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Mumbai’s #1 Sex Health Clinic

Samadhan Health Studio

Dr. Ashok Koparday
Dr. Hetal Gosalia

Dr. Ashok Koparday | Dr. Hetal Gosalia

Premature Ejaculation, the condition experienced by a few, but misinterpreted by the majority.
Sex is more of satisfaction, than of the duration or the number of thrusts.

  • Are you a man who ejaculates within a few seconds of insertion of the penis in the vagina?
  • Or are you a man ejaculating during foreplay?
  • Are you a man discharging at the attempt of insertion?
  • Or are you the one now fearing to go to bed?
  • Are you amongst the men feeling low for not satisfying their partners and avoiding sex?

If you find yourself as one of these persons, then you have arrived at the right place because a sexologist is whom you need; to help you through this. Here we have provided an all-encompassing rundown of Premature Ejaculation.

What is Premature Ejaculation?

Premature Ejaculation is a male sexual dysfunction characterized by early discharge during or before intercourse resulting in negative personal consequences, such as distress, frustration, lack of sexual satisfaction and the avoidance of sexual intimacy.

The normal time between insertion of penis and ejaculation is ONE minute to THREE minutes only.

At times it can be quicker than one minute and sometimes it can even last more than three minutes in the same couple.

TYPES

Premature ejaculation can be classified into  two types:

  1. Primary / Lifelong
    The man ejaculates early ever since his sexual activity has started.
  2. Secondary / Acquired
    The man previously had healthy sex life without ejaculatory issues. But now he is not able to continue as long as it used to be and ejaculates early.

New Classification
Recently, a new classification of PE was proposed based on controlled clinical and epidemiological stopwatch studies, and it included two other PE syndromes: ‘Natural variable PE’ and ‘Premature-like ejaculatory dysfunction’

Biology Of Procreation

The role of the penis in men is to deposit semen in the vagina. Penis acts like a dropper. Once there is discharge the erection is lost and next erection takes quite some time in all the males. This is called the refractory phase. Scientists believe that impregnation being the primary role of sexual intercourse nature designed ‘quick timing’.

SYMPTOMS

  1. Ejaculation occurs nearly or always within one minute of vaginal insertion.
     
  2. Ejaculation occurs during foreplay, i.e. before insertion.
     
  3. The inability to delay ejaculation on all or nearly all vaginal insertions.

 

CAUSES

The causes of Premature Ejaculation can be psychological or biological in nature.
1. High Excitement

If the man is highly excited or aroused and is very sensitive to touch stimuli, he ejaculates quickly.

2. Unrealistic Expectation

It is common as people compare with what is shown in pornographic movies. They hear false bravado from friends who lie, “I do sex for very very long time, which lasts 30 minutes.”

3. Long Window Period

If the man is sexually repressed or starved, it becomes very difficult for him to control his ejaculation at the time of sexual contact.

4. Stress

The man is not in mood or is disturbed due to work pressure, which easily leads to early discharge.

5. Relationship Discord

If there is disharmony in the relationship, arguments, pressure to perform by the partner, varying levels of understanding sexual matters or differing desires, makes the man come early.

6. Performance Anxiety

If a man is anxious about his makeover due to past experiences or worried about losing his erection, or feels he is not able to satisfy his partner adds on to his early ejaculation.

7. Lack of Confidence

The man has low self esteem or has sexual doubts about his penis size, masturbation and nightfall effects.

8. Physical Illness

Organic illness like diabetes, blood pressure, etc. may cause Premature Ejaculation.

EFFECTS

  1. Relationship Issues
    • Timing of sexual intercourse is everything in the bedroom.
    • PE is one of the commonest sexual problems in men wherein women also suffer equally. It causes a lot of emotional disturbance and frustration in the couple.
    • Men’s psyche is penis centered. They feel more the number of thrusts, more manly factors they have. When unable to perform long, as per their own expectations, they are crestfallen and avoid sexual intimacy.
    • It leads to feelings of hurt and gradually there is a breach in the harmonious relationship.
    • The woman may feel dejected, as she thinks “Am I not that attractive?” or “Why doesn’t my partner love me as he used to?” and suffers emotionally with lack of sexual satisfaction and orgasmic feel.
    • This fear of rejection causes her mental trauma.

