Boston Counseling Therapy

Sex Therapy: Overcoming / Delay Premature Ejaculation; Information, Strategies, Tips, Steps

Portraits

As a teenager, Tim got very little privacy. If he masturbated, to avoid getting caught he would rush through it as quickly as possible. Now as an adult, he finds that for his body rushing through sexual activity is the norm, not the exception.

Brian is nervous about sexual performance. A while ago he had erectile dysfunction (ED). Now, he becomes erect without a problem, but he’s so worried about the ED he can’t seem to keep ejaculation under control.

Definitions and Key Thoughts

Premature ejaculation is the most common sexual problem among men, and is said to affect between 25%-40% of men at any given time. The Mayo Clinic estimates that premature ejaculation effects one out of every three men.[i]

Masters and Johnson defined premature ejaculation as the condition of a man ejaculating before his sex partner achieves orgasm in more than 50% of sexual encounters. However, there is no medical standard for how long it should take a male to ejaculate during sex.

The American Psychiatric Association, in the DSM-IV, lists the diagnostic criteria for Premature Ejaculation as follows:

A. Persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it. The clinician must take into account factors that affect duration of the excitement phase, such as age, novelty of the sexual partner or situation, and recent frequency of sexual activity.

B. The disturbance causes marked distress or interpersonal difficulty.

C. The premature ejaculation is not due exclusively to the direct effects of a substance (e.g., withdrawal from opioids).

Premature ejaculation is sometimes known as “rapid ejaculation.”

Even though premature ejaculation is a common problem and very often treatable, many men are embarrassed to seek treatment for the problem.

Premature ejaculation was once thought to be a purely psychological issue. However, the sexual problem is now considered both psychological and biological.[ii]

Premature ejaculation is classified as either primary or secondary:

Primary premature ejaculation refers to having the sexual problem since one has become sexually active.

Secondary premature ejaculation refers to the onset of the sexual problem after a previous sexual relationship without ejaculation problems.

Causes of Premature Ejaculation

Psychological causes
Some doctors believe that early sexual experiences may lead to premature ejaculation. Such experiences include:

• Situations in which a man may have been hurried to reach climax, such as to avoid being discovered having sex or masturbating.
• Being made to feel guilty about sex could move a male to rush through sexual experiences.
• If a man suffers erectile dysfunction or concerns about sexual performance, anxiety during sexual intercourse could bring a man to have less control over when he ejaculates.

Biological causes
In addition to psychological causes, biological causes can cause premature ejaculation. Biological causes include:

• Abnormal hormone levels
• Abnormal levels of brain chemicals / neurotransmitters
• Abnormal reflex activity of the ejaculatory system
• Specific thyroid problems
• Inflammation or infection of the prostate or urethra
• Genetic factors

Action Steps and Treatment Plan for Premature Ejaculation

For many men, treatment for premature ejaculation includes a combination of medication and sexual therapy.

1. Sexual therapy

Sexual therapy can be an effective tool for overcoming premature ejaculation. Three sexual therapy techniques include:

1) Masturbating within one hour to two hours prior to sexual intercourse may delay ejaculation, during sex.

2) Focusing on foreplay and the experience of sex, instead of sexual intercourse and orgasm, can help one to overcome premature ejaculation.

3) Practicing oral sex, or manual stimulation, on your sex partner will facilitate female orgasm, which will take the pressure off of the man who is worried about ejaculating before his female sexual partner.

2. The squeeze technique

A four-step method known as the “squeeze technique” can help one to delay ejaculation.

Step 1. Begin sexual activity as normal, until the man feels that he is about to ejaculate.

Step 2. Before ejaculation occurs, squeeze the end of the penis at the point where the head (glans) joins the shaft. Hold the squeeze for several seconds—until the urge to ejaculate passes.

Step 3. Once the penis is released, wait 30 seconds before commencing sexual activity. Squeezing the penis may cause it to become less erect. However, when sexual contact is resumed, a full erection will return.

Step 4. Repeat process when approaching ejaculation.

After numerous trials and practice using the squeeze technique, the man with premature ejaculation will learn how to control ejaculation without using the squeeze technique.

4) Control Breathing

Controlling one’s breathing can help delay ejaculation during sex. By consciously slowing one’s rate of breath, and taking longer and deeper breaths, ejaculation can be delayed.

5) Control Anxiety and Stress

Since premature ejaculation often occurs in moments or high anxiety, using techniques that lower anxiety (or decrease stress) will help to control ejaculation.

6) Anesthetic Creams

Some topical anesthetic creams are used to treat premature ejaculation. These creams usually contain either lidocaine or prilocaine, which dull the sensation on the penis.

7) Medications

Certain medications, such as some antidepressants, have a side effect of delayed ejaculation. This makes them useful to persons trying to overcome premature ejaculation.

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