My previous column focused on the most common sexual problem for women: low libido. Now I will address the most frequent male concern: rapid or premature ejaculation (PE). About 30 percent of men climax earlier than they want. For some it only happens once in a while or only with a certain partner; for others it occurs every time they have sex. Usually, the more anxious men get about the problem, the less control they have, creating a self-perpetuating cycle. The good news, however, is that it is often possible to make a clean break and start anew.
Until recently, PE was diagnosed when a man could last no longer than two minutes. This arbitrary definition did not work very well, and now he is said to have PE if he ejaculates or comes earlier than he intends to, no matter how long he lasts.
Coming early is not always an issue in a relationship. In fact, some men have told me that they have always been quick to ejaculate, and it was never a big deal with a past partner, but that with their current partner, the problem can’t be ignored.
Each case is different and I spend a lot of time asking questions, not because I am nosy, but because I need the information to give specific feedback and advice.
When did the PE start happening? Does it also happen during masturbation? Is it only a problem with a certain partner or with all sexual partners? Can he obtain another erection and last longer the second time? Does he have any specific thoughts before it happens? What does he think about when it happens?
When I get to the latter two questions, a lot of guys say that they think about baseball scores to distract themselves in order to last longer. This is actually the completely wrong thing to do. Instead of trying to distract themselves, they need to start focusing on their sensations and learn to monitor their arousal and how close they get to ejaculating. Easier said than done, maybe. It’s a skill that’s usually not acquired overnight, but one that’s indeed possible to learn.
There are different techniques to treat PE. The one I prefer is called the “Start–stop technique.” It’s a masturbation exercise where a man learns to monitor his sexual arousal more closely. He starts masturbating but stops stimulating himself when he has reached a point near ejaculation. Once he has “cooled down” sufficiently, he starts masturbating again, then stops again, and so on. Let me emphasize that sex therapists and sexuality counselors only talk to clients about assignments, which they then practice at home. There never is any nudity or touching in the sessions—that would go against our ethical guidelines and professional boundaries.
I often start with a reading assignment. Bernie Zilbergeld’s book The New Male Sexuality is a great resource. His first chapter, “The making of anxious performers” goes right to the heart of the problem. And the second chapter, “It’s two feet long, hard as steel, and will knock your socks off: The fantasy model of sex,” takes it a step further, explaining why so many men have unrealistic expectations about their sexual performance. Zilbergeld devotes an entire chapter on developing ejaculatory control.
Another good book, by Helen Singer Kaplan, called PE: How To Overcome Premature Ejaculation, is unfortunately no longer in print, and is difficult to find. But Michael Metz and Barry McCarthy’s Coping With Premataure Ejaculation, which I recommend, is readily available.
I always invite the female (or male) partner to join our sessions. Even though it may seem as if the problem is his, it obviously affects both of them and it takes understanding from both partners to address it. The partner can take a real active role in some of the assignments I give them. And most importantly, the more relaxed and reassuring she is about the PE, the better. The less he stresses about it, the easier it will be to let him develop confidence and eventually better control his ejaculation.