The cures for sexual difficulties that have been proposed over the years are many and various – and if you have a sexual dysfunction like delayed ejaculation, you’ll probably know only too well how much conflicting advice has been offered to men in this situation.
It’s quite understandable, really, because what people like to promote is the cure that helped them – which of course is often irrelevant to the next man.
So forgive me for a moment if I propose something that seems extraordinary and perhaps even somewhat unlikely to you – but this is done with the best possible intentions, and my motivation is to give you the opportunity to expand your horizons in more ways than just by overcoming your sexual difficulties.
You see, one of the things I know about the human mind is that its capacity for solving problems is endless, and the ways in which it can solve those problems are also pretty much infinite.
It’s for this reason that I decided to move into the territory of the esoteric – in other words, the territory of manifestation using the law of attraction.
Now I think you would probably agree, whether you’ve managed to manifest desired outcomes or not, that much of what you experience in life is the product of how you think and feel about the world around you.
It follows that almost any emotional state of mind, no matter how much we might like to blame others for it, comes from our own preconceptions, our own history, and our own reactions to any situation in which we find ourselves.
The same is true of course, of conditions like delayed ejaculation, which are the product of some kind of emotional complex, albeit one usually out of awareness in the subconscious.
Yet that doesn’t make it any harder (or easier) to use the power of the conscious mind and the power of the unconscious mind to alleviate your difficulty and restore normal sexual functioning.
And at this stage you might well be imagining this means using something like visualization, positive thinking, positive affirmations… self hypnosis, maybe… The list is endless.
And while I agree that all of those are potentially extremely useful tools in the fight against delayed ejaculation, not that I would advise you to regard that particular problem as a struggle or battle, but as a cooperative process of healing between your conscious and unconscious minds, what you may not have considered is the possibility that you could actually use the power of the law of attraction and manifestation to end your delayed ejaculation.
The strange thing is that many of the tools used in the process of manifestation are the same as the tools used in visualization and self hypnosis, which is common ground to start with.
But another aspect of commonality between manifestation and sexuality is the spiritual aspect that can enter into either sex or manifestation when you go beyond and above yourself and your limited consciousness, to join with the esoteric or wider realms of infinite creativity and the subconscious mind.
You need to believe in what you are doing to be able to use these techniques effectively for curing delayed ejaculation. You also need to believe that the unconscious mind is indeed a gateway to some kind of connection with the world beyond ourselves. (If this sounds too esoteric and “far out” for you, then stop reading right now, because you won’t get any further!)
My suggestion to you is to look at some useful resources on manifestation and Law of Attraction, which you can find here – particularly information about the Law of Attraction and appealing to the universe – set out on this website.
Take a look and see if you believe there is any way in which you could adapt or use those techniques for the manifestation of better health in general, and the manifestation of better sexual health in particular.
At its root, all healing is an act of faith – in the sense that you need to believe in the fact that you’re going to get better, and you must not t believe you’re going to remain ill …… For if you do believe you will remain ill, that’s precisely what will happen.
So if you believe that you going to recover the ability to ejaculate in a normal timeframe, then why not try a process which requires the ultimate test of your faith – manifestation?
If you want to offer your partner the best excuse yet for not being able to control yourself when it comes to the bedroom antics, try quoting the latest research from Holland. It might all be in your genes!
Investigators discovered that the men who could be described as premature ejaculators had a particular type of one gene that influences the level of the hormones serotonin in the brain.
They discovered that men with this particular version of the gene ejaculated on average twice as quickly as the men who did not have this genetic configuration.
The researchers worked on the assumption that serotonin levels have a major influence over the speed with which a man reaches orgasm during sexual intercourse, and may therefore be a significant cause of premature ejaculation.
The men in this study had always experienced premature ejaculation for as long as they could remember, in other words they had “primary premature ejaculation”, and from their first sexual experience onwards they had identified themselves as men who came too quickly.
(One of the methodological points that may be open to question is that the length of time for which these men were able to engage in sex before reaching orgasm and ejaculating was determined by their female partners measuring the length of this time with a stopwatch. This is not exactly the most scientific methodology, and it may be the least romantic!)
Assuming that the methodology is in fact adequate, comparing the results from this group of men compared with an equal number of men who had no history of rapid ejaculation reveals that in the men who came too quickly, serotonin somehow was less active or potent in its effect on neuronal transmission in the region of the brain that appears to control ejaculatory reflexes.
Video – Premature Ejaculation
Premature ejaculation – How to control premature ejaculation
Doctor Waldinger claims that the low activity of the hormone serotonin means that nerve impulses do not transfer as quickly and these men as they do in others.
This leads to the conclusion that premature ejaculation is therefore physically-based rather than psychologically based. This is a big assumption, for it makes no reference to the possibility that the mind has an influence over the body as well as the other way round.
Indeed, many men with rapid ejaculation would admit to a high level of anxiety around sex, so research needs to demonstrate that the premature ejaculation is the effect of the serotonin and not the other way round.
Indeed, despite claims that premature ejaculation is in large part physically-based, the evidence actually remains very thin on the ground.
It’s also been claimed that men with premature ejaculation fast reactors in other fields: for example, they have quick reflexes and can respond rapidly to tennis shots or the moves in a computer game.
This is all highly speculative, although it does fit in with the medicalization of premature ejaculation, and the desire of the pharmaceutical companies to produce a compound which will regulate serotonin levels and so delay ejaculation.
Dapoxetine in particular has been fingered as a likely candidate for slowing down men’s reactions in bed: very unfortunate, then, if it also happens to slow down their reactions in the rest of their lives – perhaps not just in a tennis game or in bed but while driving a car?
