COMING TOO QUICKLY
The most common problem men have is coming too quickly. It's difficult to know exactly how many men have this problem, but in surveys around a third of men say it is a problem for them.
How quick is too quick?
There's a difference between being quicker than you might like and having a problem. Men sometimes come to hospital complaining that they last ten minutes after they have put their penis in their partner. Most hospitals wouldn't class that as a problem. The average man lasts a lot less than ten minutes. How long is a matter of debate, most men don't time themselves. But around five minutes or so after entry is probably common.
What also complicates it is that some men like to be quick. It really only counts as a problem if you are quicker than you want to be, if you feel you have no control over when you come. Because doctors have to have some sort of arbitrary way of deciding it is usual to class anyone who regularly lasts less than 2 minutes as having premature ejaculation - but there is not a hard and fast rule.
What causes it?
In most cases premature ejaculation is idiopathic - a word that just means we don't know what causes it. Usually a man who has the problem will have had it since he started having sex.
We don't know why some men have problems controlling their ejaculation. There is probably a constitutional element, some men are just naturally quicker. However we also think that men have to learn to control their ejaculation and that sometimes that learning doesn't happen, maybe because their first sexual experiences were hurried and they wanted to get it over with. Coming quickly got to be a habit. Men who have never masturbated may be particularly prone to premature ejaculation, simply because we think many men probably learn to control their ejaculation in masturbation, so if you don't do it, you find it harder to learn. However in most cases we just don't know, it is one of those things.
Occasionally it is possible to develop premature ejaculation later in life after a man has had good control. In these cases it is important to get checked out. Sometimes prostate problems, usually an infection, can cause the problem. However even in most cases of late onset premature ejaculation there is no obvious cause.
Treatment is usually successful. It is normally possible to slow a man down to a reasonable extent. There are three main ways of treating premature ejaculation, tablets, creams and behavioural treatments.
Many men seeking treatment for premature ejaculation are surprised to be offered antidepressant tablets. It is not that the doctor thinks they are depressed. It is one of the side-effects of antidepressants that they slow down a man's ejaculation, it takes him longer to come. Low doses of antidepressants are sometimes prescribed for premature ejaculation. About half of men benefit from them.
There are some problems. Firstly the tablets tend to have side-effects, although these tend to wear off over a few weeks. They can give you a dry mouth, upset your stomach and cause blurred vision. Depending on the tablet they can make you restless and cause sleep problems or make you excessively sleepy. These problems do tend to wear off and they are tolerable for most people as long as they expect them.
However one problem causes particular difficulty. Antidepressants and driving don't mix very well. Antidepressants slow down reaction times so, unless you leave a big gap to the car in front, you can find yourself sitting on his back seat before you can stop. Some tablets are worse than others, but they can all be a problem. It is difficult to predict who will be affected and how much. It's a problem also with high-speed machinery, chain-saws and bacon slicers don't mix with antidepressants. It's also a bad idea to drink alcohol with the tablets, the effects of the alcohol are magnified hugely.
The talbets are usually prescribed so that you take them for a month or two every day, mainly to speed getting over the side-effects, and then you shift to taking them when you expect to have sex, maybe a couple of hours before, so you do need to plan ahead. The tablets are not a permanent cure, as soon as you stop taking them, you are just as quick as you always were.
One common way of dealing with premature ejaculation is local anaesthetic cream of which the most common is EMLA, which has to be prescribed by a doctor. The cream is rubbed onto the head of the penis (the glans). The cream reduces the sensitivity of the penis, although how it works is complicated. The bigger the area you cover, the bigger the effect. The longer you leave it on the bigger the effect.
Usually men start with a pea-size lump of cream which they rub in and leave on half an hour. If a man puts too much on or leaves it too long his penis will go numb and he will lost his erection, which is not much use. However the effect wears off as soon as the cream wears off so no permanent harm is done. In fact the only real problem is if you turn out to be allergic to the cream in which case you should stop using it.
After twenty minutes or so the man wipes away any excess cream (there shouldn't be much if any left) so he doesn't get any on his partner (they wouldn't take kindly to reduced sensitivity). EMLA has an oil base, which means that it doesn't mix too well with condoms. There is a theoretical risk that it will weaken them and increase the risk of breakage. It is possible to get plastic condoms (such as Avanti in the UK) which don't have this problem. Otherwise wiping off any excess and using a second contraceptive to prevent pregnancy, are important if it matters that a female partner shouldn't get pregnant.
Although cream sounds messy and awkward, and you have to plan sex at least 20 minutes in advance, it is probably a more realistic choice than long-term use of antidepressants.
There are a number of behavioural programmes, basically training programmes a man and his partner can undertake to learn to slow himself down. These are the only treatments whose effects last beyond when you stop using them. It is possible to get a permanent 'cure' in perhaps a third of cases. But, they are a lot of effort. They usually involve a man learning to control his ejaculation in masturbation first and then working with his partner to transfer his control to sex.
These programmes involve hard work over a period of time. Some men do not want to masturbate for personal or religious reasons. Others do not have a sympathetic partner willing to work with them, or do not wish to involve their partner. In these cases behavioural treatments are not suitable.
Simply talking about the problem with a therapist does not make any difference, you need to embark on an active practical programme to make any progress.
Simple things you can try
If you are only occasionally too quick or if you have some control but wish it was better, there are some simple things you can do that may slow you down to a worthwhile extent.
* Try with the woman on top. Reducing muscle tension increases time to ejaculation so this can help
* If you don't use a condom, try using one, this slows some men down
* Take your time. Often men with premature ejaculation try to enter their partner as soon as possible after getting an erection, because they are afraid if they wait they will come. In fact a man's urge to ejaculate tends to pass of a little if foreplay is prolonged
* Many men try to distract themselves by thinking about their car or bank balance or the weather. Not only does this stop sex being any fun but it makes it difficult to learn to control your ejaculation. It would be difficult to learn to drive while trying to memorise a dictionary and it is difficult to learn to control your ejaculation while thinking about your tax return.
TREATMENT AND ADVICE FOR SEXUAL DYSFUNCTION
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