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Treatments:

Include: the squeeze and stop/start techniques, anaesthetic creams, anti- depressant medication and counselling. Acquired and/or situational PE suggests a psychological cause and behavioural treatment [outlined below] and relationship therapy are most appropriate. Lifelong PE suggests a physical cause and medication and/or behavioural treatment are preferred [3].

In many relationships PE causes few if any problems. In others the couple may use various strategies, for example masturbating prior to making love, or having intercourse a second time when they find that control is better. Frequently, however, PE does lead to problems in the relationship where the partner regards the man with PE as selfish and they develop a pattern of sexual avoidance – which makes matters worse because of increased anxiety and greater difficulty in control of ejaculation. It is best if both partners are involved in treatment.

The partner may be male or female, and for convenience and clarity will be referred to here as female.

Being involved helps her to understand that it is not ‘his fault’ and that she can help him to gain control. She should not feel that she is ‘being used’, or that her needs are being ignored during treatment, and realize that she too will benefit once he gains control of ejaculation. In situations where men have become so embarrassed that they are reluctant to form relationships, they can learn to achieve control on their own by using the squeeze and stop/start techniques described below, while stimulating themselves. Once the man has acquired control, and then has a partner she should be involved so that he learns to accept erotic stimulation and control in relation to her.

Squeeze & stop/start technique: [5]
This treatment is based on the fact that orgasm in the man has two phases: at first semen passes from the seminal vesicles [small pouch under the bladder where semen is formed and sperm are stored] and prostate gland into the prostatic urethra [the tube that passes from the bladder through the prostate gland], - this gives the man the feeling of fullness at the base of his penis – called the ‘moment of inevitability’ or ‘point of no return’ [that he is about to ejaculate]. This feeling lasts for 2-4 seconds and is then followed by loss of voluntary control as the surrounding muscles contract and eject the fluid – ejaculation.

Squeeze and stop /start exercises:
The purpose of these exercises is to gain control of ejaculation. Concentrate on feeling and expressing your sensations. This will help to reduce performance anxiety, ‘spectatoring’ [watching yourself with anxiety] and goal orientation, and will increase communication.
The exercise helps both partners to recognize the “moment of inevitability” and to gain control over the ejaculatory reflex, and focuses attention on erotic stimulation. You should control the level of stimulation by guiding your partner with your hand on hers.

Intercourse should not take place during the exercise period.

In a relaxed situation lie on your back and your partner starts to stimulate you slowly. indicate to her to stop [verbally or by gesture] when you reach the moment of inevitability. She then places her thumb on the lower surface of where the shaft of the penis and the glans [tip of the penis] meet, and her middle finger on the top surface of the penis, and her index finger on top of the glans, and applies a sharp and hard squeeze [short of pain] for about 20 seconds to abort ejaculation. This will make you lose the urge to ejaculate, and you may also lose some of the erection which will be regained by further stimulation. [Be careful to use the pads of your [or your partner’s] fingers and avoid scratching the penis with fingernails].

EXERCISES: your partner stimulates you to the ‘point of inevitability’ and then delays ejaculation as follows:

1. Stimulate - squeeze –stimulate -3 times - then bring you to climax.
2. Repeat this exercise on one other occasion.

Once control has been acquired in this way, you can progress to gradually replace the squeeze by the stop/start technique, as the squeeze technique cannot be used during intercourse.
Stop/start means that when you recognize the moment of inevitability you indicate this, and she stops stimulating. Once you lose the urge to ejaculate she starts stimulation again. This pause allows you to get used to the sensation and condition yourself to control the delay of ejaculation

3. Stimulate - squeeze - start - stop - start- squeeze - then bring you to climax.
4. Repeat this exercise on one other occasion.
5. Stimulate- stop – start - squeeze – start – stop - bring you to climax.
6. Repeat this exercise on one other occasion.
7. Stimulate – stop – start – stop – start – stop - bring you to climax.
8. Repeat this exercise using KY jelly or baby oil to increase sensuous feelings.

You can stimulate your partner to orgasm manually/orally if she desires after each exercise.

Once you have confidence that you can indicate the moment of inevitability and that your partner responds to that effectively, and you are both confident that you can control and delay ejaculation, you can incorporate these exercises into sexual intercourse.

SEXUAL INTERCOURSE: After gentle stimulation your partner sits astride in the 'woman - above' position. She stays still while you focus on what you are feeling. When you are in control, signal to her to move gently, and indicate to her to stop when you reach the moment of inevitability. She then keeps absolutely still until you are in control. This is the same effect as the “stop” above. When you are in control, show her that she can move [by using your hands or verbally].
This is repeated 3 or 4 times until you feel in control, and then you can start to thrust as you both feel inclined until you ejaculate. In this way both partners share the gaining of control.
Once control has been mastered, the need for ‘conscious’ control diminishes as you gain confidence. Regular intercourse reduces early ejaculation. Once control of ejaculation has been achieved, intercourse can take place in any position you both choose, and you or your partner herself can continue stimulation of her clitoris while you ‘stop’, so that she continues to be aroused.
Voluntary control is usually gained in 2-6 weeks depending on the severity of the problem and the degree of mutual co-operation, and men are usually able to extend sexual intercourse as long as they desire--- the main thing being that you feel in control. If the problem recurs perhaps under stress, start with basic exercises again.

Anti-depressant medication: provides a new approach to the management of PE. These drugs are known to delay ejaculation as a side effect during treatment of depression, and have been found to be effective in delaying ejaculation in men with PE. Delay of ejaculation usually occurs within 5-10 days of starting treatment [3]. The drugs are safe and well tolerated. Some of the medications that have been used are: Paroxetine, Sertraline, Fluoxetine, Anafranil. These can only be prescribed by medical practitioners. Side effects are minor, start in the first week and gradually disappear within 2-3 weeks. These include: fatigue, mild nausea, loose stools or perspiration [3].

There are two ways to use the medication:

  1. taken on a daily basis. This is thought to achieve the best response [3].
  2. as-needed treatment taken a 4-6 hours before anticipated intercourse. This is effective and well tolerated, but gives less delay of ejaculation than daily treatment. This can be combined with using daily treatment at first and then before intercourse.
Anaesthetic cream, gel or spray: can be applied to the penis to diminish sensitivity and delay ejaculation. This is moderately effective in delaying ejaculation, but sensation is diminished for both partners and can cause vaginal numbness prevent the partner from reaching orgasm, or cause the man to lose his erection. These problems can be reduced by covering the penis with a condom, for 15 minutes prior to entry, during foreplay. Remove the condom, and wipe the penis [so that the partner is not affected]

Medicines used for the treatment of erectile dysfunction [Cialis, Levitra or Viagra]: these are recognized treatments for erectile dysfunction, but may be used for PE if prescribed by a doctor, especially for men who have developed PE following erectile dysfunction. Although the duration of intercourse may not be significantly increased, some studies have reported increased confidence in the perception of controlling ejaculation as well as increased overall sexual satisfaction, and decreased refractory period [recovery time after intercourse] to achieve a second erection after ejaculation [6]. The use of these oral medications can be combined with the anti-depressant medication or anaesthetic cream.

PE can affect the sexual relationship between partners and may lead to rejection, guilt, anger and avoidance, and as effective treatments are available if you feel that this is your problem, then it is important to seek advice, ideally with your partner from a sex therapist or general practitioner. Sexual arousal in women is slower than in men, and couples should be prepared to spend time on foreplay, communicating their feelings and needs. PE can affect the relationship – or your willingness to form a new relationship, so as PE is treatable, you can look forward to an improvement not only in your quality of sex life, but that of your partner as well.

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