Certainly the research does not deserve to be dignified with the heading “Premature Ejaculation Gene Found”. It proves nothing of the sort.
PE May Be In The Genes
In a study conducted in Holland, just under 100 men with premature ejaculation were recruited alongside 92 men who had never had premature ejaculation.
The object was to investigate the variables which might contribute to premature ejaculation. The men’s partners were asked, perhaps slightly bizarrely, to time the period between intromission and ejaculation with a stopwatch.
Whether or not this could give a fairly balanced view of the men’s performance as lovers is slightly questionable, but that was the way the researchers established their data.
The results revealed that men who were unable to delay their ejaculation showed lower levels of serotonin than men who did not, a significant finding in view of the fact that serotonin is responsible for the control – or at least exerts significant influence over – the processes of ejaculation, sexual activity, aggression and appetite. A low level of activity of serotonin means that nerve activity will be lower.
Apparently, the study showed that a particular gene (5-HTTLPR for those with a fanatical interest in detail) which is responsible for levels and activity of serotonin in the brain has three forms in the human body, named LL, SL and SS.
The men whose genetic constitution carries the LL version of the gene are primed to ejaculate faster than those who carry the other variants – twice as fast, in fact.
What’s revolutionary about this, of course, is the fact that we have mostly seen lack of control over premature ejaculation as a psychological issue up till now.
This strongly contradicts that idea, and suggest that at least part of the problem is physiological. It remains unclear how significant this finding is in terms of practical application: gene therapy specifically to deal with premature ejaculation would seem to be both unethical and unlikely.
Historically, treatment was to provide extra stimulation to the man’s penis during intercourse in an attempt to break down inhibition while concurrently looking at any unconscious or conscious expression of hostility or conflict in relationships to women.
We do not support a model of treatment for DE that requires prolonged and intense stimulation to the penis, since this is clearly not normal, and may indeed in some way reinforce negative associations with sexual stimulation.
If a man is more comfortable having sex with himself than with a woman, then there is a clear case for the exploration of this psychological issue in psychotherapy.
The process of uncovering and clarifying what it is that is causing a man to fail — even to refuse — to achieve orgasm and release inside a woman is regarded by many therapists as essential to understanding what’s going on.
Most men with delayed ejaculation seem to believe that they are not giving their partner enough, even though they may in reality be putting immense effort into sex. That dysfunctional attitude is a cornerstone of delayed ejaculation and clearly needs to be explored.
So how would treatment proceed these days?
One major goal is to openly encourage a man to express his feelings, to empower him to engage in relationship without fear or anxiety, and to overcome the sense that his “performance” is simply a means to please his partner.
These goals can be achieved by giving new interpretations to beliefs that a man holds around his sexuality and around relationships with women.
It has been called a “reframing” approach, where cognitive shifts can pave the way for a new kind of sexual experience.
Since the beliefs held by many men with delayed ejaculation – also known as retarded ejaculation treatment – tend to be fundamentally similar, it’s actually quite simple to do this by using a self-help program on the Internet.
(A fact which has the advantage of avoiding embarrassment; it seems most men with delayed ejaculation prefer not to see a therapist in person: it seems men with DE find personal consultations more challenging than men with PE, although comparatively few men with that condition seek therapy either).
Alongside the psychological shifts which may be needed, a man with delayed ejaculation needs to learn how to feel and accept sensory stimulation on his body. After all, much of sexual arousal is generated by physical touch and sensory “input” to the body, rather than by mental process such as fantasy.
Certainly, sensory arousal in the body is the main route towards the point of ejaculatory inevitability for the majority of men beyond the age of 40. For men who have erectile dysfunction or erection problems, it is necessary to treat the erectile dysfunction before the delayed ejaculation.
In practical terms, an enjoyable sequence of behavioral training exercises designed to re-establish a man’s awareness of the feelings in his body can be enjoyed by both a man and his partner.
These exercises have a very powerful impact, and can shift psychological inhibitions in a dramatically short space of time — always provided, of course, that the man is motivated to overcome his delayed ejaculation, and is not holding onto the psychological blocks that may or may not have contributed to it in the first place.
All in all, we wish to leave the reader with the impression that delayed ejaculation is a condition which can be treated quite successfully, either with or without the help of a sexual psychotherapist; and there’s certainly no need for pessimism about the prognosis of the condition, or the outcome of treatment, provided, as we said before, that a man is highly motivated to overcome delayed ejaculation, probably in the context of a sexual relationship with his partner.
Definition of premature ejaculation
At the moment, different doctors have different criteria for diagnosing the condition, and the definitions that are available depend to a large extent on subjective measurement or opinion. Also, there is no clear agreement on what is a normal ejaculatory latency (time after penetration but before ejaculation), which has hampered research into this particular sexual dysfunction.
What men and women think of as “normal” ejaculatory latency is different from country to country and – perhaps not surprisingly – between women and men even in the same country. But despite these problems of definition, the Global Study of Sexual Attitudes and Behaviors has enough information for us to conclude that rapid ejaculation affects at least 30% of men across all age groups.
And exactly what causes premature ejaculation? Like erectile dysfunction, PE is becoming more medicalized, which means that doctors are seeing it more as a condition they can cure than a psychosexual issue caused by emotional issues like anxiety. While we don’t know for sure what causes a man to lose control of his ejaculation (or never to develop it in the first place), current thinking is moving away from psychosexual ideas towards neurobiological bases.
Of course, knowing what causes men to lack control of their ejaculation will certainly help produce more effective therapies, but for the moment it has a major effect on men (and their partners) and a significant burden on their psychological well-being.
Up till now, the prevalence of premature ejaculation has been little understood, but recent research has offered a clearer picture and shows there are regional differences in the frequency of premature ejaculation among men.
