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By: Joshua Gonzalez | Published on: Jul 15, 2019 | Categories: Blog , Erectile Dysfunction , Mens Health
Photo by @konrad_hop
One of the most challenging sexual problems in men’s health is ejaculatory dysfunction. Men can have all types of ejaculatory problems. Sometimes men ejaculate too early or too quickly. This is a condition called premature ejaculation, or PE. Sometimes men take too long to ejaculate or can’t ejaculate at all. These are termed delayed ejaculation and anejaculation, respectively. Certain men experience pain with ejaculation and some ejaculate backward (a condition called retrograde ejaculation). For whatever reason, my practice this summer seems to be dominated by premature ejaculators. So I thought I’d take a few minutes to discuss the facts and fiction about Premature Ejaculation.
First, let’s set the record straight on what constitutes a normal time to ejaculation. Men are often misguided when it comes to ejaculation and often overestimate what is normal. In a large observational study of men and their partners, half of the 1,500 men studied ejaculated in under 7.3 minutes (Patrick 2005). And the average time to ejaculation is under 10 minutes (Patrick 2005). Patients who see me often think they have a problem if they can’t last 15-20 minutes or more. But that’s just not realistic.
So how then do we characterize real Premature Ejaculation (PE)?
Definition.
PE is characterized by ejaculation which always or nearly always occurs prior to or within one minute of penetration or the inability to delay ejaculation on all or nearly all penetrations. To qualify as PE, the ejaculatory issue should cause negative or uncomfortable personal consequences such as distress, frustration and/or the avoidance of sexual intimacy (Althof 2014).
Prevalence and types.
Did you know that Premature Ejaculation is the most common male sexual dysfunction? Depending on the population, the prevalence has been reported as high as 30% (Carson 2006). Many incorrectly assume it’s a young man’s problem, but premature ejaculation can occur at any age (Rosen 2004).
PE comes in two primary types, congenital and acquired. That means, sometimes you’re born with it. And sometimes it’s Maybelline. I mean, sometimes it occurs later in life. Men with the congenital version have always had a problem controlling their ejaculation, even from their first attempts at masturbation. Men with the acquired kind experience a period of normalcy and suddenly or gradually develop an inability to delay time to ejaculation. Both types can be especially distressing and negatively impact a man’s self-esteem or cause relationship issues.
Treatment.
In my experience, guys are often embarrassed to discuss premature ejaculation with their doctors. And many don’t know that there are safe and effective treatments available to improve their ejaculatory control. Thanks to online platforms like hims that seems to be changing. Maybe that’s why this summer I’ve seen an influx of men talking to me about PE.
There are several ways to approach treating Premature Ejaculation. The first is to decrease penile sensitivity. This can involve applying a condom or using a topical anesthetic spray. hims offers this PE treatment option that you spray on 5-10 minutes before sex. These topical treatments can be useful for some patients, especially those with a regular partner. Younger patients and single men may find them cumbersome and sometimes report they interfere with intimacy or don’t allow for spontaneity with new partners. Thankfully there are other options.
A more commonly prescribed treatment for PE is a family of drugs known as selective serotonin reuptake inhibitors (SSRIs). You may have heard of these drugs before because they are also a common type of anti-depressant. One of the side effects of SSRIs is delayed ejaculation. So in patients with PE, we use this side effect to our advantage! These medications have been studied and used on-demand (just before sexual activity) and as daily treatments and both are effective. One of the more commonly prescribed on-demand options is sertraline, which can be used a few hours before sex with reasonable success. If you’re interested in reading more about this option, check this out .
If PE exists alongside erectile dysfunction (which commonly occurs), then phosphodiesterase-5 inhibitors (think Viagra, Cialis, etc.) can be helpful. Another commonly employed treatment is the use of the pain medication tramadol. This treatment is most often used on-demand and essentially dampens the brain’s processing of the genital stimulation that leads to PE. Additional treatments, including Botox injections, are under study as we speak. Some non-medical approaches that can be helpful in PE include pelvic floor physical therapy, sex therapy, psychotherapy, and cognitive-behavioral therapy.
All this is to say, if you’re having problems ejaculating seek help. Do some research, just be careful what you read. hims is a great place to start. And if you’re interested in trying one of the many treatments they offer for sexual dysfunction, talk to your doctor about whether that option is right for you. We are here to help!
