Premature ejaculation is one of the most common sexual problems amongst men. In this article, our resident sexologist Louise Paitel sheds light upon this phenomenon with her expertise and classic, well-meaning approach. No doubt she’ll shake up everything you think you know about premature ejaculation, whilst also offering advice for those affected.
Premature, early or rapid ejaculation is one of the most common sexual issues amongst men, as almost one in every three experience it at some point in their lives (Porst et al., 2007). Moreover, it’s the most common sexual problem for men under 30 (Wisard & Audette, 2008).
It’s identified by ejaculation taking place too quickly, generally before or just after penetration into a partner’s orifice. The impact of this issue goes further than a simple physiological problem, it also brings about psychological suffering and alters one’s self perception, as well as their relational dynamic. Fortunately, there exists a number of solutions proven to regulate arousal and prolong intimate activities.
What Is Premature Ejaculation?
According to The Italian Society of Andrology and Sexual Medicine (2020), premature ejaculation is classified through three criteria: ejaculation that takes places less than three minutes after stimulation begins, even within thirty seconds in more severe cases; the inability to control the ejaculatory reflex; and a significant amount of stress experienced by the sufferer and/or their partner. It happens repeatedly (during around 75% of sexual relations), and spans over a minimum of six months (DSM-V, APA, 2015).
This can manifest itself in a primary form (during one’s first sexual experiences) or secondary (after a functioning sex life). It can be caused just as much by psychological factors (stress, anxiety, conflict within a relationship…) as it can by physiological factors, including erectile dysfunction, hyperthyroidism or chronic inflammatory issues such as prostatitis (Carson & Gunn, 2006). In the latter cases, it’s important to consult your GP or a urologist for more information.
Why is it so difficult to control ejaculation?
Ejaculation is an automatic neuromuscular reflex that is triggered when one reaches a certain level of arousal. Once the ‘point of no return’ is reached, ejaculatory discharge becomes inevitable. Thus, men shouldn’t try to learn to control ejaculation (as this isn’t possible!), but they should instead learn to regulate their level of arousal before hitting this critical point.
Performance anxiety
Many men who suffer from premature ejaculation get stuck in a vicious cycle, as the fear of not being able to ‘hold on’ creates anxiety, thus causing stress and muscular hypertension, meaning they end up ejaculating more quickly. This reinforces the idea that the man is incapable of ‘holding on’, therefore creating this repetitive cycle in which he feels powerless, thus affecting self confidence and relational harmony.
"Rapid ejaculation isn’t a curse but rather something that stems from learning to masturbate very quickly, often during adolescence. It’s more than possible to rectify this learned behaviour in adulthood by practicing different techniques." - Louise PAITEL, clinical psychologist, certified sexologist, and researcher at the University Côte d'Azur, Nice -
What can be done:
1. Techniques to slow things down: try the stop-and-start or the squeeze method
Introduced by Helen Kaplan (1974), the stop-and-start technique involves a voluntary suspension of sexual stimulation from the moment the first signs of ejaculation begin to show. Once arousal levels decrease, stimulation can be reintroduced. By repeating this exercise either alone or with a partner, the affected will learn to better gauge their arousal levels and thus delay ejaculation.
The squeeze technique consists of pressing your thumb into the frenulum, and at the same time pinching the head (just above the crown of the penis) using the index and the middle fingers. You can also squeeze the base of the penis with your other hand. These gestures should be performed at the same time, at a moment in which arousal becomes too intense (Masters & Johnson, 1970). Designed to interrupt the ejaculatory reflex, this method is uncomfortable and ineffective in the long term (Serefoglu et al., 2013). It can, however, be useful during the first stage of sexual rehabilitation.
2. Mindful breathing and the pelvic curl
Inspired by the works of Jean-Yves Desjardins (Monzée & Tremblay, 2009), the pelvic curl technique mixes abdominal breathing with pelvic movements in a sort of synchronised dance. By inhaling when pulling out, and exhaling extensively when penetrating, men can learn to channel their sexual energy whilst remaining relaxed. Arousal is therefore easier to control. This method requires a bit of practice, but once mastered it’ll become a natural part of your sexual practice.
Anteversion
Hollowed back
Shoulders and buttocks behind
Head straight
Breathe out abdominally
Retroversion
Rounded back
Shoulders and buttocks forward
Let the head go
Breathe in abdominally
3. Kegel exercises
Although well-known in the field of postpartum rehabilitation, Kegel exercises are actually great for men too. They strengthen pelvic muscles, specifically the bulbospongiosus muscle, one which is involved in erection and ejaculation. In men, pelvic floor muscles are situated between the testicles and the anus, a zone that can be localised by momentarily stopping urine flow (there’s no need to use force). They differ from the anal, thigh or abdominal muscles that are relaxed in these moments
Kegel exercises are simple and discreet: contract the pelvic muscles whilst breathing in deeply for five seconds, then exhale for ten seconds. Repeat this exercise 10 to 20 times per day (the more you do it, the easier it’ll get). A study by Pastore et al. (2014) shows that exercising these muscles regularly for three months provides a clear improvement in your level of ejaculatory control. This muscular reinforcement will also keep your erection strong!