Of course, a big problem is that the lack of clear diagnostic criteria for normal ejaculation has hampered attempts to measure the frequency of sexual dysfunctions like early ejaculation: values between 25% and 60% are reached, depending on which criteria the researchers used. One thing we do know is that that premature ejaculation is the most common sexual complaint among men.
First one is labelled as delayed ejaculation treatment on YouTube.
Defining normal ejaculatory latency (period between penetration and ejaculation) is difficult
Men and women’s ideas of what is normal is not consistent – the perception of the normal period before ejaculation varies widely – between 7 and 14 minutes, with significant geographical variation.
For example, in Germany, the perceived average latency time is only 7 minutes, but in the US it is over 13 minutes. The perceived average for men in the United Kingdom, France, and Italy is around 9 minutes.
Generally, the time before ejaculation as estimated by women is similar to the time estimated by men, though slightly lower in most cases. The difficulty of agreeing what is the “normal” ejaculatory latency is reflected in the lack of a universally accepted definition of PE. The best definition is probably that of the DSM-IV diagnostic manual: persistent or recurrent ejaculation with minimal stimulation before, on, or shortly after penetration and before the person wishes it.
As you can see, this definition of premature ejaculation encompasses three components:
• a short period before ejaculation
• a lack of voluntary control over ejaculation
• a lack of sexual satisfaction for one or both partners
Obviously these are subjective criteria, which do not provide a rigorous basis for either the definition of PE, or useful research on how to treat it effectively.
In fact, in about 45 studies undertaken between 1963 and 2000, only half contained a quantifiable measure of ejaculatory progress such as number of thrusts, or IELT, while subjectively assessed criteria, such as a man’s perceived lack of control, were reported in less than half.
Of course, most men who seek help know full well they have premature ejaculation, perhaps partly because they are so dissatisfied with their sexual performance, and partly because rapid ejaculation is so widely known to be a problem among men.
The Global Study of Sexual Attitudes and Behaviors (GSSAB) collected data from more than 13,000 men in 29 countries. Overall, approximately one third of all men seem to have difficulty with premature ejaculation.
The prevalence of premature ejaculation varies widely, though: in Latin America it was reported as 28.3%, in the Middle East, 12.4%, and in South East Asia 30.5%. These reports were based on men who said PE was a frequent problem which had persisted for a long time. These men appear to have a chronic sexual dysfunction associated with significantly lowered quality-of-life or sexual fulfillment.
Then again, there are religious and cultural influences which may affect the prevalence of premature ejaculation. What is thought of as premature ejaculation may be different among Protestant and Catholic populations.
Also, rates of premature ejaculation may appear to be higher in places where sex has special cultural significance or where female sexuality is regarded as equal to male sexuality. However, in patriarchal societies where women have a lower social position, premature ejaculation may actually be seen as a sign of virility rather than a problem.
There may be a suspicion that premature ejaculation is linked to other physical conditions – not in a causative way, but because the pain and discomfort of any condition which affects overall health will affect sexual functioning, wither psychologically or physically.
In the latter case, the link may actually be no more than the fear of pain striking during sex. Arthritis and gout are excellent examples of conditions which fall into this category. For health resources on gout, in particular a great diet for gout – click here to learn more.
There is conflicting evidence about the association of race and the reported frequency of premature ejaculation. The National Health and Social Life Survey, which was conducted in 1992, looked at over 1,400 men between the ages of 18 and 59 years.
The results suggested that premature ejaculation among black, Caucasian, and Hispanic men was 34%, 19%, and 27%, respectively.
However, a more recent study suggested the figures were 21%, 16%, and 29% respectively, although this study involved an older population of men aged between forty and eighty years.
Data from the NWLS reveals that the lack of ability to overcome premature ejaculation is not correlated with age. Indeed, the prevalence of PE is basically constant throughout the 18 – 59 age group. Overall, the GSSAB found few firm correlations for the prevalence of PE.
One which did appear was the finding that education level is negatively associated with PE. For instance, in the Middle East and Central and South America, men with no college education appeared to be twice as likely to report they had premature ejaculation as men who had received some college education.
The only other factor of significance clearly associated with premature ejaculation was infrequent sex, which is hardly surprising.
Based very loosely on an article in The Journal Of Sexual Medicine, 2005, Supplement 2: Prevalence of Premature Ejaculation: A Global and Regional Perspective by Francesco Montorsi, MD. Any errors of interpretation are solely the responsibility of this website.
It’s worth concluding with a review of delayed or retarded ejaculation.
This has been described as one of the most challenging male sexual disorders: and it’s certainly true that men who have a problem ejaculating, whether they are alone, or with a partner, will likely feel anxious, frustrated, and possibly consider themselves a failure in the arena of sexual relationships.
(So, if you fall into this category, and you would like some dating advice for men from a master of seduction like Joshua Pellicer, check out these dating tips for men.)
Often, the woman who partners a man like this also feels stressed, partly because she’s deprived of sexual pleasure, but also because she feels she cannot arouse him sufficiently to bring him to climax.
The majority of men who need some kind of treatment or therapy for retarded ejaculation have a normal level of sexual desire, and get apparently normal erections, but they simply cannot reach climax during intercourse.
As you may well imagine, this condition has produced a whole host of theories and a lot of speculation about what might possibly cause it: opinions differ widely on the subject, but in broad terms there are two main explanations.
The first is that the man who is unable to reach his own climax is simply too focused on the pleasure of his partner, probably insufficiently aroused, possibly unaware of his feelings and level of arousal, and basically trying too hard to please his partner.
