Dr Pauline Williams Green on Premature Ejaculation

Problems of ejaculation are common occurrences in the sexual life of men. This week we will discuss premature ejaculation. It occurs when a man ejaculates shortly after intercourse begins.
At least a third of men surveyed in the United States in a 1999 report at least one incidence of premature ejaculation in the previous year. It may well be the most common male sexual problem. It occurs in men who are sexually inexperienced and also among those in sexual partnerships for many years.

Orgasm and ejaculation
Ejaculation is distinct from orgasm in men. While ejaculation describes the release of semen, orgasm is the subjective, pleasurable sensations which occur before ejaculation.
Before a boy reaches puberty, he can experience orgasm but does not ejaculate because the male organs are still immature. After several ejaculations, young men can experience orgasms without ejaculations during intercourse.
So, premature ejaculation becomes a non-issue for men who are concerned only with their own orgasms. In fact, in some cultures, it is considered very masculine to ejaculate very quickly.

Why does premature ejaculation occur?
Men are capable of orgasm within two minutes of initial stimulation while women usually require about eight minutes. It is, therefore, 'normal' for young, inexperienced men to ejaculate before their partners have reached orgasm. To achieve mutual satisfaction, men have to be able to time their ejaculation. Overanxiety will cause premature ejaculation in any relationship. Afterwards, the penis goes down and will not respond immediately to stimulation during the normal refractory period.
Premature ejaculation becomes a problem only when there is the persistent and recurrent absence of reasonable voluntary control of ejaculation. It is generally believed to be caused by psychological factors. Men may have had early sexual experiences where they hurried through intercourse. Sometimes, premature ejaculation presents many years into a relationship and may represent interpersonal problems in the relationship. Premature ejaculation results in disappointment, frustration and ultimately loss of self-esteem.

Medical therapy
Treatment is twofold - medications that delay ejaculation and counselling. Pharmacological agents that may be used to delay ejaculation include antidepressants and benzodiazepine anxiolytics. These are useful in the short term.

Sexual therapy
Open discussion between partners with or without the help of a therapist may resolve the problem. They can be taught simple behavioural techniques to help them manage the problem. First, the frustration of the couple is reduced by teaching them sensate-focus exercises.
These exercises teach the man not to hurry during sexual relations. Then the couple is taught to manually stimulate the penis until the man is close to orgasm. They cease stimulation whenever the man feels ejaculation is imminent. This stop-start technique is repeated several times. In another technique, the man can ask his partner to squeeze his penis firmly behind the glans whenever ejaculation seems close at hand.
Both stop-start and squeeze techniques teach the man to delay ejaculation. Eventually, the man learns to change his thoughts and mental pictures when ejaculation is imminent and thus prolong intercourse.

Dr Pauline Williams-Green is a family physician and president of the Caribbean College of Family Physicians; email yourhealth@gleanerjm.com