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Thinking critically about ‘Premature Ejaculation’

November 19th, 2012

Dr Petra

This post takes a critical look at premature ejaculation (PE). What it is (and isn’t), how to know if you have PE, what you can do about it, and how to avoid scams that exploit men’s anxieties about their sexual functioning. The aim is to help you if you are worried about PE, but also if you work within healthcare, therapy or education to consider different approaches to the way we conceptualise and manage men’s concerns over the timing of their orgasm.

A couple of weeks ago I answered a reader problem about premature ejaculation at The Telegraph’s Wonder Women. The problem and my subsequent advice looked at PE causes, treatments and the problems that may occur if you self medicate with PE drugs purchased online.

In my reply I mentioned ‘edging’ as one method to prolong sexual pleasure. One excellent additional resource on this comes from Cory Silverberg. It may be worth mentioning penis size anxiety and orgasm worries can coexist, so if you are concerned about penis size this resource may help. The reader who wrote to me used the term ‘premature ejaculation’ and I also did the same in my reply. However not everyone agrees this is even an appropriate term to use. Dr. Erwin Haeberle of The Magnus Hirschfeld Archive of Sexology takes issue with this terminology. (Although heterosexual in focus, it is worth watching in terms of how it unpacks ideas about orgasm, ejaculation, erection, and the timing of penetrative sex). Haeberle says we should refer to PE as ‘the unsatisfactory timing of the male orgasm’. Which is a bit less catchy than ‘PE’ but certainly gets to the heart of the problem.

I asked colleagues for feedback on whether my reply was appropriate and detailed enough, and to add their advice about timing/orgasm. Here are their thoughts.

“Breathing. I know it sounds like a basic technique but (as someone who has a tendency to come sooner rather than later), breathing deeply and slowly is something I find helpful. It’s a similar sort of practice as mindfulness, though I would probably find that the exercises mentioned in the mindfulness article would make me come even quicker!”

This comment by T is relevant, as some therapies for dealing with PE have been criticised for serving to draw more attention to the problem – and therefore exacerbating it. If you are worried about coming before you would like to and ‘treatment’ involves either stopping before you ejaculate then resuming sex (stop/start technique) or squeezing the penis as you feel orgasm approaching then you are still very much thinking about trying not to come. Which may make you feel more anxious and increase the chances of you having an orgasm before you want. These techniques are designed to make men feel more in control of their orgasm and therefore reduce anxiety. Which may be the case for some men. For others it may have the opposite effect. Which is why having a range of therapies to suit individual needs (as outlined in my reply) is important. It is worth noting some of the more vocal critics of the squeeze and stop/start techniques are not necessarily those who wish to widen the number of therapeutic options open to men, but those who seek to medicalise this issue and see it solely as a physiological problem that is best managed through drugs as the first (and only) port of call.

Meg Barker
“Nice answer. As usually you strike a good balance between addressing the issue for somebody who is defining this as a problem, and injecting some critical consideration. I especially like ‘ Rethinking how he defines and experiences sex’ – ‘premature for what?’ is a good question! Good to see mindfulness in there. Being present to whatever is going on and accepting it rather than trying to make some things happen, and other things not happen, is generally a good way to go with sex (and life!)”

“It doesn’t help that publications (whatever the publication – I see this in the Graun as well as the Telegraph) usually accompany articles with a picture of someone in agony or misery. Like you say, it’s not necessary a crisis…without meaning to be glib, coming prematurely can be fun/funny in some circumstances, but it’s often painted to represent a total disaster for masculinity. My instinct is that the techniques needed to address PE will be different for different people – which is why it’s good that you gave a list of possibilities to explore. The squeeze technique gets talked about a lot but I have found, as you mention, that it tends to respond to the symptom (ejaculation) whereas what you really want to do is slow down and not get to the point of coming at all. I’d also be interested in responses from other men about their experiences with kegel/PC type exercises for men”.

Leonore Tiefer
“A lot of women adore premature ejaculators. 1) There’s not so much abrasion, 2) They overcompensate in other ways. Whatever happened to diversity?”

Mary Clegg
“I subscribe to a combination of approaches according to how the man describes his unique situation and how it affects his partner. Pelvic floor exercises to understand relaxation and contraction combined with masturbation help as does mindfulness. Being fully present and enjoying the intimacy for its own sake without expectation of end goal is something that may be considered. Martin Steggall’s work is worthy of further investigation as yet unpublished using masturbators. Hope this helps”

Mary’s mentioning of Martin Steggall reminded me of his wonderful essay Premature ejaculation: defining sex in the absence of context which echoes and expands on some of the points set out by Haeberle above.

As this post outlines there are a variety of ways to approach men’s anxieties about the timing of their orgasm. This can range from basic challenging of the ideas of what we mean by ‘premature’ through to sexual techniques, meditation, talking therapies or interventions like using delay condoms or anti depressants (as prescribed by a doctor). One of the biggest problems in this area is men are often not enabled to think about this issue critically and shame or embarrassment about PE can mean men can be exploited and harmed by those selling PE products. Sometimes the problem comes from the product itself being sold that at best wastes money or at worst can cause harm, but sometimes it’s the abusive sales techniques used to sell PE medication that lead to men experiencing distress and anxiety. More information about this can be found here and here. As well as this Cochrane Review Psychosocial interventions for premature ejaculation

The take home message is while ‘PE’ can affect men of all ages, races, and sexualities; quite often the way the media, therapeutic and pharmaceutical industries construct this as a problem can cause unnecessary anxiety or make men feel they have a problem that they may not actually have. Men can also feel there is little help available, whereas there actually is. A lot of it may require self reflection and clear communication with a partner, but seeing this as an insurmountable physiological and psychological crisis is unhelpful and disempowering.

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