The second is that the man with delayed ejaculation is basically either demonstrating his psychological “withholding” from the relationship, or is highly resentful and/or angry against women.
Another reason is that this condition has received comparatively little attention is that it’s been regarded as the least frequent male sexual dysfunction, a supposition which is not true, since its occurrence in the population is around 10% of all men.
And it’s also been assumed that treatment for delayed ejaculation is significantly less likely to succeed than it is for other sexual dysfunctions, but this too is a falsehood.
Treatment can be very successful, although it may involve more psychological work than a condition like premature ejaculation.
In a brief review like this we don’t necessarily need to go into the physiology of (delayed) ejaculation: suffice it to say that although ejaculation and orgasm have been regarded as events which occur simultaneously in men, this is untrue — they are separate events and either may occur without the other.
In the case of men who aren’t able to reach the point of ejaculation, it’s clear that there is some inhibition of the normal reflex reaction which provokes ejaculation.
There’s some kind of dissociation between the emission of semen into the base of the urethra prior to ejaculation, and the experience of orgasm.
Delayed ejaculation may be something that a man has had for his entire sexual life, or it can be acquired later in life; equally, it can occur with every sexual encounter, or it can be an intermittent condition that only occurs with certain partners.
Finally, some men with delayed ejaculation can masturbate successfully, whilst others are unable to do so. It certainly true that the most common form of delayed ejaculation is coital anorgasmia.
Every degree of difficulty from complete anorgasmia to a limited ability to reach climax with a partner can be found in this spectrum of dysfunction.
None of the degrees of difficulty that a man may have with his ejaculation responses have noticeably less impact on the relationship than any other: in all cases, achieving orgasm is hard work, and there is little room for intimacy or a satisfying sense of pleasure.
For the woman, the experience of extended intercourse is often uncomfortable or painful, and will probably require additional lubricant to be acceptable.
Partners may miss the shared experience of intimate intercourse, and clearly cannot experience a mutual exchange of pleasure in response to the other partner’s climax.
And the inability of the male partner to “let go” can be seen as symptomatic of his withholding in more general terms in the relationship; a woman who, as most women do, relies on her ability to give sexual pleasure to her partner to maintain her own sexual self-esteem and confidence is likely to feel negated and devalued.
So what’s to be done about this? It’s clear delayed ejaculation is a dramatic contrast to the phenomenon of premature ejaculation, but in some ways it’s much more troubling.
It seems from research that men with delayed ejaculation have difficulty connecting with their own inner world of arousal: although they may have a long-lasting and rigid erection, this in itself does not indicate a high level of sexual arousal.
There may also be some physiological mechanism at work which prevents men from responding to the stimulation applied to their penis, so that they are unable to move through the sexual response cycle, unable to reach the plateau phase or the point of ejaculatory inevitability.
Our own experience in dealing with this condition suggests that there may be two main antecedents: the first is when a man has simply conditioned himself through extremely harsh and vigorous masturbation during puberty, so that he can only respond to physical sexual stimulation of an extremely forceful kind.
This “traumatic masturbatory syndrome” is a comparatively common condition, and it certainly causes a great deal of difficulty for men in future life, as they struggle to reach climax.
It can be seen as a lack of arousal even during adolescent sexuality; but whether that’s so or not, this conditioning process leaves men with a real problem — fortunately, one that can be overcome, by a process of retraining the body to achieve orgasm with lower stimulation thresholds.
The other main cause of delayed ejaculation, in our experience, appears to be related to a man’s psychological orientation: in its simplest form, DE may express a lack of trust, an inability to fully release into his partner’s body, that inability being, perhaps, a metaphor for not being able to open up and trust her fully.
It’s certainly observable that many men with delayed ejaculation have traumatic sexual histories, although it’s not entirely clear why they would develop this condition rather than premature ejaculation.
If we rely on psychological interpretations, we might see PE is a means of quickly “getting out of here” – which can be a different manifestation of a desire not to invest fully in a relationship.
In the case of delayed ejaculation, the psychological mechanism seems to be more about appearing to cooperate, but secretly withholding a sense of self in a private inner psychological world.
Clearly, this delayed ejaculation isn’t going to be amenable to treatment if the man concerned isn’t willing to explore the psychological issues that may be preventing him from investing himself fully in his partner or his relationship with her.
In some cases, men will deny any knowledge of such issues: but, in the hands of a skilful therapist, they’re not hard to tease out, and generally speaking at some level most men are aware of how they really feel towards a partner — it just requires appropriate and skilful questioning by a competent therapist to draw this out, and then to establish the connection between these insights and a man’s lack of responsivity during intercourse.
It’s been said that if a woman stimulates her man vigorously so that he nears the point of orgasm and then rapidly transfers his penis into her vagina, it’s possible for him to ejaculate intravaginally, and that this will somehow break down the inhibitions which currently prevent him from ejaculating inside her, thereby allowing him to establish greater and greater levels of sexual responsivity.
Oddly enough, we think this may be true for some men, but only if they’re psychologically ready to allow the massive shift that needs to happen in their belief systems.
The significance of ejaculating intravaginally should not be underestimated: it signifies many fundamental psychological tenets of human existence on many levels.
Superficially, it’s about the possibility of creating new life. On a deeper level, it’s about possession and ownership.
It’s also about the psychology of giving (here, giving the essence of life and vitality to a woman), and also about rendering oneself completely powerless in the throes of orgasm, subject to a woman’s protectiveness and, for want of a better word love, at the moment when one is most vulnerable and where one’s psychological masks are most likely to be weakened, if not torn off completely.
No wonder that a man who has had traumatic relationships with women may find it difficult to express himself in this most vulnerable of sexual experiences.