     

  2. Fertility Problems
    If the man ejaculates early even before insertion of penis in vagina, it becomes impossible for the sperms to enter in the vaginal tract to fuse with the egg for pregnancy.

DIAGNOSIS

There is no specific method or a diagnostic test to confirm PE.
After detailed history the Sex Expert will locate the exact cause of your problem and guide you acccordingly. Needful medicines may be prescribed.

Wake Up Call
Sex does not mean only sexual intercourse. The more the man explores the self and the partner, having more of love making before insertion of penis, more is the fun and the highs.
It is not only the short duration, early ejaculation, and less number of thrusts that makes a woman unhappy. Men unnecessarily are more focused on their penis and delaying their ejaculation. Here the question arises

Are you more interested in increasing the number of strokes?
OR
Are you interested in giving your partner the climax, she desires?

Sex is something which a couple enjoys, gives and takes pleasure equally. You don’t have to bear it silently. There are lists of things to do to last long in bed to your heart’s content.

TREATMENT

Only individuals with lifelong PE with ‘Intravaginal Ejaculation Latency Time’ [IELT] shorter than 1–1.5 minutes should require medication as a first option, with or without therapy. Treatment consists of patient reassurance, behavior therapy, and/or psychoeducation to explain irregular early ejaculation is a normal variation. We here at Samadhan Health Studio take a detailed interview of the man via which

  • Cognitive Distortions are corrected.
  • Behavior Therapy is advised if needed.
  • Psycho-Sexual Therapeutic Counselling makes a major shift in treatment of people with premature ejaculation as counseling has an important role in the treatment
  • Choice of appropriate medicine if grossly necessary along with, methods not requiring medicines have proven to be effective.
  • There is no role of surgery at all in the management of premature ejaculation.

For a better outcome of the treatment, we suggest to:

  1. Have Realistic Expectations
    Firstly know what PE is by understanding it right. Do not label yourself by listening to your friends and relying on the web search. Read about  precum, masturbation, nightfall, penis size on our blog.
     
  2. Practice Kegel Exercise
    Do pubococcygeus muscle exercise a couple of times a day. To do this imagine you have a strong urge to defecate, but there is no toilet around. In such a situation, you would contract your anal sphincter. Contraction and relaxation of anal sphincter helps to strenghthen the pelvic floor muscles. Do this for about 2 minutes every day.
     
  3. Incorporate Start-and-Stop Technique
    The Stop & Start Method that has been described here trains the human body’s ejaculatory reflex to get DELAYED. Do this when you are alone in your privacy, may be in your bedroom or bathroom and when you are sexually aroused.
    • Imagine you are doing sexual intercourse.
    • Massage your penis as you do while you masturbate. (you may use coconut oil/soap or simply nothing)
    • Recognize the point when you feel that you are about to discharge. This point is called the ‘Point of Ejaculatory Inevitability’.
    • When you are massaging, just before you reach this point of ejaculatory inevitability, stop massaging.
    • Focus on breathing and count up to 10 breaths.
    • Then return to your massaging until again you reach the point of ejaculatory inevitability. You don’t have to allow yourself to discharge.
    • Stop massaging penis for the second time. Now again focus on breathing and count 10 breaths.
    • Return to massaging. After having stopped twice, this time you can let there be discharge.
    • Practice this repeatedly once a day for months.
       
  4. Adopt a Healthy Diet and Exercise Regularly
     
  5. Go for the Second Honeymoon
    Go for an outing to
    • Increase your partner’s sensitivity
    • Heighten her sexual pleasure
    • Make it easier for both to orgasm
    • Feel relaxed as there would be no work pressure but ample time to fulfill sexual desires.

Do so because it is relaxing and reviving for general health. Consider it as a health tonic.

