The DSMIV describes premature ejaculation as persistent or recurrent ejaculation within minutes. Statistics list 4 to 39% of men have premature ejaculation. Treatment is usually with SSRI’s and Sildenafil (Viagra™). The disorder may be lifelong or acquired, global or situational, with different treatments. It can be biogenic, psychogenic, or mixed. The discussion included the criteria for clinical trials. Objective assessment is made by a number of thrusts and intra-vaginal latency time, but there is no information regarding a normal range of a number of thrusts, and the average intercourse lasts 4-7 minutes according to current literature. The classic definition of rapid ejaculation is if the man ejaculates within 1 minute of penetration. It is theorized that the central regulation is by dopamine and penile hypersensitivity, so treatment may be with Sildenafil and local anesthetic. If you have premature ejaculation there is a 91 % chance that a first-degree relative (father, brother, son) will also have it. SSRI’s which are used for depression are the first-line treatment as well. They may be used before intercourse or taken every night. This treatment works better for people whose rapid ejaculation is acquired. Since Sildenafil is more effective than SSRI’s, a combination of an anti-depressant, local anesthetic and Sildenafil is effective in 97% of the time. The anti-depressant with sildenafil is significantly better than the SSRI alone. Although this is currently the preferred therapy, medical insurance typically covers 30 pills for SSRI’s and only 4 sildenafil tablets per month. If that doesn’t work a local anesthetic like Emla cream (with a condom to protect the partner) should be added to the regimen. If that still is not effective the patient makes you intracavernosal injection. Fast-acting SSRI’s specifically for rapid ejaculation is currently in development.
Delayed ejaculation carries with it issues of inability to achieve orgasm and infertility. Anti-depressants or agents which act centrally such as Valium, anti-hypertensives, and alcohol abuse all can affect this. First, it is important to evaluate if this is a psychological problem, but a physical assessment must be made as well. A common cause is a pudendal neuropathy, caused by a crush to the perineum such as from bike riding with a narrow saddle. If the delayed ejaculation is situational is probably psychologic; if it is generalized the problem is probably biological. Buproprion may be used but it is not all that effective. The patient must be checked to see if there are reversible causes before being given medication. There is research still needed in this area.
Tips on how to control ejaculation
Here are some more tips on how to control ejaculation.
Pause at the right moment
The best method to control premature ejaculation is the use of the "stop-start" technique. Its purpose is to get closer to the peak of excitement as possible, but do not cross the line that separates the arousal from the thrill of ejaculation.
One should stop sexual stimulation shortly before the critical moment. Stop for 10-20 seconds and this pause will be enough to postpone the climax. Then you can go on moving.
Reduce stress
The reduction of stress is another tip. Muscle tension is one of the reasons that accelerate the moment of ejaculation. It is most difficult to control the growth of arousal when the man is on top of the "classic position". However, if during the next closeness, the position "woman on top" is selected, the man can relax as much as possible, preventing early ejaculation. It is also possible to control the movements of the partner, slowing or stopping the movement.
Ejaculation from hyper-arousal
Learn to control the ejaculation. The partner stimulates the penis partner with a hand before you reach ejaculation then the base of the penis is squeezed for 3-4 seconds. As a result, the arousal is reduced. Then the stimulation is repeated again and lasts for 15-20 minutes.
Deep regular breath prolong your sexual pleasure
There are special techniques that slow or stop premature ejaculation and deep breathing is one of them. Deep breathing is able to stop early ejaculation. Shallow breathing or short breathing do not affect the duration of sexual contact as these factors speed up the heartbeat and entail PE. The deep breath continues for about 5 seconds. Try to keep up the rhyme: hold the breath for 3 seconds and concentrate on the breath as you inhale and exhale within equal timeframes.
Use condoms
Try to use a condom or 2-3 at a time, to minimize the sensitivity of your penis. Special products are able to prolong your sexual activity. Use condoms with benzocaine that increase your sexual activity and sexual contact become at least 5 minutes longer. Benzocaine produces a little numbing effect therefore the numbing sensations decrease.
Medications developed to treat premature ejaculation
There are special medications that were developed to treat premature ejaculation. Some of them were even approved by the FDA such as Promescent. It is applied topically 10 minutes before sex. The medication penetrates through the skin and makes the nerve ending less sensitive though you can still feel what is happening, giving you great sensations without risk to achieve ejaculation earlier than needed. Sometimes selective serotonin reuptake inhibitors can be prescribed for the treatment of erectile dysfunction. Prozac, Zoloft can be helpful during treatment. These medicines inhibit arousal so they should be used only if you are sure that such products can be helpful for control. The only specialist is able to diagnose your condition correctly and then choose the right treatment. There is no universal solution and the approach is always individual.
There are other recommendations that prolong sexual intercourse:
- It is recommended to be mentally distracted during intercourse. But one should not think about anything unpleasant. Choose a neutral topic, such as sport, for instance. Think about your favorite sports team.
- Masturbation before intercourse can help you to prolong the sex.
- Kegel exercises help to control the process of ejaculation.