Premature ejaculation is simply defined as "ejaculation occurring before the individual wishes it". The condition can be temporary - and normal - in inexperienced men, adolescents and men who are too highly excited or who have abstained from sex for a long time. The Hite report on Male Sexuality surveyed over seven thousand men and found that 21% ejaculated within 50-60 seconds and another 62% ejaculated within 1-5 minutes. Only 1 in 6 men lasted over 5 minutes and 1 in 10 over 10 minutes. There is no difference between nations and races, and no difference between circumcised and those men with foreskins. Most men will last longer if they have sex again a little while later, but it can take a man anything from several minutes to several hours to get another erection. In books and movies the male heroes have sex for hours on end, but in real life such men are the minority.

Causes of premature ejaculation

Premature ejaculation can be caused by physical, psychological or a combination of both factors.

Physical causes of premature ejaculation

Through the years many physical causes were linked to premature ejaculation. However, there are very few medical reasons that have been documented as causing premature ejaculation. In the early 1990's, research indicated that the pelvic muscles, specifically the muscles that surround the erectile bodies in the penis, are in a hyperactive state in men with premature ejaculation. Further, it is known that during the ejaculation process there is increased activity of these same muscle groups. Consequently, it is likely that men who have premature ejaculation have hyperactive muscles that are already on their way toward the threshold to producing ejaculations. Recent studies have also shown that infection of the prostate can also cause premature ejaculation.

Psychological causes of premature ejaculation

For the majority of men with premature ejaculation, the origin is psychological. It may stem from a first sexual experience, where there is an enormous of pressure to perform and premature ejaculation occurs. This can cause a feeling of inadequacy that can manifest again as performance anxiety and cause the problem to escalate. This may result in years of feeling inadequate and frustrated. Some men go through their whole lives never really experiencing control of their ejaculation.

Treating premature ejaculation

Various urban legends exist that claim to treat or cure premature ejaculation. Generally speaking these techniques do not work. Examples of such treatments include, getting drunk, using one or more condoms, concentrating on something other than sex while having sex, biting one's cheek as a distraction and frequent masturbation. One must bear in mind that premature ejaculation is a treatable condition even though it seems to most men to be a huge problem. Various proven techniques exist for treating premature ejaculation.

The squeeze method

Developed by Masters and Johnson, this method has the partner stimulate the man's penis until he is close to ejaculation. At the point when he is about to ejaculate, the partner squeezes the penis hard enough to make him partially lose his erection. The goal of this technique is to teach the man to become aware of the sensations leading up to orgasm, and then begin to control and delay his orgasm on his own.

The stop-start method

Stop-start involves the partner stimulating the man's penis, except that when the man instructs, the partner stops stimulating the man's penis before ejaculation becomes inevitable. Then as he feels he regains control, he instructs the partner to begin stimulating his penis again. The couple repeats this exercise three times a week, until the man has good control, then they progress to stop-start with lubrication, and then intercourse with the woman on top and the man not moving. He again instructs her to stop moving when he senses he is losing control. The couple progresses over subsequent times to the having the man move during intercourse in this position and then side by side intercourse. Instead of stopping and starting, the couple may progress to merely slowing down to enable the man to regain control of his urge to ejaculate. While the exercise methods are effective, they both rely on the cooperation of the man's partner, which in some cases may be a problem. For that reason, other methods are used to help the man get control of the sensations leading up to orgasm.

Drug Therapy - Antidepressants

There have been reports in the urology literature of successful treatment of premature ejaculation through the use of low dose antidepressants including Anafronil, Nuzak, and Zoloft. One of the known side effects of these medications when used for depression is significantly delayed ejaculation. In the studies, extremely low doses of the antidepressant medication have prolonged ejaculation by at least 5-10 minutes. The medication is given approximately four hours before intercourse and will result in a significant delay of ejaculation. Some patients have described side effects (drowsiness or nausea) with this treatment.

Drug Therapy – Self-Injection Therapy

Recently doctors have reported significant success using self-injection therapy. Essentially this approach is a self-paced therapy and medication, which over a period of six to twelve weeks will allow one to gain control of the erection rather than the other way around. Within 5 to 10 minutes of administering the medicine to the side of the penis, a full erection will develop that will last for even after ejaculation. This means that even if one ejaculates prematurely, the erection will remain firm so making love can continue. The rationale behind this approach is that it will enable extended penile contact with the vagina thereby "desensitising" the penis. When used in conjunction with the exercise techniques described above this type of therapy has proved successful.

Counseling

Frequently, marital and relationship issues may be an underlying cause of premature ejaculation. These issues should also be addressed in counseling sessions to improve the success of the therapy.

General Advice

Remember that sex is for the pleasure of both partners. The concern of satisfying your partner should mean that sexual intercourse becomes unpleasurable for you. You must get rid or any beliefs that real men make a woman orgasm purely by prolonged thrusting with the penis. This is not true. Most men have read stories or seen movies in which the male heroes thrust away for hours on end and the women have multiple orgasms. But in real life this usually does not happen because almost 75% of women can only have an orgasm by directly stimulating the clitoris. Thus, for the majority of women, a good lover is a man who can stimulate their clitoris, not a man who can thrust away with his penis for ages and ages. Many women find prolonged penile thrusting uncomfortable and they may even fake an orgasm to get the whole thing over. The benefits of foreplay and clitoral stimulation can not be stressed enough. Try to use your manual, oral, or mechanical (a vibrator) stimulation on your partner's clitoris to bring her to orgasm before you even attempt penetration with the penis. This will take the pressure off you to perform.