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ejaculation problem: what is PE?
Premature ejaculation is usually an unmistakable experience to a man or his partner, but through the years it has been difficult for professionals to agree on a precise definition of this common sexual concern. As Helen Kaplan, M.D. and other professionals point out, this phenomenon may occur because the man is unable to recognize that he is about to ejaculate. And even when he does recognize he is approaching ejaculation, he feels he is unable to control or delay the process.
Premature ejaculation is the most common male sexual dysfunction. In the United States, premature ejaculation affects about one in five men ages 18 to 59. Although the problem is often assumed to be psychological, biology also may play a role. In some cases, premature ejaculation is a secondary problem related to erectile dysfunction. Men who are anxious about obtaining or maintaining their erection during sexual intercourse may form a pattern of rushing to ejaculate.
Men with PE have a lack of ejaculatory control, which can cause psychological distress among men who suffer from it. Likewise, partners of men with premature ejaculation express dissatisfaction with the timing of ejaculation, and may also experience reduced self-esteem and sexual pleasure. (read more on ejaculation problem)
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Ejaculation is a reflex that, once a certain level of stimulation is reached, is automatic. Controlling the ejaculatory reflex requires that the man be able to recognize and regulate the amount of stimulation he is experiencing so that he does not reach the level that will trigger the ejaculatory reflex before he wants to.
"The penis can be trained without the hassle of starting and stopping or pressing your fingers anywhere," says sex therapist and former sex surrogate Anita Banker-Riskin, coauthor (with her husband, Michael Riskin) of Simultaneous Orgasm & Other Joys of Sexual Intimacy (Hunter House, 1997). "But first you must make the effort to develop your pubococcygeus (PC) muscle, which you’re now sitting on. The PC muscle involuntarily contracts as you ejaculate, causing semen to fly. But if you purposely contract it during the peak of sex, the PC muscle, says Banker-Riskin, acts like the brakes on a car and can bring an ejaculation to a halt. "Like any other muscle, you need to exercise the PC," says Banker-Riskin.
The main cause of premature ejaculation is biological. Upon sexual stimulation and arousal, the normal physical responses for a man and a woman are similar. A man will achieve a climax and then ejaculate about two to three minutes after penetrating the vagina. Women will reach orgasm about 12 to 14 minutes after intercourse occurs. Many women do not achieve orgasm especially if only penetration of the vagina by the penis occurs during sexual activity. Many women achieve orgasm through other methods of sexual stimulation although for some, orgasm is not achieved under any circumstances nor with any type of stimulation. Roughly 10% of women fall into this category. Other causes of premature ejaculation include psychological factors such as marital and relationship issues; performance anxiety (with partners new to each other and especially in the inexperienced partner); fear (associated with concerns regarding getting caught or discovered, sexually transmitted diseases or potential pregnancy ); and guilt (believing the activity is sinful e.g., premarital or extramarital sex).
For many years, sex experts have tended to say that premature ejaculation is caused by early 'conditioning'. In other words, the man's early, rushed (and perhaps furtive) sexual experiences had to be quick - so as to avoid detection! The idea is that all this hectic rush 'conditions' him to climax as quickly as possible.
ejaculation problem
The stop-start method involves the partner stimulating the man's penis, except that when the man instructs, the partner stops stimulating the man's penis before ejaculation becomes inevitable. Then as he feels he regains control, he instructs the partner to begin stimulating his penis again. This procedure is repeated three times before allowing the man to ejaculate on the fourth time. The couple repeats this exercise three times a week, until the man has good control, then they progress to stop-start with lubrication, and then intercourse with the woman on top and the man not moving. He again instructs her to stop moving when he senses he is losing control. The couple progresses over subsequent times to the having the man move, then side by side intercourse. Instead of stopping and starting, the couple may progress to merely slowing down to enable the man to regain control of his urge to ejaculate. The therapists counseling patients using this stop-start technique report a 90 percent success rate in delaying ejaculation.
"The impact premature ejaculation can have on men and their partners can be devastating for a relationship and, currently, there are no truly optimal therapies for premature ejaculation," says Jon L. Pryor, M.D., chairman and program director of the Department of Urologic Surgery at the University of Minnesota and lead investigator of the dapoxetine phase III clinical trials. "The results with dapoxetine are compelling. They demonstrate that, for the first time, a medicine can be taken by men on an on-demand basis and provide significant improvement in their premature ejaculation condition. The unique profile of dapoxetine translated into targeted treatment of premature ejaculation compared to existing therapies. There are meaningful improvements in this study across all primary and secondary endpoints, including a three-to-four fold increase in IELT."
Behavioral therapy is one possible approach for treating premature ejaculation. Most commonly, the "squeeze technique" is used. If a man senses that he is about to experience premature orgasm, he interrupts sexual relations. Then the man or his partner squeezes the shaft of his penis between a thumb and two fingers. The man or his partner applies light pressure just below the head of the penis for about 20 seconds, lets go, and then sexual relations can be resumed. The technique can be repeated as often as necessary. When this technique is successful, it enables the man to learn to delay ejaculation with the squeeze, and eventually, to gain control over ejaculation without the squeeze. Behavioral therapy helps 60% to 90% of men with premature ejaculation. However, it requires the cooperation of both partners. Also, premature ejaculation often returns, and additional behavioral therapy may be needed.
A common side effect of one class of antidepressants is "sexual dysfunction." These Selective Serotonin Reuptake Inhibitors (SSRI) medications such as Prozac, Zoloft, Paxil, Celexa, and others, actually can inhibit the ability to ejaculate. Because of this, they have been used by some clinicians in the treatment of premature ejaculation. Your doctor or therapist can give you more information on this treatment. (read more on ejaculation problem)
ejaculation problem - Tips
Make some noise. Love moans help men (and women) relax, and they often help men last longer.
Start with masturbation with a dry hand. By varying how you caress your penis, you can learn to stay highly aroused for quite a while without coming. When you feel yourself approaching your point of no return, simply back off a bit, stroke yourself more gently or not at all, and stay aroused without ejaculating. Then as you feel yourself getting a little distance from your point of no return, return to more vigorous self-stimulation. Repeat this several times over several sessions. Approach your point of no return, then back off. For most men, it doesn't take long to develop good ejaculatory control while alone.
Some penile skin creams advertise that they help a man last longer. These products contain topical anesthetics that dull sensation in the penis. If you like to play with penile sensation, there's no harm in using them. But they're not a good idea for learning to last longer. They dull sensation. But the key to lasting longer is for the man to become more familiar with what he feels so he can back off from his point of no return while still remaining highly aroused.
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