The Ins and Outs of Premature Ejaculation

Premature Ejaculation is a Common Health Concern for Men

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Premature ejaculation (PE) is a worldwide sexual health concern, and roughly one-third of American men have either experienced lifelong or acquired PE. According to the fifth edition of The Diagnostic and Statistical Manual of Mental Disorders, one of they key factors in determining premature ejaculation is a persistent or recurrent pattern of ejaculation that occurs within one minute of penetrative vaginal sex with a partner.

How each person expresses their early ejaculation varies. Some men with PE reach orgasm and ejaculation before physical stimulation begins. Others may experience PE during physical stimulation, such as during foreplay, petting, oral sex, penetration, and intercourse. Some individuals have always experienced PE (lifelong) while others develop it later in life (acquired).


There are a number of possible origins to PE, including a lack of sexual knowledge. Increasing a man’s comfort and empowerment through improved understanding about his body and his partner’s body can reduce sexual anxiety and help a man begin to manage his PE concerns. For a number of men, learning basic sex education that challenges myths, misinformation, stereotypes, and provides accurate information and techniques can help normalize and improve his concerns about PE.

Physiological factors such as hypersensitivity of the penis, genetic factors, nerve conditions, low serotonin levels, medication side effects, and an over-excitable bulbocavernosus reflex can also lead to PE.

Some evidence points to PE and ejaculatory control being associated with the brain, specifically the nucleus paragigantocellularis.

In addition, psychological factors such as performance anxiety, guilt, recalling negative experience, fear, as well as other factors including substance use, relationship issues, and infrequent sexual or masturbatory outlets, can contribute to premature ejaculation experience.

Treatments and Management

Treatments have shown varying levels of effectiveness for the treatment of PE. However, there are some common methods for learning ejaculatory control and managing PE.

The squeeze method was first utilized by American gynecologist and Sexual Health research William H. Masters and his research assistant Virginia Johnson. It was used as a behavioral treatment for improving PE symptoms. This method consists of arousing the penis to the point of no return and then ceasing intercourse or stimulation. At this time, pressure is placed on the frenulum until the feeling of ejaculation subsides. This teaches ejaculatory control and reduces involuntary contractions. A variation of this method is called the start-stop method, and it does not utilize the squeezing of the frenulum.

Pelvic floor muscle training can help strengthen the penis and allow for improved tone and reduction of PE symptoms. One of the more common methods for treating premature ejaculation incorporates exercising the deep pelvic floor muscles, which along with the urethral and anal sphincters help maintain urinary and bowel continence, and the superficial pelvic floor muscles that help maintain erectile rigidity and seminal expulsion.

The exercises are called Kegel exercises, and they can be done solo or partnered, with an erect or flaccid penis. Kegel exercises consist of a series of repetitions that squeeze the PC muscles in a similar manner as if to stop the flow of urine. The erect penis Kegel exercise creates a noticeable upward flinching motion. According to Jack Morin, PhD and author of “Anal Pleasure and Health,” contracting the anal sphincter muscles can help improve pelvic muscle tone near the rear coccyx area of the pelvic floor.

In a study done on pelvic floor rehabilitation to improve muscle tone, 61 percent of research subjects learned to control their ejaculatory reflex and manage their premature ejaculation with 15-20 sessions of rehabilitation. To aid in rehabilitation, the FDA approved Private Gym, a male pelvic exercise system for Kegel training.

Some men try topical desensitizing sprays and creams to reduce sensation for hyper-sensitivity related PE. Application of desensitizing agents, typically lidocaine-based, must be allowed time for absorption so that a man lowers the risk of transferring the numbing agent to any sexual partners. Two FDA-approved topical anesthetic products used for PE management are Promescent and Dynamo.

Seeing a Sex Therapist

Another treatment option for individuals and couples is counseling from a qualified sex and relationship therapist. Sex therapy can be used as a means of expressing fears, releasing anxiety, challenging self-defeating narratives, improving self-esteem, dealing with relational difficulties, and processing past and present biopsychosocial components to their PE difficulties. Men and their partners can learn deep breathing, meditation, relaxation techniques, and desensitization techniques that may challenge anxiety and increase comfort and sexual confidence. can learn deep breathing, meditation, relaxation techniques, and desensitization techniques that may challenge anxiety and increase comfort and sexual confidence.

Some sex therapists may suggest using a sexual surrogate to help a client learn ejaculatory control and anxiety management. While a sex surrogate is granted permission to touch his or her client, this type of therapeutic intervention is only done under the supervision and guidance of a trained sex therapist.

Closing Thoughts

While it’s important to work on the mental obstacles to dealing with PE, it’s also important to seek a consultation with a qualified medical provider. A urologist or pelvic floor therapist that specializes in sexual concerns is beneficial to assess and treat medical factors that may contribute to PE concerns. These medical professionals can discuss surgical options or prescribe various medications that have been used as off-label prescriptions for PE management.

However you go about managing PE, it’s important to remember you are not alone and there is help.


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Dr. Hernando Chaves holds a B.A. in Psychology, an M.A. in Marital and Family Therapy, and a Doctorate in Human Sexuality. He is a professor of human sexuality and licensed marriage and family therapist, specializing in erotic minorities, alternative sexuality, and sexual concerns/dysfunctions. Dr. Chaves is co-host for Penthouse magazine's “Sex Academy” instructional DVDs and a past president of the Western Region for the Society for the Scientific Study of Sexuality.

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