Partner Sex

  1. Masturbate before actual Sexual Intercourse
    Masturbating before sex releases the buildup of excitement and sexual anxiety. After ejaculating once, there is a refractory period. This delays the second erection giving enough time for the foreplay.
  2. Use a Condom
    Using a condom adds a layer between the penis and the vagina thus decreases the sensitivity of the tip of the penis. This helps in preventing premature ejaculation.
  3. Do NOT Hurry to Insert
    The first and foremost thing with a partner is to not hurry to insert the penis in vagina.
    • The time, trust, touch and talk before sex matters!
    • Learn and use non penile methods to have more fun. This takes away a major burden off the mind and acts as an aid to stop premature ejaculation.
    • You can use your finger, tongue, lips to stimulate the erotic parts of your partner.
    • Do not just sexual inter-course, but sexual outer-course too. By sexual outercourse what we mean is the entire skin from head to toe can be caressed for sexual stimulation. Please remember, just putting the penis inside the vagina is not sex. Know the ‘Secrets to Satisfy a Woman

    Most women do not orgasm during penetrative sex.

    • You can even bring her to climax with foreplay alone. Those women who are orgasmic do not necessarily have orgasm on every sexual intercourse. It is possible for women to be sexually satisfied even when they do not have an orgasm. This is unlike men. In men orgasm is required so that they feel complete and done.
  4. Wait for Woman’s Arousal
    Insert only after the woman is highly aroused and all wet down. Do not feel defeated and crestfallen, if you ejaculate quickly the first time. Ejaculating early is not a crime. 
  5. Don’t Uncouple
    Do not remove penis after ejaculation. This is the commonest mistake men make. Do rubbing instead of thrusting. Thereby the vulva rubs against the man’s penis and the woman orgasms. This is because the clitoris has nerve endings sexually sensitive a thousand-folds than those inside the vagina. After-play like foreplay is also of paramount importance.
  6. Increase Frequency of Sexual Intercourse
    Young boys do sex for immensely longer time when they repeat sex second and third time successively after first sex, which is almost always quick. If you ejaculate quickly it means your sexual arousal is high. (This frequently happens during sex before marriage.) Nothing bad about having high libido. Best thing for such people with high sex excitement is after first sex wait. Keep talking or do some masti. After some time repeat sex. Almost always in the 2nd and 3rd successive erection, discharge is delayed. This attitude is appreciated because a man who appears confident is liked more than a man who appears defeated and feels guilty.

If Premature Ejaculation does not Trouble either of you
Do not trouble the trouble.
Or else the trouble will double
And trouble others too.

Medicines

For using any medicine as treatment of premature ejaculation please meet the doctor and get a prescription.Usually with medicines results last only as long as you are using the medicine. Once you stop medicine you will be back to where you were.

  1. Sex Therapists may use Selective Serotonin Reuptake Inhibitors (SSRI) medicines such as Fluoxetine (Prozac®) and Paroxetine (Paxil®).
  2. The only medicine approved by FDA for treatment of premature ejaculation is Dapoxetine.
  3. Alternatively, one can use Tricyclic Antidepressant (TCA) such as Clomipramine.
  4. Local anesthetic cream: Lignocaine or spray.
    [Disclaimer: We at Samadhan Health Studio do not advocate use of anesthetic sprays or creams as it can interfere with sexual sensation.]
  5. Some condoms called ‘extra long’ have local anesthetic in it.

PROGNOSIS

By consulting a sexologist for the treatment of Premature Ejaculation you will be doing The Best Thing For Yourself And Your Lover. If you are scared, you may have a rapid discharge after marriage so it is better to meet a doctor. You are never too old to heal. If you feel immense guilt because you cannot satisfy your partner then whatever be your age it is advisable opt for the therapy. Please, visit a Sex Therapist before PE becomes a major problem in your life causing discord and dissatisfaction in relationship.

REFERENCES

Waldinger, Marcel D. “New Insights in Premature Ejaculation”. Psychiatric Times Vol. 24 No. 9. Psychiatric Times. Retrieved 1 August 2007.

^ Serefoglu, EC; Yaman O, Cayman S, et al. (2011). “Prevalence of the complaint of ejaculating prematurely and the four premature ejaculation syndromes”. J Sex Med (8): 540–8.

http://www.issm.info/education-for-all/featured-education/

http://brown.edu/Student_Services/Health_Services/Health_Education/sexual_health/sexuality/female_orgasm.php