4. Mindful masturbation
If you masturbate without having an orgasm as your end goal, you’ll be able to get a better understanding of how your arousal levels fluctuate. By voluntarily slowing things down, you can familiarise yourself with sensations, learn to detect the point of no return and develop a better understanding of your bodily reactions.
It can easily be put into practice by mentally calculating your arousal on a scale from 1 to 9 (9 being the point of no return and 10 being ejaculation). By doing this, you can keep an eye on the moment in which you cross over level 7 or 8, give yourself a minute to calm down, and learn to play with this limit to postpone ejaculation. Lay down on your back with your hand set in place (meaning your body that does the moving, not the other way round), you can even practice the pelvic curl at the same time. It could also be the occasion to try out the stop and start and/or the squeeze.
Once you’ve figured this step out, you could try using different types of sex toys before jumping straight into sex with a partner. Try things such as male masturbators so that you become used to more intense sensations that more closely reflect those produced by natural stimuli. This type of practice has already proved effective when used alongside other techniques previously detailed (Rodríguez et al., 2021).
5. Choose the right position
Deconstructing sexual scripts (meaning the way in which sexual activities take place) (Simon & Gagnon, 1986) is essential. Decentring yourself from typical objectives such as speed, performance and duration will allow you to better understand your arousal. Varying the rhythm (slow pelvic movements are great), taking breaks, exploring non penetrative practices and adopting positions in which the man is more passive (like the cowgirl) favour relaxation and control. Little by little, the man can tame and regulate his arousal, by beginning with positions in which the muscles are relaxed, then slowly starting to take initiative, working towards more active, varied positions.
6. Be less demanding and nourish connections between you and your partner
Fixed ways of thinking (“I need to perform well”, “I need to be in control at all times”) increase anxiety and negatively affect one's capacity to regulate ejaculation. Cognitive behavioural therapy offers a number of tools to help you recognise, question and transform these dysfunctional beliefs (Reid et al., 2012). This will allow you to have a more open mind in which pleasure and connection take precedence over performance.
Being able to effectively communicate with your partner is another determining factor. Having sincere dialogues, accepting possible difficulties and cooperating all help to improve these sorts of problems. As McCarthy and Farr (2012) state, it’s not the length of the act that counts, but the amount of attention, care and the quality of the emotional connection that matters.
7. Sensory anchoring and guided attention
By voluntarily focusing your attention on your breathing, non-genital sensations (strokes down your back, contact with your partner, feeling their skin etc., ), as well as employing more positive thinking, you’ll find more peace within yourself. This is a great way of thinking about something else all whilst remaining present and not avoiding the issue. It’s also important to familiarise yourself with external stimuli that you find arousing, so as to better deal with your feelings.
When it comes to mindfulness (paying attention to a specific object with a kind, accepting and open intention and attitude (Shapiro et al., 2006)), one interesting practice to try with your partner is the Sensate Focus (Masters & Johnson, 1970). The first few steps to this method will allow you to rediscover the pleasure of sensual touches without direct genital contact or orgasm as the end goal. This way, the man can learn to play around with arousal and the point of no return without feeling pressured on time or performance.
What if none of these techniques work?
If despite trying various techniques to prolong sex you still don’t notice any significant changes, we recommend you consult your GP or a urologist. They could help you to identify the potential causes of your ejaculation problems (or issues relating to maintaining a satisfying erection, as these two problems can be related), and recommend appropriate forms of therapy or treatment to help improve your sex life.
Amongst the numerous pharmacological possibilities you’ll find:
1. Local anaesthetics (Fortacin®, EMLA®)
Lidocaine-based products can temporarily reduce sensitivity in the head of the penis. Used wisely, it will extend pre-ejaculation time without significantly affecting pleasure. Fortacin® is a spray specifically designed for this type of issue and has shown to be quite effective, multiplying pre-ejaculation time by six (Carson et al., 2017). Similarly, EMLA® cream is a good option, and can, in certain places around the UK, be acquired on the NHS. Otherwise it’s sold over the counter in pharmacies.
2. Dapoxetine (Priligy®)
Dapoxetine is a fast-acting selective serotonin reuptake inhibitor (SSRI). When taken between 1 and 2 hours before sexual activity, it can help you last up to three times longer (McMahon et al., 2010). This treatment is available on prescription but a medical consultation is required before use.
Conclusion
It’s not as easy as saying you want to delay ejaculation for it to happen. It’s a process involving intentional muscular rehabilitation and a transformation of one's relationship with their sexuality. By combining these cognitive, behavioural and physical strategies, as well as targeted medical support if needed, it’s possible to regulate arousal and rediscover sexual satisfaction. Of course, this is all done within the confines of mutual attention, respect and understanding.
