Porterbrook Clinic
Sheffield Care Trust
Sexual Fitness
Andrology Service
(Urology)
Sheffield Teaching Hospitals
For Men
Overcoming Rapid Ejaculation
Information for Users of our service
Dr Kevan Wylie
Clinical Lead
Lead Clinician (Andrology)
Porterbrook Clinic
75 Osborne Road
Nether Edge
Sheffield S11 9BF
Telephone: 0114 271 6671
Fax: 0114 271 8693
Email: [email protected]
www.porterbrookclinic.org.uk
Do I have a problem with rapid
ejaculation because you think you
ejaculation?
should be lasting longer, then the first
thing to ask yourself is, says who? Is it
How long should sex last? There aren’t
you who wants to enjoy longer
any hard and fast rules: the best answer
intercourse? Or is it that you think your
is, as long as the couple involved wants
partner wants you to last longer? If it’s
it to.
Some couples might be very
the latter, have you actually asked her
satisfied with, say, twenty minutes of
(or him)? Sometimes we find a man has
sexual touching and caressing, followed
unrealistic expectations about how long
by intercourse that lasts a couple of
sex should last and thinks he should be
minutes; whereas others might enjoy
thrusting away like a piston engine for
having intercourse lasting ten, twenty,
hours, based on what he’s heard, read,
thirty minutes or more.
or seen in the movies… but in fact it
turns out that his partner is perfectly
There probably isn’t a man alive who
happy with the way things are, or even
doesn’t ejaculate (also referred to as
wishes intercourse didn’t go on quite so
come or cum) more quickly than he was
long!
expecting to, once in a while. What we
wonderful thing …
Communication
can
be
a
mean by “rapid ejaculation” is a
pattern of:
If, however, it’s clear that your pattern of
coming before, during or very
ejaculatory control is causing problems
shortly after penetration, which
for you and your partner, then this
occurs at least half of the time, and
leaflet aims to help you do something
which causes you and/or your
about it.
partner disappointment and distress.
In the most severe cases, a man might
Who is affected?
ejaculate just by thinking about or
preparing for sex, before he or his
Rapid ejaculation is one of the most
partner has even touched his penis
common sexual problems, affecting
(while he is undressing, for example).
around four out of every ten men. The
problem is seen most often in:
If this doesn’t sound like you, but you
Younger men, with limited sexual
worry you might be suffering from rapid
experience
Sexual Fitness for Men
Men who have recently started a
It is believed that the following factors
sexual relationship with a new
can all have a role in primary rapid
partner
ejaculation:
Men who have infrequent sexual
„ Infrequent sexual activity
intercourse.
„ A lack of sexual knowledge, in
Most men with this difficulty have always
particular a lack of awareness of the
had it, i.e. they have never been able to
sensations that precede orgasm
gain control over when they ejaculate
„ Early sexual experiences that were
once they are sexually aroused; this is
rushed, uncomfortable and included
called primary rapid ejaculation. In other
a fear of discovery, for example
cases, however, the difficulty can develop
secret masturbation in a bedroom
later in life, perhaps following years of
shared with a brother, or hurried sex
the back of a car
satisfactory functioning, either because
of a change of circumstances, or
„ Sexual guilt or negative views about
sometimes as an early sign of the onset
sex, perhaps caused by a restrictive
of erectile dysfunction or other disease;
or strict religious upbringing, or by
this is known as secondary rapid
being uncomfortable with certain
ejaculation.
sexual fantasies
„ Neurological problems which means
What causes rapid ejaculation?
the arousal circuit is not fully intact
„ Low free testosterone levels.
The causes are still not fully understood.