The squeeze technique certainly is a development which adds to the success of the stop start technique. It does however depend on the co-operation of both partners.
The squeeze is applied by the man’s partner just below the ridge of his penile glans with the index finger just above the ridge of the glans, and the middle finger just below it. The thumb is near the man’s abdomen.
When the man feels that he is approaching orgasm, he tells his partner who then squeezes his penis as described above until his urge to ejaculate diminishes.
It is also possible for the man to do this himself; having tried it myself I can testify to the fact it certainly does allow you to reduce your level of arousal and even if your erection weakens it soon returns and sex can then continue for much longer.
The treatment, or as some have called it, training, takes a period of weeks but it seems to be effective and certainly allows a man to extend the time for which he is able to enjoy intercourse.
In cases where self help therapy regimes are an option for PE treatment, there are several strategies that need to be used.
The first is to make the man aware of his partner’s need for sexual satisfaction and pleasure before he reaches orgasm; he needs to guide her to climax through oral or manual stimulation if that’s what she desires.
Next, the couple must make a commitment to abstain from sexual intercourse for a certain period of time during which they follow the exercises described below until the man’s ejaculatory control has improved considerably.
The program of exercises described here should be practiced three times a week at least. They begin with manual stimulation.
To start with the woman masturbates her man until he is about to ejaculate.
She then applies the squeeze technique to control his orgasm whenever he senses that he is about to ejaculate (clearly he must be able to recognize this in good time).
The squeeze is applied by the woman – she simultaneously presses the pad of her thumb against the man’s frenulum (which is the fold of skin on the underside of the penis just below the head).
At the same time she puts the pad of her first finger over the coronal rim of the glans on the opposite side of the penis head with the second finger parallel to it on the shaft of the penis.
The pressure comes directly from the pads of her fingers and is maintained for about four seconds.
Pressure applied to the sides of the penis will be ineffective.
When a man feels discomfort, he tells his partner – that is a signal to her about the extent of the pressure that she can apply.
When she applies this pressure, the man’s erection will subside slightly and as it does so his sexual arousal will decrease as well. To be effective the squeeze technique should be applied at least three times in each session of training, just before the man ejaculates.
This means that the man needs to also develop the skill of recognizing when his arousal is high enough that he is on the verge of ejaculation.
And this is a common problem with men who suffer from PE: they do not recognize when they are about to ejaculate, and are constantly surprised by the speed with which it happens.
Self training with masturbation can help a man recognize this point and learn to resist the urge to head straight on to ejaculation.
However, assuming that the woman can stimulate her man to some point of arousal before his ejaculation becomes inevitable (she too can learn the signs that he is about to ejaculate), and then apply the squeeze on top of the penis, this is a powerful treatment for premature ejaculation and ejaculatory control will be achieved.
Once the man’s erection has reduced in firmness and his arousal has decreased, his partner can begin to stimulate him again by hand, repeating this process up to 3 times in a session. On the fourth approach to the point of no return, he or she can continue stimulating him to orgasm and ejaculation.
The woman sits aside her partner facing him, and moves his erect penis around her genital area, over her labia and clitoris, applying the squeeze technique whenever he feels that he is coming near to the point of ejaculation.
Sidebar: muscle control is about having good muscularity and control over all the muscles in your body – and to me this raises an important point. Control of premature ejaculation is not something that happens in isolation.
It’s part of a much bigger aspect of good bodily health, and in fact for that matter, good emotional health as well. What I mean by this is that if you’re fit and healthy, if you don’t carry excess weight, and your body is lean and muscular, it’s likely that you have a high level of fitness, and the muscles of your body will be very much more under your control.
If that’s true, then the pubococcygeal muscle (the pelvic floor) is likely to be strong, and also likely to be something that you can learn to control much more easily. This muscle group controls ejaculation.
If you’re not carrying excess weight, and your body is lean and muscular you’re going to feel confident and project this into your relationships with women – and nothing increases a man’s sexual performance better than confidence! What I’m suggesting is that you take some trouble to to get fit, and to build a better body.
And of course you don’t even have to be a bodybuilding fanatic to do this — there are plenty programs on the market like the Adonis Golden Ratio, a perfect body building program for the average man, which will allow you to get fit and healthy, and therefore confident, and therefore avoid premature ejaculation.
Once both he and she are confident that he’s achieved a degree of control over his ejaculation – which actually means he is experiencing a reduction in the speed with which he becomes aroused – then the technique can be applied during the first stages of intercourse.
The female partner positions herself astride him and guides his penis into her vagina, at which point they rest without moving – this is called a period of vaginal containment (i.e. the man rests his erection inside his partner with no movement).
This containment must go on for quite some time: this is possible because it’s highly likely that a man who lacks control of his ejaculation will not find his erection decreases, but that he remains aroused and hard, even without moving inside his partner.
When either he or she senses that he is coming close to ejaculating just because he is inside her, either he should tell her or she may sense it, and she should immediately lift herself off his penis.
She can then apply the squeeze technique to reduce his arousal. Once again, this procedure should be repeated at least three times before the man ejaculates.
It’s inevitable in training like this are that the man will occasionally ejaculate without control, but the couple can best respond by taking this as nothing more than an accident and laughing it off; this light-heartedness will make subsequent attempts developing control easier.
This is because anxiety, high expectations, or negative criticism will all work against the possibility of relaxing into a state where his ejaculation can be controlled.
What is actually needed is patient perseverance from both members of the couple, the loving support of the woman for the man, and the man’s increasing confidence in his ability to delay orgasm.
Good progress should be made in control after three or more sessions conducted in the manner described above, at which point the woman can begin to move her pelvis gently after her man has penetrated her.
