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Premature Ejaculation – It’s About The Journey, Not The Destination!

| By: Dr Robert Stevens

Yikes, there’s no doubt about it, premature ejaculation is a taboo subject.  I wasn’t sure how to approach this blog, us men find it difficult to talk about these things.  We are men, strong, successful men.

The official definition is ‘ejaculation that occurs prior to, or within about one minute of vaginal penetration’.  It’s a next to useless definition in my opinion.  Sex should be a mutually pleasurable experience for both you and your partner.  Time should be irrelevant, you shouldn’t rate ‘effectiveness’ with a stop watch.  There are different types of sex, from the wham bam quickie up against the wall in the department store changing room to the romantic candlelit session, bed adorned with rose petals, where you take your time.  Don’t worry, you can read onwards, this article won’t turn into a lame 50 Shades of Grey substitute or cheesy Mills & Boon type blog!  Hopefully you get my point though, both extremes have a time and a place.  What is important is control, not time, there’s a time to lose control and there’s a time to maintain it.

I don’t care who you are, we all want to be great in bed!  Sex is important, we don’t just engage in it to procreate, it plays an important role in our psyche.  Almost all of my patients report an improvement in sexual function on Testosterone Replacement Therapy, it isn’t just placebo.  This improvement leads to improved relations, and improved confidence and self-esteem.  This has a snowball effect on other elements in our lives.  I’ve said it before, when it all boils down, we are simple creatures.  Right now, pubertal boys everywhere are discovering strange feelings, sexual feelings that will no doubt take them away from their all-important studies, to naughty feelings that will consume their every thought if they let them.

A recurring theme you will notice if you follow my blogs, is the importance of balance and control.  It’s great to lose control every once in a while and, as a matter of fact, it is even important in my opinion.  How incredibly dull life would be without risks and challenges that ignite the spark in your inner core.

I love the Cus D’Amato quote he made about a young Mike Tyson…

“A boy comes to me with a spark of interest.  I feed the spark and it becomes a flame.  I feed the flame and it becomes a fire.  I feed the fire and it becomes a roaring blaze.”

All too often, case in point, it can ultimately become destructive.  I remember as a teenage boy… Only joking, some things should stay private!  This is my point, my sexual performance is not something I want to talk about with you, my friends, or even my partner about.  It’s human nature to compare ourselves with our peers.  I’m sure most tales of sexual exploits are often highly exaggerated stories of sexual prowess to make the stories more entertaining.  Or are they?  I don’t know?  That combined with the constant bombardment of pornographic material on the internet, who know’s what is ‘normal’ anymore?  As a doctor, I see a lot of depressed and anxious people.  They are often preoccupied with other people’s perceptions of them, something they ignore and dismiss when they are well again.  Constantly living up to a fantasy is unrealistic and detrimental.  I want to be like the Terminator…

“It can’t be bargained with.  It can’t be reasoned with.  It doesn’t feel pity, or remorse, or fear.  And it absolutely will not stop…  ever”

As discussed in a previous blog, erections are a complex neurovascular process under hormonal control.  We take them for granted, perhaps because as teenage boys they were so frequent, not only because of our raging hormones, but we were also in good health!  Not only physical but our psychological health.  We weren’t under the ever-growing stresses and strains of this peculiar modern civilised world we live in, we were essentially free to explore and discover our sexual identities within the confines of what is considered ‘decent’, but still relatively free.

So…  Premature Ejaculation.  Are you concerned you may have it?  Does your partner think you have it?  Has it happened more than once?  Does it bother you or your partner?  And probably most importantly, is there anything you can do about it?

No one wants to admit they suffer from Premature Ejaculation.  I don’t care who you are, we all want to be ‘stallions’ in the bedroom, but bottling the issue up will unfortunately only worsen the psychological component of the condition.  So, is it all in your head?  Premature ejaculation was long thought to primarily be a psychological problem.  However, we now know that there is also a physical element.  If you’ve been brave enough to approach your doctor in the past and he / she took pity on you, you may have been offered psychosexual counselling.  There are mechanical techniques that might help, including the ‘Masters and Johnson Squeeze Technique’ which decreases the engorgement of the glans with blood reducing sensitivity.  Although, as with most things to do with the human body, it isn’t a one size fits all solution.

There are a number of medications that have been used off label to help manage premature ejaculation.  This has led to the emergence of a UK licenced medication specifically for the treatment of premature ejaculation called ‘Dapoxetine’.  It is a short acting Selective Serotonin Reuptake Inhibitor (SSRI).  Erections are mainly under parasympathetic nervous system control, whilst ejaculation is thought to be more of a cerebral event.  Serotonin is the ‘happiness’ hormone, so flooding your body with serotonin whilst having intercourse has been shown to delay ejaculation.

If you do suffer from it, don’t worry, you are not alone.  It is estimated to affect 30% of males worldwide, it’s just a topic that is reserved for internet searches behind the privacy of a computer screen.  Something that may or may not cheer you up is that there is a biological advantage for ejaculating quickly.  In the animal kingdom, you increase your chances of survival if you ejaculate quickly.  Other animals ejaculate quickly because they are vulnerable to attack from predators when they are engaged in intercourse.  The tiger isn’t going to sit in the bushes patiently waiting for you to climax before killing and eating you!  No, it’s survival of the fittest out there.  So, by ejaculating quickly you are less liable to attack from predators, you are biologically superior.  As far as we are aware, only humans and dolphins use sex for both pleasure AND procreation, although I’m not sure how they know dolphins enjoy sex and, to be honest, I’m not sure I want to know.

Humour is important, in fact it is necessary.  Not only because it allows us men to talk about serious matters without losing face, but it also releases the pleasure hormones in your brain, endorphins.  Hopefully you’ve read this blog and had a bit of a chuckle, but also taken away from it that it’s ok to talk about these things.  If not with someone close to you, but perhaps with us here at The Men’s Health Clinic.  I would like to thank [insert name] for being so open and honest about your problems, and to reassure you, we will get there eventually!

Dr Robert D Stevens MBChB MRCGP Dip.FIPT