A problematic false start

Dear Dr Mitchell,

I am a 47-year-old black man who climaxes quickly while having sex. I have no issue getting an erection. My issue is creating a problem in my relationship. Can you offer any assistance?

The problem that you are experiencing is premature ejaculation. It is a common issue for men. Approximately 30-40 per cent of men will have it at some time in their lives.

The exact cause of premature ejaculation is not known. Serotonin, a natural substance made by the nerves in the brain, is thought to play a role. High levels of serotonin increase the time to ejaculation. Low levels can shorten the time to ejaculation, resulting in premature ejaculation.

The overwhelming underlying problem is usually psychological and problems which tend to commonly occur include temporary depression, stress, guilt, unrealistic expectations about performance during sexual activity, history of sexual repression, overall lack of confidence and relationship problems.

It is important to manage any emotional problems you might have.

Premature ejaculation may also be due to inflammation in the prostate gland (prostatitis). If you are on medication for medical conditions such as hypertension and diabetes these can also aggravate the problem. So you need to reveal and discuss any medications that you are currently taking with your doctor.

Know that this is a problem that can happen at any age. For older men erection many not be as firm or large and may not last as long before ejaculation occurs.

Premature ejaculation also affects your partner so it is important to talk about the problem. Counselling involving couples or sex therapy may be helpful.

Learning to relax during sexual activity is important for both you and your partner. When you worry it increases performance anxiety and makes the problem worse.

Sometimes premature ejaculation can be a problem for men with erectile dysfunction (ED). This is a condition when the penis does not remain firm enough for sexual activity. Treating ED may cure the premature ejaculation. Viagra, Cialis or Levitra may help to maintain an erection.

You should consult your doctor and get a physical examination done. Ninety-five per cent of men are helped by behavioural techniques that help to control ejaculation.

The Stop-and-Start technique may help. You or your partner would stimulate your penis until your feel like you are going to have an orgasm. Stop the arousal for about 30 seconds or until the feeling passes, and then start the stimulation again. Repeat the process three or four times before you actually ejaculate.

Exercises such as the Squeeze Technique may also be helpful. This works in a similar way to the Stop-and-Start. When you feel like you are reaching orgasm, you or your partner should squeeze the head of the penis until you lose the erection. You’ll then repeat this a few times before ejaculating.

It also helps to think about something else during sexual activity since this will help you to last longer.

There are some medications that can help to treat premature ejaculation. These include antidepressants, Tramadol, and anaesthetic creams or sprays.

Antidepressants can cause nausea and drowsiness and can decrease the desire for sexual activity. Tramadol is a pain reliever that can delay ejaculation. It is addictive so it may not be an option for you. Anaesthetic creams or sprays, when applied to the head of your penis, may make it less sensitive. It is left on for 30 minutes, then it must be washed off before sexual activity so you don’t lose your erection or cause loss of sensation for your partner.

Exercises to strengthen the pelvic floor (Kegel exercises) may be of some benefit. You should practise tightening your muscles to stop your urine midstream. Hold them tight for three seconds and then release them for three seconds. Practise this at least three times daily.

Using a condom may also help to desensitise you, and masturbating a few hours prior to sexual activity may also help you stay in control during sexual intercourse.

You should seek counselling with a psychologist or psychiatrist to get help to work through any problems that you might have with depression, anxiety, or stressful circumstances that may be contributing to your premature ejaculation.

Best wishes.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 968-2025. All responses are published. Dr Mitchell cannot provide personal responses.

DISCLAIMER:

The contents of this article are for informational purposes only, and must not be relied upon as an alternative to medical advice or treatment from your own doctor.