MEN IN BED: TREATING PREMATURE EJACULATION
Coming on time. One or the ironies about assisting premature ejaculators to slow down is that they often expect fast results. They ask for a quick fix and want to be cured’ in one consultation. The last thing they feel they can tolerate is a drawn-out program that takes weeks to complete.
But there is no proven quick fix for this condition. Short-term measures are available but these mostly yield short-term results. The experts generally agree that it takes several weeks to achieve a lasting change in ejaculatory patterns.
Every man can learn to control his ejaculation provided he has no neurological abnormality. It is simply a reflex that can be brought under voluntary control. Like children who are taught urinary control through heightened sensory awareness, through knowing what it feels like to have a full bladder, so men suffering PE can heighten their sensory awareness and gain more control.
But in trying to slow themselves down, many men often use methods which ultimately make the condition worse. They attempt to switch off. As the crucial moment approaches, they try thinking about something completely unrelated to what is happening. Some calculate their tax, some bite the insides of their cheeks or remember the last funeral they attended — anything to get their minds off the inevitable. Others drink or use an anaesthetic ointment to dull sensation.
Such methods take a man down the wrong track. They distract him from his sensations and slow him down by reducing his desire and excitement. But what he really needs is to prolong his pleasure by learning to stay in control while he is highly aroused and excited.
The squeeze method, developed by Masters and Johnson, requires the partner to stimulate the man until he is close to the point of ejaculation. When he warns that he is about to climax, the partner squeezes him hard behind the head of the penis. This causes a partial loss of the erection. When he is back in control, stimulation recommences. Ultimately, the aim is for him to become sensitive enough to forestall orgasm on his own. The technique progresses from manual stimulation through various stages to complete intercourse.
The stop-start technique, devised by Dr James Semans in the 1950s, was ignored for years and then taken up again and considerably refined. It begins much like the squeeze method. The difference is that the partner stops stimulating the man when he asks her to, before the point of inevitability. Instead of a squeeze, there is simply a pause. As this technique progresses, the couple do not stop, they just change pace. With a trained therapist, both the stop-start and squeeze methods are successful with more than 96 per cent of men. They can take anything from four weeks to four months to learn.
The ‘testicular tug’ is another method. Just before ejaculation, a man’s testicles rise. If his partner tugs them down, ejaculation can be delayed, but this can be difficult to do.
There are several shorter ways of treating PE, none of which can be guaranteed to produce lasting results on its own. These include the use of tablets, ointments and sprays.
Drugs such as Prozac and Anafranil are known to retard ejaculation. But these drugs may have other, unwanted side effects and have to be taken with care. When therapists do prescribe them, it is mostly in conjunction with behavioural treatment programs.
Injections which allow men to maintain an erection for thirty to sixty minutes can also be used to treat PE. Over several weeks they may help men gain confidence and break the old patterns of rapid intercourse. But side effects may include scarring, development of fibrotic nodules (which may lead to a curve in the penis shaft) and prolonged erection (priapism).
Often the partners of men with PE are unwilling to discuss, contribute to or cooperate with therapy of any kind. They may take the PE personally and misinterpret it as a sign of rejection or as an indication that the man has someone else. Where the man is not in a stable, secure relationship it is important that successful treatment occur as soon as possible so that he does not lose an opportunity with a new partner.
There are basically two types of PE: primary and secondary. Primary PE occurs when the man’s penis is hypersensitive. He can desensitise and learn control using the methods outlined above. Secondary PE often results when there is an element of erectile dysfunction because of physical or psychological problems. The man is so anxious about losing his erection before he has ejaculated that he rushes to finish. By treating the erectile difficulty, the secondary PE problem is often automatically cured, too. Depending on its cause, erectile difficulty can be treated medically, surgically, with injections, with prostheses or with psychological counselling.
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Tags: Women’s Health