Althof SE, McMahon CG, Waldinger MD, Serefoglu EC, Shindel AW, Adaikan PG, Becher E, Dean J, Giuliano F, Hellstrom WJ, Giraldi A, Glina S, Incrocci L, Jannini E, McCabe M, Parish S, Rowland D, Segraves RT, Sharlip I, Torres LO. An update of the International Society of Sexual Medicine’s guidelines for the diagnosis and treatment of premature ejaculation (PE). J Sex Med. 2014 Jun;11(6):1392-422.
Patrick DL, Althof SE, Pryor JL, Rosen R, Rowland DL, Ho KF, McNulty P, Rothman M, Jamieson C. Premature ejaculation: an observational study of men and their partners. J Sex Med. 2005 May;2(3):358-67.
Carson C, Gunn K. Premature ejaculation: definition and prevalence. Int J Impot Res. 2006 Sep-Oct;18 Suppl 1:S5-13. Review.
Rosen RC et al (2004) The Premature Ejaculation Prevalence and Attitudes (PEPA) Survey: A Multi-National Survey. J. Sex Med 1 (Supp 1): 57-58
Joshua Gonzalez, MD 5901 W Olympic Blvd Suite 303 Los Angeles, CA 90036
I know you don’t need a lecture in Biological Chemistry so I won’t give you one.
So let’s just stick with the basics.
Serotonin and Dopamine are two naturally occurring hormones directly responsible for ejaculation control. Increased Dopamine levels cause quicker ejaculation times while increased Serotonin levels cause slower and more delayed ejaculation times. An increase in Serotonin levels automatically decreases Dopamine levels and vice versa.
In a nutshell, while making love, you need slightly higher levels of Serotonin in your bloodstream than Dopamine.
But this is a VERY delicate balancing act.
If Dopamine levels drop too low and your Serotonin levels become too high, your sexual urge is affected (erectile dysfunction or anorgasmia, aka inability to ejaculate). In short, you will experience a waning libido.
Unfortunately, humans hardly have any direct control on the body’s production of these hormones.
So the trick is to regulate the body’s production of these two hormones and keep it in a balance. But this has to be done in a non-invasive way with the help of natural treatments so as to avoid any unwanted side effects.
Histamine is another naturally occurring chemical in the body that’s directly responsible for the sensitivity of the penis (Lidocaine, the most-common ingredient in numbing creams, is simply an antihistamine!)
The more Histamine present in the bloodstream during sex, the more sensitive the penis becomes. And the more sensitive the penis is, the more likely for ejaculation to occur prematurely.
This means, in order to lessen the sensitivity of the penis thereby making it last longer before ejaculating, Histamine levels should be decreased.
Other treatment programs solve this with Histamine blocking creams which have a harmful long-term side effect on the penis.
Traditional drugs that block Histamine also result in less harmful but counter-productive side effects.
Sleepiness, headaches, nausea (antihistamines) or loss of feeling (numbing creams).
Now, what good would it be to lessen the sensitivity of your soldier so it lasts longer in battle if you end up dozing/sick on the frontlines or find yourself (or both of you!) unable to feel anything at all?
So the solution is to naturally decrease the “delivery” of Histamine on a cellular level by introducing another naturally occurring substance – Arginine, one of the most common amino acids.
You see, there’s only enough room in the cells for either Arginine or Histamine. So if you increase your Arginine levels, you naturally lessen the circulation of Histamine in the body (much like the relationship between Dopamine and Serotonin).
You probably know that Viagra or sildenafil, is the leading drug that aids men who suffer from Erectile Dysfunction.
The sildenafil in Viagra relaxes the smooth muscles of the blood vessels of the penis thereby increasing blood flow.
This increased blood flow results to a firmer, stiffer and stronger erection.
But what has that got to do with premature ejaculation?
You should understand that ejaculation control is closely interrelated with erectile dysfunction. Many men who cum too soon also have trouble with erectile dysfunction as well.
It’s a complicated internal connection but you can sum it up by saying this – balancing the hormones necessary to control ejaculation will also help strengthen your erection. It’s like a win/win for you and your penis!
Now most people think Viagra or Cialis are the only options when it comes to a strong erection…
However in my research, I found certain herbs were just as effective as Viagra and Cialis in promoting increased penile blood flow – and they had fewer side effects!
The Psychological Issue (Sympathetic/Parasympathetic Activity)
Bodily functions operating below the level of consciousness such as heart rate, digestion, respiration, salivation and sexual arousal are governed by the Autonomic Nervous System.