Although we know that anxiety is
The following factors are more likely to
perhaps the most important factor, and
be
that early sexual experiences are often
ejaculation:
implicated, it is not certain whether
„ Infrequent sexual activity
some men also have an inherent physical
„ Prior sexual experiences in which the
reason for being more easily aroused
than other men are, for example a
difference
in
the
way
ejaculatory
implicated
in
secondary
rapid
man has felt a failure or been
shamed
„ If his partner has a sexual problem
function is mediated by the nervous
such as a lack of desire, the man may
system, or sensitivity in the skin of the
adapt by learning to “get it over
penis.
with quickly”
Overcoming Rapid Ejaculation
likely to be successful if the man’s
„ Similarly, the onset of erectile
dysfunction can cause a man to use
partner is willing to attend sessions
high levels of fantasy to try to keep
at the Clinic and to work on the
his erection, leading to over-
problem at home with him in a kind
excitement and ejaculation
and co-operative way.
„ Disease such as urological disorders,
Rapid ejaculation can also lead to other
prostatitis or diabetes mellitus
problems in sexual functioning, both for
„ Withdrawal from ephedrine,
the man and for his partner. The man
trifluoperazine and opiate drugs.
who is worried about coming too soon is
likely to get into a number of habits that
What effect does it have?
make sexual dissatisfaction more likely:
Rapid ejaculation can cause a lot of
misery and conflict in a relationship. At
1. He may be so preoccupied with trying
an emotional level, the man will often
to control his ejaculation that he
feel
becomes
ashamed,
humiliated
and
a
spectator
frustrated and angry – “this wouldn’t
participant. If this leads to a reduction
happen if he just tried harder”. If he
in pleasure and sensation for him, this
senses
-
may have a negative impact on his
especially if it spills over into sarcastic
levels of sexual desire, and lead to a
and cutting remarks - this will only serve
difficulty in getting future erections.
to make the problem much worse. This
2. Similarly, if he tries “thinking about
is because over-excitement and anxiety
something else” during sex in the
produce a very similar effect in the body
mistaken belief that this will help him
- and both are basic features of rapid
to last longer, his partner may well
ejaculation. Hence, the more he thinks,
sense detachment and emotional
‘I mustn’t come too soon, or else my
distance, and feel unhappy as a result.
partner will be furious’, the more likely
3. He may reduce the length of time
he is to do just that. This means that
spent in foreplay in an attempt to get
partners have a crucial role in
on to intercourse before he comes; as
helping a man to overcome rapid
a result, his partner is not sufficiently
ejaculation: treatment is much more
aroused and is even less likely to have
partner’s
Sexual Fitness for Men
annoyance
than
a
the
inadequate, while his partner feels
his
rather
in
lovemaking,
full
an orgasm, compounding the sense of
men’ produced by the NHS in Sheffield).
dissatisfaction between them.
Relaxation exercises are also useful to
help you to reduce your anxiety levels –
Very often, the net result of all this is that
ask for the leaflet in this series,
the couple start to attempt lovemaking
“Relaxation”.
less and less often; and you won’t need
two guesses for on the effect this has on
Treatment specific to the problem can be
the man’s tendency to come too quickly.
divided into two main approaches:
Is there a cure?
1. Exercises that teach you voluntary
Happily, many men are able to overcome
2. Physical treatments that prolong the
this problem in time with specialist help.
time it takes you to reach orgasm, if it
At the Porterbrook Clinic, you will be
is not possible for you to gain
invited
ejaculatory control.
control of the ejaculatory process;
to
attend
an
assessment
interview, ideally with your sexual
partner if you have one, where a
1. Learning Control
thorough psychosexual, relationship and
medical history is taken, and a tailored
This programme has three elements, but
treatment
before you start you need to get any
plan
will
be
devised.
notion out of your head that you will be
The early part of therapy will involve
able to control ejaculation better if you
helping you both to understand the
do not think about what you’re doing or
condition and to share with each other
how excited you are. In fact the opposite
how you feel about it. We will also help
is true – in order to learn how to control
you find ways to improve your intimate
your ejaculatory response, you need to
relationship while treatment is underway.
