Premature ejaculation is a common sexual dysfunction. In fact, probably every man experiences this at least once in his sexual life, though most would be loathe to admit it. Definitions of this problem have varied greatly over the years and among the sexperts, with an earlier definition being ejaculation before penetration or within 30 seconds of penetration. Obviously, people asked: ‘Well, what about 35 seconds?’ and ‘How can I tell without a stopwatch?’ or quipped ‘Somehow I forget to time it’. Today the definition is ejaculation (and the subsequent return to the flaccid state of the penis) too quickly for the partner to experience pleasure from the episode of intercourse. This is a better definition, but is also not perfect. We suspect that, even without a perfect definition, couples know when they are having a problem in this area. And if they do not know, either because of lack of experience or because their rela-tionship is otherwise so fulfilling in its entirety, then who are we to tell them that they have a problem? Jim and Marilyn had been married for fifteen years.
For the first two years, they experienced wonderful sex and then Marilyn’s father died and her mother moved in with them. Sex became a bit more subdued. Three years later, Jim’s dad died and his mother also moved in; the mothers were alternately good friends and bitter rivals, and this took up a great deal of Jim and Marilyn’s emotional energy. Sex became a quick bit caught when and how they could. It felt almost like being guilty teenagers. Two years ago, the mums announced that they felt just too cramped in this small apartment and were moving together to an independent living facility, and ‘no, it’s no use trying to talk us out of it. We don’t want to hurt your feelings, but we’ve already made all the arrangements.’
Jim and Marilyn felt conflicted; they felt a vague sense of having failed in a duty and a huge relief that they could be on their own now. In fact, perhaps it was not too late to have children.
The first weekend on their own, Jim brought home flowers and a special bottle of wine and Marilyn cooked their favourite meal. They took a long leisurely bath together and arrived in bed with a good head of steam going. And then, spurt, flop. Later in the week, a more spontaneous performance ended in the same anticlimax. Instead of building a wall of silence, Jim and Marilyn got up out of bed and cuddled on the couch and discussed what to do about ‘our problem’. Their answer was to buy a vibrator. Any time intercourse was truncated by Jim’s coming too soon, he brought Marilyn to orgasm with the vibrator. This worked very well for them and within six months they rarely had to use the vibrator because Jim had become accustomed to again having the luxury of time.
The physiological basis to premature ejaculation is an inability for a man to voluntarily delay his sexual responses. Most men can delay orgasm— ‘hold back’— for some time while thrusting before ejaculation becomes inevitable. The man who has a problem with premature ejaculation cannot do this. All sorts of psychological theories, Freudian and otherwise, have been proposed to explain this. Indeed, whole books and reputations have risen and fallen on this subject! The most sensible expla¬nation is that the man’s previous sexual experiences have been frequently hasty and furtive (remember the back seat of the car at the drive-in?) and may have been associated with guilt or a fear of discovery; his responses have there¬fore been programmed to fit these circumstances. Most men will have occasional episodes of coming too quickly, usually associated with environmental factors of some sort. Certainly premature ejaculation is often a problem at the beginning of a relationship, associated with the high levels of excitement with a new partner.
Jenny and Don were happily married with two small children who used up much of their energy. They would fall into bed at night, exhausted, with little energy for sex. Even so, they managed to have one or two ‘quickies’ each week—usually in the early morning hours, keeping one ear cocked for sounds from the children’s room.
One fine weekend, Don’s sister took the kids for Saturday night. Don and Jenny were so looking
forward to this long lazy Sunday morning in bed— just them and croissant crumbs! And all was perfect, right up to the denouement, when Don just could not hold back.
So what is the difference between a quickie and pre¬mature ejaculation? Most relationships combine quickies with more leisurely sex and a quickie is a mutually agreed need to have sex, but to be quick about it. This can be because of children or in-laws or schedule demands, or any of a thousand other reasons, including the fact that it’s fun in itself, but it is quick sex with no expectation of anything else. Premature ejaculation is quick sex because of an inability to prolong it. In both cases, the woman can be brought to orgasm by other means if she is not satisfied.
