What is premature ejaculation?

Premature ejaculation is a very common sexual dysfunction. There are no rigid criteria for diagnosis. However, if a man’s ejaculation limits his partner’s ability to reach a high level of arousal, we can safely call that premature ejaculation.

Premature ejaculation is easy to diagnose when defined by a pattern of ejaculation that occurs before penetration, just after, or shortly after the insertion of the penis into the vagina. LoPiccolo discussed that if there is no female arousal when the ejaculation occurs prematurely during at least 50% of coital opportunities, it then becomes problematic, defining premature ejaculation.

Nevertheless, inability to control ejaculation can be can be a problem in the bedroom.

There has been much research on premature ejaculation. Typical past histories may include fear of being discovered during a first coital experience, with a continuation of this pattern. It is clearly seen as a psycho-physiological disorder. There were theories that prostate or genitourinary inflammation could be the cause. However studies did not support this. However there is stronger evidence to suggest relationship problems, usually some unconscious hostility or fear of women. Other evidence suggests high arousal states obtained due to intercourse infrequency; however, according to the literature, there is no evidence to support that length of time between intercourse episodes can cause or exacerbate premature ejaculation.

Unfortunately, anger and hostility can develop with regard to this situation. Shortening the time of petting and sex play prior to the an arousal state has proved to be helpful.

What is the treatment for premature ejaculation?

Therapeutic techniques

In therapy, I explain to my patient that this is a very common problem. It is helpful for patients to understand that others also experience this.

1. The “squeeze technique.” The squeeze technique is where the woman places her thumb on the frenulum (the area on the underside of the penis, beneath the glans) of the penis and places her 1st and 2nd fingers just above and below the coronal ridge of the penis and with a firm grasp, pressure is applied for approximately 4 seconds, then released. This has proven to be extremely helpful, and most definitely increases the length of an intercourse episode. This technique is must less effective when the man attempts it himself. The woman is encouraged to apply this technique every few minutes during touching and during intimacy. Couples should also note that this may cause a reduction in firmness of the erection, approximately 15%, but that is only transient.
2. Another helpful technique: The man is instructed at the beginning of the intercourse process not to do any thrusting.

High success rates have been found with these techniques. Literally within one week, we have found that patients are able to maintain their erections, and do not ejaculate. It is not uncommon afterwards for patients to maintain erections for approximately 10 minutes, as opposed to 1-2 minutes.

The basilar squeeze technique, which is squeezing at the base of the penis, has proven not to be nearly as effective as squeezing towards the head of the penis.