Whether we are talking about Usain Bolt, Lewis Hamilton or the Flash, the title of fastest man on earth comes with quite some prestige. But when we are talking about your bedroom game coming second usually puts you in the winners circle. 

If you hadn’t guessed it already, we are talking about premature ejaculation (PE). This will affect most men at some point during their lives but the focus here is on recurrent or recently acquired regular PE.

What is premature ejaculation?

Premature ejaculation is when a male ejaculates, i.e. cums, too quickly to achieve a satisfactory sexual experience for both him and his partner, it usually occurs immediately after or close to penetration. 

While there is no official time that classifies ejaculation as too soon, it is generally agreed upon that ejaculation before the two-minute mark counts. The result is both parties having an unsatisfactory sex life (not ideal) and recurrent PE results in a significant loss of libido and distress for everyone involved (also not ideal). 

There are two main types of premature ejaculation: primary or lifelong, occurring with the first sexual experience and continuing since; and secondary, where there are periods of normal sexual activity after which PE occurs.

While not much is known as to why some men get it and some don’t, we do have a better idea about the factors that affect it. Newer evidence suggests that there are some genetic components to PE, however it is best to note that this is tied into mental and psychological health aspects, so watch this space.  

What impacts premature ejaculation?

Age 

Including chronological age and sexual experience age. The less you have had sex, the more excited you tend to be and as such you finish faster. While PE in younger males is common, it usually resolves with a bit more *cough* practice.

Psychological factors

There are a number of factors at play here but primarily anxiety has a major role for most men. This includes performance anxiety relating to not satisfying your partner or previous incidence of PE, and worry and anxiety over been caught having sex such as in teenage relationships, share house situations and affairs. 

Less talked about in men but still critical is previous sexual trauma and abuse. Sexual assault is one factor and a history of sexual partners who have belittled or dominated a sexual experience significantly affect future performance. 

Stress

Tie it in with anxiety and you have a PE cocktail. This includes stress relating to work, family and relationships, and will all take a toll on libido, sexual drive and function.

Penile sensitivity

This is a big one, no pun intended, and is currently the only issue that has an easy medical treatment available. The penis is sensitive and the glans penis can have increased sensitivity due to a number of reasons. If it is a bit too sensitive then once touching or penetration occurs, ejaculation follows quickly. 

Other health issues

Obesity, heart disease, diabetes, depression, the list goes on. Because so much of our physical and mental health affects our sexual health, it is critical to deal with all other factors to help improve the symptoms of PE. A classic example is if a man suffers from erectile dysfunction and as a result tries to finish quickly before the erection is lost – treat the ED first, and then the PE should reduce. 

What can be done to fix the situation?

• Medication. To touch on it briefly there are many medications available to help reduce the symptoms of PE but most are focused on other areas and any improvement in the bedroom is a bonus. Typical examples are anti-depressants and anti-anxiety medications. While these may help with the psychological stresses, this reduction in stress may enable longer lasting intercourse. 
• Desensitising gels, sprays, condoms and toys. Like it says on the packet, the idea here is simple: if the penis is extra sensitive, numb it up and it will take longer for you to experience enough stimulation to create orgasm. There are a number of products on the market today that promise the ability of longer lasting sex, most of these gels have natural or synthetic ingredients that mimic lignocaine – a topical anaesthetic. While these do work, they also reduce the general enjoyment for the user, and using a topical application without a condom can also affect your partner. In a similar category to the gels are cock-rings or penile shaft rings, worn at the base of the penis that restrict blood flow once an erection is achieved. The use of these rings can also delay orgasm by restricting the movement of both blood and ejaculatory fluid.
• Counselling. Talking these issues over with your partner and a professional, and dealing with any of the background issues that may have an impact, are important. There are a number of very experienced counsellors and sex therapists who are able to help you overcome previous trauma, sexual inadequacies and life stresses to reduce the mental load and effect on performance.
• Training and edging. I’m hoping that you lasted long enough to reach this point as it may just be the most critical and valuable tool in your toolbox to help reduce PE. Everything mentioned above is critical and if you are in need of help with your mental health it is vital to sort that out first, but helping to reduce PE does have some perks to it too. The idea of controlling ejaculation is not new and has been used for generations to help men improve their sexual performance.
  • Edging: there are many names for this technique and it is the easiest to apply. In basic terms the male will be taken to a point of high arousal and almost to the point of climax and then left to relax before climax to help improve endurance. This can be done with penetration and pull out, masturbation or manual stimulation from a partner. The reason why this technique is popular is that once ejaculation control is achieved many couples adopt this technique to create a bigger and more satisfying orgasm in future intercourse.     
  • Penile sleeves, male masturbators and fleshlights: while newer to the market the idea is simple, a silicon sleeve that mimics a vagina, anal or oral opening, often modelled on adult film favourites. These devices have different openings and internal textures, and allow the same training approach as above. As these devices can be used alone or with a partner it is possible to help improve the sexual dialogue in a relationship and both partners can climax in different ways, helping to restore a fulfilling sexual relationship.
• Pelvic floor: the muscles that help to control orgasm are all based in the pelvic floor, and doing specific exercises to help improve pelvic floor muscle tone allows for improved endurance and also a better awareness of onset of climax to allow for a down regulation of ejaculation. If you need a simple way to activate the pelvic floor try this – in a standing position, try to pull the penis inwards, a feeling of shortening the penis. If you feel a tightness from the penis toward the anus you are doing it well. During intercourse this same ‘tightening’ sensation can be used to delay the onset of ejaculation.   

With the right support network, the right treatment and the understanding support of a partner it is very possible to overcome it and move forward with one’s sex life. 

This article was contributed by Alex Mackay, a Senior Physiotherapist who specialises in musculoskeletal, pelvic health and pelvic pain at Brisbane’s Ironside Sports and Physiotherapy.  If you want to hear more from Alex you can follow him on Twitter @MackayPhysio.