This is further divided into 2 subsystems: the Sympathetic Nervous System and the Parasympathetic Nervous System.
This is where most remedies and treatment programs screw things up.
Without getting too technical, here’s how this affects ejaculation.
You probably know that the same organs we use for reproduction is also used in urinary excretion. So most of the muscular and nervous controls between these 2 functions operate generally the same.
The Parasympathetic Nervous System is responsible for “holding matters together” in this area of the body, which includes storing urine and in effect, semen.
The Sympathetic Nervous System , on the other hand is in charge of “letting things go”, in short, urinating and ejaculation.
To put things simply, whichever nervous system is stronger gets its way. The key is to balance them – too strong of a Sympathetic Nervous System results in premature ejaculation, while too strong of a Parasympathetic Nervous System results in erectile dysfunction and/or anorgasmia.
Most ejaculation control products or programs focus solely on your Parasympathetic Nervous System, but if you actually do that, you’ll find your “little man” losing strength real quick.
Understanding how these mechanics work gives you control over when you use each Nervous System, in effect letting you control when your body holds your semen and when it decides to ejaculate.
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Try the pause-squeeze method. If you and your partner are willing, you might try the pause-squeeze method for learning to delay ejaculation. [2]
X
Trustworthy Source
Mayo Clinic
Educational website from one of the world's leading hospitals
Go to source
[3]
X
Research source
Stimulate the penis without entering your partner. Notice when you are about to ejaculate.
Ask your partner to squeeze your penis at the place where the head meets the shaft. Your partner should squeeze for several seconds until the need to ejaculate lessens.
After 30 seconds, resume foreplay and repeat as necessary. This will help you to gain control and enable you to enter your partner without ejaculating immediately.
Another variation on the pause-squeeze method is the stop-go technique. This is the same as the pause-squeeze method, except that the partner does not squeeze the penis. [4]
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Research source
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Use self-help techniques. These are methods that you can do yourself that may help you to delay ejaculation: [5]
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Public healthcare system of the UK
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Masturbate before sex. If you plan to have sex later in the evening, try masturbating an hour or two before.
Use a thick condom that will reduce the amount of stimulation you get. This may make it take longer for you to climax. Avoid using condoms that are designed to increase your stimulation.
Breathe deeply right before you ejaculate. This can help you to stop the ejaculation reflex. It may also help to switch to thinking about something boring until the urge passes.
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Change the position you have sex in. If you are usually on top, consider switching to the bottom or changing to a position that will allow your partner to move off of you if you are about to ejaculate. [6]
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National Health Service (UK)
Public healthcare system of the UK
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Then resume sex once the urge to ejaculate has passed.
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Go to counseling . [7]
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Expert Source
Robert Dhir, MD Board Certified Urologist & Urological Surgeon
Expert Interview. 23 September 2020.
You can do this either alone or with your partner. This can be helpful in dealing with: [8]
X
Trustworthy Source
Mayo Clinic
Educational website from one of the world's leading hospitals
Go to source
[9]
X
Trustworthy Source
National Health Service (UK)
Public healthcare system of the UK
Go to source
[10]
X
Trustworthy Source
Mayo Clinic
Educational website from one of the world's leading hospitals
Go to source
Performance anxiety or other stresses in your life. Sometimes if men are concerned about being able to get or keep an erection, they may develop a pattern of ejaculating too quickly.
A traumatic sexual experience when you were younger. Some psychologists believe that if your early sexual experiences included feeling guilty or a fear of being discovered, that you may have learned to ejaculate very quickly. [11]
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Research source
If you and your partner are having problems in your relationship, this may be a contributing factor. This could be the case if the problem is new and did not happen in previous relationships. If this is the case, couples counseling may be helpful.
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Try topical anesthetics. These medications are available by prescription or as over-the-counter as sprays or creams. You put them on your penis before sex and they reduce the sensations you feel, helping to delay the climax. Some men, and occasionally their partners as well, have reported a temporary loss of sensitivity and reduced pleasure. Common ones include: [12]
X
Trustworthy Source
Mayo Clinic
Educational website from one of the world's leading hospitals
Go to source
Keep in mind that these topical options are not helpful for everyone. [13]
X
Expert Source
Robert Dhir, MD Board Certified Urologist & Urological Surgeon
Expert Interview. 23 September 2020.
Lidocaine
Prilocaine
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