Again, either he can tell her that he is reaching the point of no return, or she can sense it from the changes that she recognizes in his body as he nears the point of ejaculation.
Once again she stops moving, lifts off his penis, and uses the squeeze technique to slow him down, before resuming penetration and gentle movement.
With practice, it’ll be possible for the man to sustain an erection inside his partner without ejaculating for at least 15 minutes.
However, the trouble with this is that he’s not moving – he’s not thrusting. Nonetheless, perseverance, playfulness, and a constructive attitude to the process will enable him to develop the skill of ejaculation control.
Over time, using these techniques diligently, it will be possible for a man to feel confident enough so that he can increase the thrusting movement he enjoys during intercourse.
As he nears ejaculation, the woman does not necessarily need to lift his penis out of her vagina; instead she can apply pressure to the base of the penis using her thumb on the area just above the scrotum on one side and the first two fingers on the opposite side of the penile shaft; she applies pressure on the base of the shaft.
Again his penis should not be squeezed at either side.
In all this work, the woman on top sexual position is used because it provides the man with the least opportunity to thrust – and thrusting definitely speeds up a man’s ejaculation!
The man on top sexual position is a difficult one for men with a tendency to come quickly, because the muscular tension that it generates, and the power and depth of thrusting that is possible, both lead to premature ejaculation.
By using the squeeze technique and Sensate Focus exercises together, a couple can will increase the speed with which the man is able to develop control of his ejaculation through each stage of his sexual response cycle.
In addition, sensate focus exercises are very useful because they help a man to relaxing more into a different way of being sexually – based on sensual touching and leisurely intercourse.
They also enhance the emotional relationship between a man and a woman in relationship.
As we all know, premature ejaculation is actually very common – it’s the most common male sexual dysfunction. It is not fully understood what causes PE, but it’s clear that both physical and psychosocial factors play a role.
Historically, the etiology of PE has been attributed to a variety of psychogenic causes including psychodynamic formulations from Dr James Semans in the 1950s, Dr Masters and Virginia Johnston in the 60s, and Helen Singer Kaplan in the 70s.
They all believed that PE was more or less either learned behaviour or a conditioned response caused by early sexual experiences – sexual experiences that were rushed and associated with anxiety.
It is true that this viewpoint has a compelling commonsense appeal: we all know that sexual experiences in adolescence and early adulthood can be furtive, hurried, and unsatisfactory.
We also know that they can be associated with a great deal of anxiety, since the social pressures on adolescents and young adults to be sexual, and to behave in a particular way, is considerable.
Nonetheless although many of us feel that we know what premature ejaculation is, and maybe even what causes it, there is no hard evidence that specific psychological traits or personality styles are closely linked with rapid ejaculation.
However, we do know that depression and anxiety disorders can appear as sexual dysfunctions of some kind.
The essence of the problem is that it’s difficult to separate cause and effect as far as psychosocial events are concerned: for instance is a man ejaculating quickly because his relationship is in difficulties, or is it more likely that his tendency to ejaculate quickly will be the cause of relationship difficulties?
Another factor that is important in considering both the etiology and the treatment for premature ejaculation is the fact that the man is not in a sexual relationship in isolation.
While he may feel anxiety about sex and lowered self-confidence, together with the interruption of intimacy that premature ejaculation inevitably brings, his partner is most likely to be affected by the impact on her self-esteem.
She may, perhaps, conclude that her partner doesn’t care about her, or that he can’t be bothered to improve his sexual performance for her sake.
She may think then the relationship may not be important to him.
Obviously, therefore, the effect of premature ejaculation on not only the man, but also his partner, and the relationship as a whole, needs to be considered when determining an effective treatment strategy.
Perelman also observes that although there was a large early literature which proposed a wide range of psychological etiologies, significant evidence has accumulated in recent years of organic factors playing a role in the variability of male ejaculatory latency.
But is it surprising that a review of the literature reveals that male ejaculatory latency is distributed along a normal curve similar to many other human characteristics? Hardly.
The organic factors that have been proposed as accounting for this type of curve include central nervous system effects such as hypersensitivity of serotonin receptors, variability in sex hormone levels, variability in sexual “arousability”, a hypersensitive ejaculatory reflex, and even a theory that rapid ejaculation is actually the normal sexual male condition.
This latter suggestion arises from a historical perspective which suggests a male who copulated rapidly would be less at risk from predators than a male who took his time over reproduction.
Perelman observes that sexual therapy, in all its guises, can be effective as a treatment for premature ejaculation, but it does not work in all cases.
But from my experience this is more about the man’s determination to apply the techniques that he’s been given as a remedy for premature ejaculation rather than a reflection on the effectiveness of the techniques themselves.
It’s also important to note that sex therapy is actually an expensive and time-consuming business which may only be available for a certain class of individual.
It is also true, regardless of how many men have access to this therapy of this kind, that there are few scientific studies on effectiveness of rapid ejaculation treatment in the long term.
Discussion about the causes and origins of premature ejaculation (PE for short) have been going on for decades.
First of all, between 1887 and 1917, it was called rapid ejaculation in the medical literature; next, between 1917 and 1950, it was termed ejaculatio praecox.
Typical of this time, Abraham came up with a psychodynamic theory for the origin of premature ejaculation, suggesting that PE was the adult expression of unresolved narcissism during infancy, a narcissism which caused exaggerated importance to be assigned to the penis.
Between 1950 and 1990, the psychological aspects of the condition were emphasized, as was a behavioral approach to treatment, largely because of the pioneering work by Masters and Johnson.
This suggested premature ejaculation might be a “learned behavior”.
