Part 1 of a new three-part series for men with premature ejaculation and their partners, on contemporary issues in the understanding and treatment of PE.
What Causes Premature Ejaculation?
Eight Ways Men with Premature Ejaculation Can Last Longer in Bed
The answer’s always been a bit foggy.
Over the last few decades, researchers have experimented with definitions like “lack of control over ejaculation, “ejaculation with minimal stimulation,” or “ejaculation before you want it to happen.”
Which do seem to capture the essence of the thing. But unfortunately they’re too subjective for research purposes.
Lately the field has moved towards defining premature ejaculation in more objective terms by simply noting how long a man lasts after penetration. Researchers call this your “intravaginal ejaculation latency time,” of IELT for short.
It’s less technical than it sounds. To measure your IELT, your partner simply clicks a stopwatch at the moment of penetration, then clicks it again when you ejaculate.
In the current DSM-5 definition of premature ejaculation, your IELT has to be consistently a minute or less to qualify you as potentially having PE. (The DSM-5 notes that duration criteria haven’t been established yet for men whose sexual activities don’t involve vaginas).
This helps eliminate what my colleague Paul Joannides calls “El Prematuro Loco”: guys with normal IELTs who freak out because they can’t last as long as the guys in porn.
But as a sex therapist who treats men with premature ejaculation, I’m troubled by this duration-based definition, since it fails to capture relevant details, like what exactly were you doing during penetration, and how much was it actually turning you on?
Consider the following: Let’s say you and your partner are doing what’s called “motionless intercourse,” a common technique for managing PE, where you lie completely still together for the first two minutes after penetration. No thrusting at all.
Let’s say with motionless intercourse you can increase your IELT from 30 seconds to 2 minutes. According to the latest criteria, you now technically no longer have premature ejaculation.
For motionless intercourse to work, though, sex has to be very controlled. No moaning, or anything else that might get you too excited.
You see the problem, right? It’s not just a matter of how long sex lasts. We also need information about whether you (and your partner) felt free to be fully turned on.
Almost all men with premature ejaculation, in the hopes of lasting longer, consistently do things to keep themselves from getting too aroused—from motionless intercourse, to "start-stop," where you return to motionless intercourse every time you feel an orgasm might be around the corner, to numbing creams and sprays, to thinking about your least favorite elementary school teacher, to masturbating beforehand so you're not so highly excited.
These are all ways to keep yourself less aroused. Think about that, for a moment. Who else but a man with premature ejaculation would ever think of doing such a thing?
To have good sex, you have to be in the moment. But if you’re trying not to get too excited so you won’t have an orgasm too quickly, that takes you out of the moment.
In fact, the whole point is to take you out of the moment. Again, who else in the universe but a man with premature ejaculation would ever dream of doing that?
Oh, and one more thing . . .
Let’s not forget the man’s partner. I often hear from partners of men with PE that their biggest frustration is when he removes himself from the erotic moment, in a desperate attempt not to get too excited.
It’s not just about how long intercourse lasts. It’s also about whether there’s any joy in lovemaking.
To quote one exasperated wife, “I don’t really mind him coming so quickly inside me. Intercourse has never been especially my thing. What really upsets me is that all he focuses on is not getting too excited. It’s like I’m not even there.”
I propose we define premature ejaculation, not just by how long a man takes to come, but by the kind of efforts he has to make not to come.
Let’s say we define premature ejaculation not just by the fact that a man comes very quickly, but also by the fact that he has to do some form of “Arousal Reduction”—“AR,” if you will—in order not to come quickly.
We might express this logically as follows:
PE = rapid ejaculation + AR
Where AR might include everything from thinking about flesh-eating zombies during intercourse, to avoiding sex positions that really turn you on, to avoiding partners who really turn you on, to avoiding intercourse entirely.
When you consider things from an AR perspective, many of the traditional work-arounds for premature ejaculation—like motionless intercourse, stop-start, numbing creams and sprays, or masturbating first before going on a date—suddenly just look like extensions of the problem.
From an AR viewpoint, these all just look like forms of Arousal Reduction.
What we’d really like, as a treatment for premature ejaculation, would be something that not only enables a man and his partner to enjoy sex longer, but also relieves him of the need to do AR. So he and his partner can enjoy getting more aroused, not less.
Do any current treatments for premature ejaculation meet this higher standard?
In fact, some do. But they’re not widely known.
For decades now, we sexual medicine specialists have been treating men with persistent, severe premature ejaculation by combining psychological techniques with medication. For many men, this kind of combination treatment provides not only longer-lasting sex, but also freedom from having to do AR.
For one, none of these medications are yet approved in the US for the treatment of premature ejaculation. They’re approved for other uses, but their use in men with premature ejaculation is what’s called “off-label,” which requires informed consent.
Their effectiveness for premature ejaculation has been shown in multiple published studies. But until one of these medications gets approved in the US for premature ejaculation, you’ll never see a TV ad in this country saying, “Ask your doctor about PE.”
To really understand how combination treatment for PE actually works, though, we’ll need to discuss what actually causes premature ejaculation in the first place.
That’s where we’re going in Part Two of this series. I hope you’ll join me.
Parts of this article have been adapted from Love Worth Making: How to Have Ridiculously Great Sex in a Long-Lasting Relationship by Stephen Snyder, M.D. Copyright © 2018 by the author and reprinted by permission of St Martin’s Press.
All content here is for informational purposes only. Please consult a licensed mental health professional for all individual questions and issues.