Britain because a company started using large advertisement hoardings to promote its treatment for PE: a nose spray. In fact, the only point of the spray is to deliver a drug into the bloodstream more quickly than could be achieved through taking it by mouth. The drug which is mainly being used in these new nose sprays is clomipramine – which, as have mentioned above, is an antidepressant. There have also been reports in 2009 of sex clinics suggesting the use of the major painkiller tramadol in a nose spray. This does not strike us as a good idea, in view of the drug’s side-effects which include mental confusion and abdominal pain. Tramadol is related to morphine, and is widely misused by people with drug problems.
A special constriction deviceIn 2000, a clinical trial of a new technique for treating premature ejaculation was published in the medical press.It was developed at St George’s Hospital, London, and involved wearing a slightly constricting ring below the head of the penis for 30 minutes each day. The theory was it would make the organ less sensitive.Unfortunately, at the present time the inventors of the device have not been able to publish any results of large scale trials.Don't attempt any constriction techniques like this off your own bat. Such a method should only be prescribed by an expert at a sexual problem clinic. It may or may not turn out to be useful.
A new medicationAt a medical conference we attended in December 2004, it was announced that a new anti-PE medication should be released during 2005. However, it is still awaiting approval for use in the UK.The product is a tablet called dapoxetine - a name which means that it is related to Prozac, but much shorter lasting.Taken by mouth, it is intended to lengthen the time between a man’s arousal and his climax.Unfortunately, the trial results we've seen indicate that this is a far from 100 per cent cure for PE. Only about 45 per cent of men said that the drug gave them control that was ‘fair, good or very good’.Possible side-effects of dapoxetine include dizziness, nausea, insomnia, headache and diarrhoea.However, if you have bad PE, this drug (which may the first of various such products) would certainly be worth trying when it becomes available.
Cognitive behaviour treatment (stop-start technique)In December 2006, we attended a conference on sexual medicine in Vienna. One of the speakers, Dr Mehmet Sungur, talked of the cognitive behaviour (CBT) method of treatment for PE.The CBT method focuses on addressing the kind of thinking that has proved unhelpful.For example, a man may believe that ‘real men’ must thrust endlessly to give a woman pleasure. Such thinking is not only damaging to the man, but wrong. Most women want penetration but also derive great pleasure from love play – often preferring fondling and oral sex to intercourse.The CBT method also aims to alter the man’s behaviour: he is encouraged to masturbate using the stop-start technique to gain more control over his responses and his urge to ejaculate quickly.
The stop-start technique
The man is encouraged to masturbate alone.
He is asked to set time aside to be private and to masturbate with dry hands.
The man is encouraged to masturbate almost to the point of ejaculation and then stop.
He should do this three times.
On the fourth time, he is permitted to ejaculate.After he has achieved this measure of control, he can try masturbating with a wet hand, which will feel more like the inside of a vagina. He is encouraged to do the stop-start technique as before.Obviously, this technique could be adopted by a man who does not seek treatment from a therapist.But because there are often psychological difficulties as well as behavioural and mechanical ones, most men will benefit more from seeking treatment rather than using the stop-start technique on their own.

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