understand much better how your body
Your therapist may teach you how to
works, which means paying very close
practice pelvic floor exercises (also called
attention indeed to the sensations and
Kegels) regularly, to help you understand
thoughts that you have as you approach
your pelvic area better and to tone your
orgasm.
muscles. (Ask your therapist for a copy
of the leaflet ‘Pelvic floor exercises for
Overcoming Rapid Ejaculation
A positive attitude of mind is important
breathe out for longer than you
throughout the exercises: if something
breathe in - for example, breathe in to
goes wrong (e.g. you ejaculate before
the count of three, then out to the
you intend to), and it probably will
count of four.
sometimes,
to
2. Now imagine you have a scale of
experience and try again another time.
just
put
it
down
arousal, where 0 is no arousal at all,
Don’t turn it into a catastrophe; it isn’t.
and 10 is ejaculation.
It’s just what happens when you’re
stimulate your penis using your hand
learning a new skill.
(do not use lubrication at this point),
Start to
and as you do so try to imagine your
Your therapist will decide with you
excitement rising along that scale until
whether you would be best starting with
it reaches the top (10) and you
option a) or option b); both lead on to c).
ejaculate. Really focus on the different
sensations in your penis, scrotum and
It is crucial that you do not try at any
the rest of your body.
stage to have sexual intercourse
‘point of no return’ as being when
until you get to that point in the
you reach 8.
programme, as this would undo all
your hard work.
Picture your
3. You may need to do this two or three
times to fix in your mind what the
different levels feel like. You might do
Option a) Stop/Start
this on the same occasion if you have
plenty of time (you’ll probably need at
Choose occasions when you have plenty
least 20 minutes to recover before
of time and complete privacy. First, you
starting
need to identify your ‘point of no return’,
occasions.
to learn what that feels like.
again),
or
on
different
4. When you’ve got a handle on what
the different sensations feel like, start
This first set of exercises is carried out on
again,
your own.
stimulation when you get to ‘5’ on
1. Start by relaxing - make yourself
your scale.
but
this
time
stop
all
Concentrate on the
comfortable, allow your shoulders to
sensations and take a few deep
fall away from your ears, and take two
breaths.
or three deep breaths. Make sure you
excitement drops back down to a 1 or
Sexual Fitness for Men
When
your
level
of
2, start stimulating your penis again.
include some variations, you can move
This may take anything from a few
onto the next set of exercises.
seconds to a minute or more. (If you
find you need to stop again almost
This set of exercises is carried out
immediately, you will need to stop for
with your partner (if you have one).
a longer time; if, on the other hand,
Again, it may take some weeks to
you find you are losing your erection,
complete the set, but try to practice
you will need to stop for a shorter
at least three times a week:
period next time).
5. This time, let your excitement build to
a 6, then stop exactly as before.
6. On the third occasion, get to a 7
1. Show the leaflet to your partner and
make sure she (or he) is ready and
willing to help. Agree that under no
circumstances
before stopping.
7. The fourth time, allow yourself to
ejaculate if you want to.
will
you
attempt
intercourse during the exercises, until
you are instructed to do so.
8. Repeat nos 4, 5, 6 and 7, daily if
possible, but at least three times a
week, until you are able to stimulate
2. Agree a word you will use to ask your
partner to stop.
your penis for at least 15 minutes
before ejaculating.
3. Repeat the stop/start exercises as
9. When you can do this without
above until your partner can stimulate
difficulty, repeat the exercise, but start
you using a dry hand for 15 minutes
to use a lubricant on your hand when
before you ejaculate. You may need
you stimulate your penis.
This will
to ask her to stop many times when
increase the pleasurable feelings and
you start out, but in time, your ability
will therefore increase the challenge.
to control your excitement should
10.Once you have mastered this, add
grow.
some variation into your stimulation,
for example by using different speeds
4. Once you can comfortably last 15
or changing the type of stroke you
minutes, ask her to repeat the
use.
exercises with a lubricated hand.
