Sex

The Latest on Curing Even Chronic Premature Ejaculation (PE)

Throughout life, PE is men’s #1 sex problem. It’s usually easy to cure.

Posted May 31, 2019

The best-known men’s sex problem is erectile dysfunction (ED). But ED doesn’t affect many men until after age 50. Meanwhile, in every age group, one-quarter to one-third of men complain of PE, making it overall men’s leading sex problem.

In most men, PE is nothing more than a bad habit. Evolution has primed men to ejaculate quickly. Rapid ejaculation means greater chance of pregnancy, which promotes species survival. Consequently, men’s nervous systems have evolved to make the ejaculatory reflex very excitable. 

In addition, many men train themselves into PE by masturbating quickly, often to pornography. PornHub, the world’s largest porn site, says more than half of its largely male audience spends less than five minutes per visit.

Meanwhile, the PE habit often gets cemented by a vicious cycle of stress leading to PE, which leads to greater stress and worse PE. Stress/anxiety/worry releases the hormone cortisol that makes the nervous system even more excitable. That comes in handy when you’re physically threatened and must escape or defend yourself. But stress/anxiety/worry is strongly associated with PE.

Fortunately, the ejaculatory reflex can be controlled—and orgasm/ejaculation postponed—by limiting alcohol and stimulants, and by encouraging whole-body deep relaxation through regular moderate exercise and during lovemaking, deep breathing, a slow pace, and extended massage from head to toe for at least 20 minutes before genital play. 

During the 1960s when William Masters, M.D. and Virginia Johnson invented sex therapy, one of their earliest, biggest successes was their cure for PE. Over the past 60 years, their approach has been refined. Today, in just a few months, at least 90 percent of men can learn dependable ejaculatory control through self-help or professional sex therapy.

Recently, researchers have published several studies that reinforce what my self-help e-booklet says:

“I’m all messed up.” Few men understand the causes of PE or how the sex-therapy approach resolves them. Instead, most believe they have some unfathomable failing that caused the problem. That’s what researchers at Valparaiso University in Indiana found in a survey of 289 PE sufferers. They blamed themselves, but didn’t pinpoint any specific failings. This increased their stress loads—without any idea that stress is a major contributor to PE.

Sex-specific anxiety is the problem, not psychiatric anxiety disorders. Years ago when sex researchers identified stress/anxiety/worry as major PE risk factors, some suggested that involuntary ejaculation signaled clinical anxiety disorders. But many studies have shown that PE sufferers have no disproportionate risk of generalized anxiety problems. Their anxiety is limited to their PE. Belgian researchers recently reconfirmed this in a survey of 610 PE sufferers. They were no more likely than the general population to suffer psychiatric anxiety disorders.

Assuming men understand how to bring women to orgasm, PE bothers few women. Many men believe extended intercourse is what brings women to orgasm. That’s why they want to last longer. Actually, the research consistently shows that only around 25 percent of women are reliably orgasmic during intercourse no matter how long it lasts. The organ that triggers women’s orgasms is not the vagina, but the clitoris, the little bump outside the vagina an inch or two above it beneath the top junction of the vaginal lips. Intercourse doesn’t provide much direct clitoral stimulation, so only a minority of women come consistently from intercourse. The Belgian study just mentioned also showed that when men use their hands, tongues, and/or vibrators to help women to orgasm, few women care how long men last.

Regular moderate exercise helps. Finnish researchers used a survey of male Finns to identify risk factors for PE. The main one was little physical exercise. Exercise is deeply relaxing, which aids ejaculatory control. 

Drugs alone don’t work as well as drugs plus self-help or sex therapy.  The drugs are low-doses of SSRI antidepressants (Prozac, Paxil, Zoloft, etc.). They all share a side effect—delayed ejaculation. Italian researchers recruited 50 men with chronic PE. Half took an SSRI specifically developed to treat PE (dapoxetine, Priligy). The other half used the drug plus the sex-therapy program for learning ejaculatory control. After six months, the sex-therapy group reported significantly better control. That’s no surprise. The drugs don’t teach control. They just impair the nerves that control ejaculation. The sex-therapy approach teaches actual control so men don’t need drugs.

The PE-ED connection. Italian investigators searched the medical literature for research that suggested a link between PE and erection impairment. They found 18 studies involving a total of 57,229 men. The PE sufferers were almost four times more likely than men with good ejaculatory control to report ED. The researchers concluded that PE contributes to ED. But they got things backwards. Actually it’s incipient middle-aged erection problems that cause stress, which contributes to PE. 

While PE is prevalent in men of all ages, it’s most likely in two age groups, young men (teens and twenties) and men over 45. Young men are sexually inexperienced and nervous about partner sex. That anxiety combined with the causes discussed above make young adulthood prime time for PE. As men gain sexual experience, many relax about lovemaking and PE subsides. But in middle age, men start to develop age-related erection changes. Fantasies alone no longer raise erections. They are not as firm as they once were. And minor distractions may cause wilting. Few men are emotionally prepared for these changes, and as their erections turn iffy, they suffer sex-related anxiety—which may trigger PE. Fortunately, the sex-therapy PE cure works no matter what men’s age. And in addition to teaching ejaculatory control, it also helps men maintain erection function—thanks to the deep relaxation, slower pace, and whole-body massage the program promotes.

If you need additional assistance, individualized sex therapy is almost always successful. To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

References

Cormio, L. et al. “The Combination of Dapoxetine and Behavior Treatment Provides Better Results than Dapoxetine Alone in the Management of Patients with Lifelong Premature Ejaculation,” Journal of Sexual Medicine (2015) 12:1609.

Kempeneers, P et al. “Sexual Cognitions, Trait Anxiety, Sexual Anxiety, and Distress in Men with Different Subtypes of Premature Ejaculation and in Their Partners,” Journal of Sex and Marital Therapy (2018) 44:319.

Rowland, D.L et al. “Attribution Patterns in Men Who Ejaculate Before They Desire: An Internet Survey,” Journal of Sex and Marital Therapy (2016) 42:462.

Ventus, D. and P. Jern, “Lifestyle Factors and Premature Ejaculation: Are Physical Exercise, Alcohol Consumption, and Body Mass Index Associated with Premature Ejaculation and Comorbid Erection Problems?” Journal of Sexual Medicine (2016) 13:1482.