In other words, an initial experience of rapid ejaculation when a man first has sex, or is very sexually excited, establishes a pattern of rapid ejaculation as the man’s normal sexual pattern. Then he develops anxiety about this, which doesn’t help matters at all. In fact, it makes him come even faster.
The most recent phase in the explanation of the origins started with 1990s studies which revealed how premature ejaculation could be treated with clomipramine and various other selective serotonin reuptake inhibitors (SSRIs).
How exciting! A drug to cure premature ejaculation…. or not?
This has been taken to mean that there’s a neurological basis for PE which involves a dysfunction of the central serotonergic neurotransmission process.
But, as always with such issues in brain chemistry, what is cause and what is effect remains unproven.
Physical Or Emotional?
It has been claimed that there’s a general move towards the acceptance of premature ejaculation as a condition based on an underlying organic component which is exacerbated by emotional issues like performance anxiety.
I do not accept this, but even if I did, I’d see the issue as thrown immediately into confusion because of the need that some experts feel to distinguish between lifelong (primary) and acquired (secondary) premature ejaculation. These two forms of the condition are supposed to have separate causes.
Psychological causes could include the development of a habit of ejaculating prematurely, caused perhaps by anxiety, although this has not been proved.
Some authors believe that anxiety is more probably a result of premature ejaculation, and not the cause. See www.delayingyourejaculation.com for more information.
Support for a physiological etiology behind premature ejaculation largely comes from the surprising, not to say unlikely, theory that the condition has a genetic component.
Schapiro reported a genetic link in cases of PE in 1943, and more recently, Waldinger et al. demonstrated that around 70% first-degree relatives of men with “non-acquired” life-long premature ejaculation had the condition.
But that proves nothing…. they were probably brought up in the same environment, where sex was, most likely, taboo, shameful, anxiety provoking… or worse.
Waldinger found PE to be associated with anomalies in the central serotonin (5-HT) signaling system, and hypothesized that premature ejaculation represented a single point on a normal distribution of ejaculatory latency through the male population.
This suggests the etiology of premature ejaculation might involve a genetic predisposition.
Of course, there are those who think this might be a spurious theory, instead believing that emotional, cognitive and psychological influences are the primary cause of PE, and that the psychological disturbances associated with PE may be either cause or effect.
Admittedly, a genetic predisposition might underpin other theories about the etiology .
These include the idea of penile hypersensitivity, and the suggestion of a hyperexcitable ejaculatory reflex, as well as central 5-HT receptor sensitivity.
Penile hypersensitivity has been suggested by many authors as an important factor in the organic etiology of PE.
The idea is that men with penile hypersensitivity may reach their ejaculatory threshold more quickly, or even have a lower threshold, when compared with men who have more “normal” ejaculatory latency.
However, this theory cannot account for secondary premature ejaculation, and evidence has been lacking to support the idea in men with lifelong non-acquired PE.
Another theory has been proposed that PE is caused by an inadequate or over-excitable ejaculatory reflex, which causes the emission and/or expulsion phases of ejaculation to occur more quickly.
The bulbocavernosus muscle, which surrounds the urethral bulb, is one of several important muscles associated with the expulsion phase of ejaculation.
A Little Bit Of Science (It’s Not Compulsory!)
Studies on animals have demonstrated that serotonin receptors are essentially involved in the central nervous system control of the ejaculatory sequence.
The 5-HT2c and 5-HT1A receptor subtypes are especially important: stimulation of 5-HT2c receptors in rats slows down ejaculation, while stimulation of 5-HT1A receptors speeds it up.
Waldinger and Olivier’s hypothesis is therefore predicated on the viewpoint that premature ejaculation is the result of hypersensitivity of 5HT1A and/or hyposensitivity of the 5-HT2c receptors.
In other words, premature ejaculation is associated with a threshold I E L T that is genetically predetermined at a lower point, and is determined by the ex tent of imbalance between the 5-HTIA/5-HT2C systems. As yet this remains unproven.
What may be more important is the experience of men who have PE. This suggests that premature ejaculation is probably multifactorial with a combination of physiological and psychological causes.
Supporting evidence behind this theory is circumstantial, but it does seem sensible, and many men’s PE is indeed difficult to treat and does not respond to any current therapies or behavioral treatment strategies.
There are various psychological factors linked to premature ejaculation, including sexual inexperience, lack of sexual intercourse, fear and anxiety, and relationship problems.
This means that a strategy for treatment of this dysfunction must really involve a man’s sexual partner.
Education is sometimes necessary, as is treatment of all comorbidities, which include poor sexual education, urinary tract infections, diabetes, prescription drug regimes, non-prescription drugs, and erectile dysfunction.
However, men in whom erectile dysfunction and premature ejaculation occur together are a separate population from men with premature ejaculation who have a firm erection, and they require different treatments.
Understanding the real frequency of PE among men is difficult. This is not helped by the absence of a clear definition of “normal” and a clear definition of “premature”.
Having said that, we do know that PE is widespread, affecting about one man in three in all age groups, and we know it can have a major effect on the quality of life of a man and his partner.
While the exact origin and cause still has to be defined, it’s likely PE is, at least in part, a neurophysiological issue which is associated with dysfunctional serotonergic neurotransmission in the brain and central nervous system.
This means the best treatment for premature ejaculation might be drugs that act on the brain combined with other treatment strategies which reduce the impact of the psychological causes and consequences.
But in truth, there is very little hard and fast medical evidence about the causes of rapid ejaculation.
This is one of the reasons why it has proved so difficult to treat medically – with drugs or other medical treatments – there is nothing that you can pin down as a cause and say, “Oh, yes, we can deal with this medically.”
And for those who support drug treatments, as we shall see, it is reasoning after the event to identify a particular characteristic of men with PE and then infer that this causes PE.
