PREMATURE EJACULATION. How to last longer in bed.

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There is no definition of how long sex should last; this depends on the individual couple.

The average time to ejaculate in the vagina (intravaginal ejaculation latency time) is around 5 minutes and 30 seconds.

30% of men suffer from premature ejaculation.

90% of men reach ejaculation within 1 minute from penetration. 

10% of men reach ejaculation within 2 to 3 minutes from penetration.

The sexual medicine society recognises that males who experience premature ejaculation harm their sex life and mental health. Relationship problems are a common finding.

Early orgasm can be divided into two main groups;

1. Physical factors (prostate problems, thyroid disease, use of recreational drugs)
2. Psychological factors (depression, stress, performance anxiety, and relationship issues)

Premature ejaculation tends to improve over time on its own.

However, males who experienced quick orgasms from minimal sexual stimulation since the beginning of their sexual life (lifelong premature ejaculation) may not experience an improvement with time.

One can explore natural and medical treatment options to delay ejaculation.

Your NHS consultant or private urologist to treat premature ejaculation will need to take a detailed medical history of your sexual function and sexual relationships. The following questions may be asked;

• When and how did premature ejaculation start?
•  Has premature ejaculation been present in all your relationships?
•  How long does it take until you ejaculate?
•  What was the impact on you, your sex life and your partner/relationships?
•  Have you sought help, and if so, what approaches have you taken? Has any treatment managed to delay ejaculation?
• Do you suffer from performance anxiety?
•  Do you have erectile dysfunction (presence of morning and nocturnal erections, hardness)
•  What medical conditions do you suffer from?
•  What medications are you on?

A physical exam is performed to identify the normal development of male secondary sexual characteristics. A genital and rectal exam to feel the prostate form part of the physical exam.

 Your doctor will order a blood workup.

There are various behavioural techniques that you can attempt to prevent premature ejaculation.

1. Masturbate two hours before having sexual encounters
2. Wearing a condom (ideally thick) to help lower the sensation
3. Start and Stop method
4. Stop and Squeeze method
5. Combine the above with a medical vibrator
6. Kegel Exercises
7. Apply local anaesthetics on the glans, in the form of sprays, creams or wearing a condom with a local anaesthetic
   

Your sexual partner stimulates you but stops before ejaculation happens. At this point, your partner firmly squeezes the head of the penis (glans) for around 20 seconds. The grip is then released.

Thirty seconds rest period is taken before resuming masturbation.

Repeat these steps several times. Climax control takes a while to attain. A supporting sexual partner helps to reduce performance anxiety and ease specific sexual problems.

The start and stop method are similar to the stop and squeeze method, with the difference that the squeezing is not done in this method.

The blood flow into the groin improves when pelvic floor muscles are trained. Kegel exercises strengthen the weak pelvic floor muscles, and one may notice firmer erections. The exercises will help delay ejaculation as you will better contract the pelvic floor muscles.

Anaesthetic creams or sprays can improve ejaculatory control and sexual satisfaction; however, the results are mixed. They are typically applied 15 minutes before engaging in sexual activity. Finding the correct dosage of topical anaesthetic preparations can be challenging. The penis should be washed well before sexual activity.

The commonly utilised anaesthetic agents are Lidocaine and Prilocaine. In some countries, one can buy premature ejaculation wipes that contain benzocaine, a topical anaesthetic that lowers sensations in the penis.

Excess application may lead to penile numbness and difficulty achieving an erection and ejaculation.

Care must be taken to avoid the anaesthetic entering the partner’s vagina, causing a reduced sensation and leading to difficulty achieving female orgasm. The man using such preparations should always wash his penis thoroughly before sexual intercourse.

What are the side effects of topical anaesthetics?

Although well-tolerated, one can experience the following:

• slight pain
• mild burning sensation
• lowering of libido
• a loss of sensitivity (temporary)
• vaginal numbness
• difficulty in maintaining the erection

The role of food, herbs or supplements in delaying quick ejaculation has not been scientifically proven. Some males would like to explore these options. Always discuss with your doctor for guidance.

Zinc and magnesium supplements

Zinc helps boost testosterone production of testosterone which may help with premature ejaculation. Typically this is taken about four months.

Zinc and magnesium can be found naturally in;

• pumpkin seeds
• kidney beans
• soybeans
• yoghurt
• spinach
• almonds
• chickpeas
• sesame seeds
• dark chocolate
• garlic
• peas

Ayurvedic herbal medicine

kaunch beej, Kamini vidrawan ras, and yauvanamrit vati are commonly taken as stand-alone or combinations.

Chinese herbal medicine

Yimusake tablets or Qilin pills may play a role in enhancing sexual performance.

Treating premature ejaculation can be challenging, but it is a treatable condition for most males. For many men, to delay orgasm is to regain control. Drug therapies play a role, but often the contribution of a sex therapist and cognitive behavioural therapy are fundamental in delaying ejaculation.

This medication is an on-demand selective serotonin reuptake inhibitor (SSRI) specifically designed to treat premature ejaculation. Dapoxetine improved the control over ejaculation and enhanced sexual satisfaction both for him and his partner. 

Dapoxetine is taken 1 to 3 hours before sexual performance. This can only be taken once a day.

Dapoxetine is not recommended for men with cardiac (heart), renal (kidney), and hepatic (liver) problems. It can also interact with other medicines; your doctor will advise you.

Selective serotonin reuptake inhibitors (SSRIs) are primarily used to address depression, so these are not drugs approved explicitly for premature ejaculation. Still, they have been found to delay ejaculation: the commonly prescribed paroxetine (most effective), sertraline and fluoxetine.

Typically demand dosing of these SSRIs is not as effective. Ideally, the medication should be taken 4 to 6 hours before intercourse to achieve a delayed orgasm.

One can take a daily dose, but typically it takes up to 2 weeks before one can judge if there is a positive effect.

Your doctor may prescribe SSRIs daily for six weeks, and then on-demand dosing can be attempted to minimise these side effects.

Common side effects of SSRIs are tiredness, nausea, headaches, loose stools, and excessive sweating. 

These typically are mild and should improve after a couple of weeks.

If Dapoxetine or other SSRIs are contraindicated, one may explore daily dosing alpha-blockers like tamsulosin or silodosin. This drug therapy treats emptying your bladder but may play a role in premature ejaculation.

This is only utilised for patients suffering from premature ejaculation due to erectile dysfunction. Once PDE5i treat erectile dysfunction, Dapoxetine or other SSRIs must be used. PDE5i may help males keep their erection once a rapid orgasm has happened.

Premature ejaculation leads to trouble maintaining an erection eroding the couple's sexual pleasure and one’s self-esteem. In very severe cases of premature ejaculation, when other treatments have failed, penile injection therapy helps patients keep the erection even after ejaculation, and they can resume intercourse.

Whilst this is unlikely to lead to patient content, it might improve a partner’s sexual satisfaction. In some cases, it helps to build an element of confidence.

In most patients, a combination of the treatments mentioned above is the way forward, for example, local anaesthetic therapy with SSRIs.

Written by Mr E Calleja

NHS Consultant, private urologist, robotic surgery