When you can regularly
stimulate your penis for 15 minutes or
more with a lubricated hand, and can
Overcoming Rapid Ejaculation
When you feel you have good control
This will make you lose the desire to
during
your
ejaculate, and lessen the rigidity of your
therapist might suggest you repeat the
penis. Some couples find that if they can
exercise using oral stimulation, if that is
enjoy 15 minutes or more of sex play (by
something you both enjoy.
repeating this procedure several times)
manual
stimulation,
without the man ejaculating, this can
Option b) Squeeze technique
both be enjoyable, and give them a big
confidence boost.
In this technique, your partner stimulates
your penis until it becomes erect, then
c) Control during penetration
squeezes it as follows:
Hold the penis firmly between your
Once you and your partner have
thumbs and forefingers, with your
mastered either stop/start or the squeeze
thumb on the frenulum, and the two
technique, or (even better) both, you will
fingers on the opposite side of the penis
be ready to move on to the exercises
where the glans meets the shaft of the
shown in another leaflet in this series,
penis (see Figure 1 & 2). Squeeze hard
“Stage Three – A New Way to Make
for a few seconds.
Love”. Your aim will be to transfer the
Figure 1
Sexual Fitness for Men
Figure 2
control you have learned during manual
b) Pharmaceutical options
stimulation to being inside your partner.
If necessary, your therapist will help you
A number of anti-depressant drugs
to incorporate the stop/start or squeeze
make orgasm harder to reach, even
techniques during intercourse.
at low doses. These include
paroxetine, sertraline and
2. Physical treatments
clomipramine which are referred to
as SSRI agents. There are two
a) Desensitizing band
disadvantages to this treatment: the
first is that there can be side effects,
This is a special latex ring designed to be
including loss of sexual desire,
used on the penis during manual
headache, insomnia and nausea; the
stimulation every day for up to 30
second is that there is often no
minutes, to desensitise the penile tissue.
lasting effect – if you stop taking the
(See Figures 3 & 4) It must not be used
drug, you will probably be back to
during intercourse.
square one. Studies suggest,
however, that intermittent use of a
drug such as sertraline (i.e. a few
Overcoming Rapid Ejaculation
Figure 3
Figure 4
Sexual Fitness for Men
hours before you want to have sex)
If you would like to try any of the
can be as effective as continuous
pharmaceutical options, your therapist
use, and this can help to reduce
can refer you to one of the Porterbrook
unwanted side effects.
medical team.
The oral treatment sildenafil (Viagra)
If you use condoms, some now have a
can also be useful for delaying
local anaesthetic agent within the
orgasm, particularly if you are
condom to further delay ejaculation. One
suffering from erectile dysfunction as
example is Durex Performa.
well as rapid ejaculation. It is not
clear how much this is due to the
Helpful books on this subject
psychological effect of knowing that
include:
you will be able to get another
erection, even if you come before
A New Male Sexuality by Bernie
you want to the first time. This can
Zilbergeld (Bantam Doubleday Dell
reduce anxiety.
Publishing, 1999)
Topical local anaesthetic creams or
ointments such as lidocaine can help
Coping with Premature Ejaculation: How
to reduce sensation when rubbed
to Overcome PE, Please Your Partner, and
into the frenulum 15-30 minutes
Have Great Sex by Michael Metz and
before intercourse. This has
Barry McCarthy (New Harbinger, 2003)
drawbacks, however. It can cause
discomfort on the penis; it reduces
How to Overcome Premature Ejaculation
pleasurable sensations; and it can
by Helen Singer Kaplan (Brunner/Mazel
transfer to your partner, reducing her
Inc, 1989)
(or his) sensations too.
Written by ROSE WHITELEY for the Porterbrook Clinic, Sheffield
© Porterbrook Clinic 2006
Overcoming Rapid Ejaculation
C2
© Porterbrook Clinic 2006