One example is the suggestion that the pelvic muscles, and in particular the muscles around the erectile bodies in the penis, are hyperactive in men who experience premature ejaculation.
Ejaculation involves increased activity of these muscle groups; ergo, it seems men who come too soon may have hyperactive muscles already aroused and approaching the threshold of ejaculation.
One of the experts at The Male Health Center observes that he has been evaluating and treating men with sexual problems including impotence and premature ejaculation for several years.
He has observed that men with premature ejaculation show increased sensitivity to vibration in the penis, at least when set alongside men who do not have the problem.
He infers that PE may be caused by hypersensitivity of the penis and pelvic muscle hyperspasticity. This idea has not been proved by any research whatsoever as far as I am aware.
Mostly due to difficulties in researching sexual issues, the frequency of premature ejaculation in the male population is not actually know with any degree of certainty.
For one thing, there are different degrees of the condition: it may occur in all situations, with all partners (generalized premature ejaculation), or it may occur only at certain times with certain partners (situational).
It may be present for man’s entire life (lifelong premature ejaculation), or it may be acquired later in life.
Furthermore, anyone who is working in the field of sex therapy will know only too clearly that when a man is stimulating himself during masturbation, he subjectively experiences himself as having a much greater degree of control over ejaculatory latency than when he’s enjoying sexual relationships with a partner.
Could this mean there are interpersonal dynamics at work in the etiology of premature ejaculation? Of course!
However, as far as its frequency in the population is concerned, my own experience dealing with men who have sexual difficulties makes me think the majority of men ejaculate more quickly than they would like and they don’t have much control over their ejaculation
The majority of men means over 50% of the general population.
It’s also worth recording at this point that the female partners of men who regard themselves as having rapid ejaculation report lower levels of sexual satisfaction, and higher levels of interpersonal difficulty, than partners of men who do not see themselves as having premature ejaculation.
Hartmann and his colleagues have reported that men with PE tend to think about ejaculatory control (or lack of it) and tend to experience anxiety during sex, while men who do not have this problem seem to think about sexual arousal and sexual satisfaction.
In an article published in the Journal of Sexual Medicine in 2006, he proposed that the best therapy for premature ejaculation would be a combination of sex therapy and pharmaceuticals.
Etiology of Premature Ejaculation
Just to recap briefly about the mechanism of ejaculation: as you may be aware, ejaculation is the end product of the sexual response cycle which begins with arousal, moves through the so-called plateau phase, and ends with ejaculation and orgasm, followed by resolution or recovery.
Of course, ejaculation is a physical event caused by a reflex in the body, while orgasm is a mental phenomenon which is subjectively experienced as feelings of great pleasure.
Ejaculation itself is composed of two events: emission and expulsion. The emission phase involves the deposition of seminal fluid into the posterior urethra, an event which is experienced as the point of ejaculatory inevitability, commonly known as the point of no return. This terms describes a physiological reality, because once emission has occurred, ejaculation is but seconds away.
Ejaculation is the muscular expulsion of seminal fluid from the penis, a sophisticated series of events involving co-ordinated contraction of a number of muscles around the pelvic area, in particular the bulbospongiosus muscle.
In the run-up to ejaculation a man will experience a number of bodily sensations and changes associated with the peak of arousal, including the movement of the testicles upwards, myotonia, raised blood pressure, rapid heart rate and muscular tension.
These are the signals which can be used to enable a man to recognize that he’s on the verge of ejaculation, and which, if he’s sufficiently motivated, can be used as an indicator that prompts him to change his behaviour and enables him to delay his ejaculation during sexual intercourse.
In essence, what a man with premature ejaculation must do to find a complete remedy for the condition is to reduce the level of his mental and physical arousal so that it remains below the point of no return as he receives sexual stimulation.
The Role of the Nervous System
The central nervous system obviously plays a major role in the ejaculatory reflex, involving both serotonergic and dopaminergic neurons.
The exact neurological pathways that control the ejaculatory reflex are the subject of continuing research; what is known for certain is that the serotonergic system is involved in ejaculation, and there are close associations between the level of serotonin in certain male mammals and the speed with which they ejaculate.
Waldinger and his colleagues have been the most active proponents of the brain chemistry explanation for rapid ejaculation, but it does seem clear that in most cases of the etiology of premature ejaculation is the product of a combination of emotional, psychosocial, and physical factors.
If you regard the point of ejaculation as the product of a number of factors, it is clear that for any individual, there may be considerable differences in the particular combination of factors that leads them to ejaculate quickly.
All that can be said about the causes of premature ejaculation, is that they are a a reflection of both man’s genetic disposition to short ejaculatory latency time, interacting with social, relationship, emotional and psychodynamic issues.
And it has to be said that this is not a particularly helpful explanation of the condition: after all, we all know that Genes + Behavior = Outcome.
In many trials of treatments for PE, it is the intravaginal ejaculatory latency time (IELT) which is used as a kind of diagnostic measure, as well as a measure of the success of any treatment method.
However, many clinicians actually ignore the IELT and use their own subjective impression of whether a man is a premature ejaculator or not. Clearly this is unsatisfactory for scientific research.
A fact that Perelman emphasizes is that while some men naturally last longer than others, it’s a man’s ability to actually identify the signals that his body gives him in advance of his approach to the point of no return that allows him to exercise some kind of control over premature ejaculation by changing his behaviour.
In other words, for a man to voluntarily delay ejaculation, he must choose to respond to the sensations that he receives before he ejaculates in such a way that he delays his orgasm.
Many men report that they try and avoid ejaculation by focusing on distracting thoughts, although as you may already know, this rarely works.