How can the problem be fixed? Early approaches centred on a man training himself to think about some¬thing else during sex. Can you imagine trying to keep your mind on cricket scores or mathematical equations or listing the monarchs of England in sequence while you are in the midst of intercourse? Anyway, that was the advice. But, just as we might have predicted, it actually worsened things by making the man nervous and guilt-ridden by his failure to perform these mental acrobatics. It was also sug-gested that he use distractions such as biting his lip or pinching himself—this was equally ill-fated.
There are a few products around designed to be applied to or smeared on the upstanding member in order to prevent premature ejaculation. The common ingredient of all of these is a local anaesthetic intended to diminish sensation in the skin. Our colleague Dr Cohen assures us that he has had success in prescribing this treatment, with the gel being smeared on thinly as soon as Oscar begins to strut his stuff. A word of warning: the emphasis is on thinly. Sex under anaesthesia? Seems to us it could be a case of throwing the baby out with the bathwater, particularly if some gets smeared on the female partner as well…
The only methods that are really helpful enlist both partners to be part of the solution. Masters and Johnson, in their book The Pleasure Bond, emphasise the need for intimacy in a sexual relationship—which means time to talk, holding each other, pleasuring each other in ways that are sensual without necessarily being sexual, and not making sexuality a goal-oriented exercise, with mutual penetrative orgasm as the goal. This is not only wise, it is eminently practical advice. More time should be spent in foreplay and mutual exploration. Initially, a pact may be made not to attempt penetration at all, but rather to bring each other to orgasm by manual or oral stimulation or the use of sex toys like vibrators or dildos. If this attempt to alleviate performance anxiety and increase intimacy is not adequate, the couple should seek the help of a creden¬tialled sex therapist.
Such a therapist will start by taking a full history and will want to eliminate any medical problems causing pre¬mature ejaculation. If he or she is not a physician, the couple will be referred to their doctor for this purpose. Depression is one condition that can make a man quick to trigger. In this case, the use of antidepressants for a few months may help. (It’s also worth noting that some of the more recently introduced antidepressants have proved helpful for men with premature ejaculation, even when depression didn’t seem to be a problem. But these should only be used after consultation with your family doctor and/or a sex counsellor.)
Next, the program of increasing intimacy and commu-nication that we’ve mentioned begins. Once the couple are very comfortable with each other’s bodies and in commu-nicating with each other about their needs, the therapist will begin teaching them a squeeze technique, illustrated in Figure 15.1. This involves the couple sitting facing each other. The woman stimulates the man’s penis with her hand and, as his penis visibly engorges and rises, she squeezes him firmly just below the glans—her thumb on the under¬side, two fingers on the top—maintaining pressure for about five seconds. This doesn’t hurt and the pressure can be quite firm. The urge to ejaculate is lost and then, after a few seconds, the couple repeat the process, continuing several times before ejaculation is permitted. This tech¬nique is practised repeatedly over several weeks before any vaginal penetration is attempted and, initially, vaginal pen¬etration is done without any thrusting. Finally, the couple move on to full intercourse. During all of this, the man may stimulate the woman’s clitoris or vagina. This tech¬nique ‘unlearns’ premature ejaculation and has a good success rate.
Peggy is a divorced maths teacher. Andy is the physical education teacher in her school and he is a real hunk. Peggy’s been flirting with Andy for some weeks and he seems to like her, so why hasn’t he asked her out? Eventually, she bit the bullet and just asked him along to a Rugby match. How could he say no? They had a few more dates and finally she got him to come in for ‘coffee’ after a night out. Everything was great until they hit the sack—when Andy proved to be a sprinter: quick to the finish line. Peggy was very disappointed, as Andy could see. Fortunately, Peggy was also very sensible and analytic, and she valued this burgeoning relationship, so she suggested they see a sex counsel¬lor. Andy was initially taken aback since this was not yet a long-term, committed liaison, but then he thought: ‘Hey, what’s there to lose?’ He’d had this problem ever since his first girlfriend, Madge. Madge was deeply religious and would pray for forgiveness and urge him to hurry every time they had sex. He had really fancied Madge, but was driven off by this.
Peggy and Andy went to see a sex therapist who was quite untroubled by the fact that they had just
begun a relationship. They embarked on the course of treatment described above and found greatly increasing satisfaction, not just in the bedroom but in being together in other ways. At the time of writing, they are still together.