This article was written by Louise Paitel, a clinical psychologist/qualified sex therapist and researcher at the Université Côte d'Azur in Nice. Louise brings her scientific expertise and kind, open-minded approach to sexuality to the LOVE AND VIBES Team.
Thomas’ recommendations
Use a desensitising product
The Yokaine delay spray will be your ultimate discreet yet effective ally! It’s specially designed to help delay ejaculation whilst ensuring you still get maximum pleasure. A couple of spritzes is enough to slightly reduce sensations in the penis, giving you more control over your body, for longer, more satisfying encounters.
For masturbation
The LOVE Team recommends an automatic masturbator, or one of our ass or torso masturbators if realism is your number one priority! You can even practice by using a cock ring to help you control your feelings.
Using a Fleshlight regularly can also contribute to better endurance, giving you the possibility to prolong these intimate moments and increase the duration of passionate exchanges. You could even use it during foreplay with your partner.
The cock ring or the penis sleeve
Wearing a cock ring or a penis sleeve during sex can help maintain your erection and prolong pleasure. These male sex toys are generally worn around the base of the penis and work by limiting blood flow. They can help some men better control ejaculation by lightly reducing penis sensitivity. Thanks to these handy gadgets, you’ll have a bigger, more powerful erection than ever!
References
- Althof, S. E. (2010). Treatment of premature ejaculation: Psychosexual and pharmacological approaches. Journal of Sexual Medicine, 7(1 Pt 1), 305–312.
- American Psychiatric Association. (2015). DSM-V : Manuel diagnostique et statistique des troubles mentaux (5e éd.). Elsevier Masson.
- Carson, C., & Gunn, K. (2006). Premature ejaculation: Definition and prevalence. International Journal of Impotence Research, 18(Suppl 1), S5–S13.
- Carson, C., Kirby, M., Wyllie, M., & Ellis, P. (2017). Efficacy and tolerability of PSD502 (Fortacin®) for the treatment of premature ejaculation. BJU International, 119(3), 519–527.
- Kaplan, H. S. (1974). The new sex therapy: Active treatment of sexual dysfunctions. Brunner/Mazel.
- Masters, W. H., & Johnson, V. E. (1970). Human sexual inadequacy. Little, Brown and Company.
- McCarthy, B., & Farr, E. (2012). The impact of sexual dysfunction on sexual satisfaction and sexual self-esteem in heterosexual men and women. Journal of Couple & Relationship Therapy, 11(1), 38–52.
- McMahon, C. G., Giuliano, F., Dean, J., Hellstrom, W. J. G., Montorsi, F., & Rosen, R. C. (2010). Efficacy of dapoxetine in the treatment of premature ejaculation: Integrated analysis of results from five phase 3 trials. Journal of Sexual Medicine, 7(4 Pt 1), 1211–1221.
- Monzée, J., & Tremblay, M. (2009). Bases neurophysiologiques du mouvement de la double-bascule. Santé Sexuelle, 6.
- Pastore, A. L., Palleschi, G., Leto, A., Silvestri, L., Capece, M., & Carbone, A. (2014). A prospective randomized study to compare pelvic floor muscle rehabilitation to pharmacological treatment in men with lifelong premature ejaculation. International Journal of Andrology, 37(6), 527–533.
- Porst, H., Montorsi, F., Rosen, R. C., Gaynor, L., & Reyes-Vallejo, L. (2007). The premature ejaculation prevalence and attitudes (PEPA) survey: Prevalence, comorbidities, and professional help-seeking. Journal of Sexual Medicine, 4(6), 1526–1534.
- Reid, R. C., Garos, S., & Carpenter, B. N. (2012). Reliability, validity, and psychometric development of the Hypersexual Behavior Inventory. Journal of Sex & Marital Therapy, 38(2), 69–86.
- Rodríguez, J. E., Picazo, J. A., Marzo, J. C., Piqueras, J. A., Reina, L., Hidalgo, G., & Tornero, G. (2021). Efficacy of sphincter control training and medical device in the treatment of premature ejaculation: A multicenter randomized controlled clinical trial. PLoS One, 16(9), e0257284
- Sansone, A., Aversa, A., Corona, G. et al. (2021). Management of premature ejaculation: a clinical guideline from the Italian Society of Andrology and Sexual Medicine (SIAMS). Journal of Endocrinological Investigation, 44, 1103–1118.
- Serefoglu EC, et al. (2013). Premature ejaculation: do we have effective therapy? Translational Andrology and Urology, 2(1), 45–53
- Shapiro, S. L., Carlson, L. E., Astin, J. A., & Freedman, B. (2006). Mechanisms of mindfulness. Journal of Clinical Psychology, 62(3), 373‑386. https://doi.org/10.1002/jclp.20237
- Simon, W., & Gagnon, J. H. (1986). Sexual scripts: Permanence and change. Society, 23(4), 95–100.
- Wisard, M., & Audette, N. (2008). Éjaculation précoce : traitement médicamenteux ou approche sexologique ? Revue Médicale, 4(150).