October 28th, 2010
03:37 PM ET

Men and sex: Survival of the quickest

Even though it’s often the butt of many jokes, premature ejaculation (PE) is no laughing matter. It’s the most common type of sexual dysfunction a man can have, with many  experts estimating that up to 30 percent of men have PE. In my new book Overcoming Premature Ejaculation, I use the latest research to distinguish myth from reality and offer a new approach for managing a condition that has left many men, myself included, feeling like a sexual cripple.

There’s been a lot of disagreement and discussion in the medical community about how we should define PE. But the latest, most widely accepted definition—from the International Society for Sexual Medicine (ISSM)— says that PE is a male sexual dysfunction characterized by:

  • ejaculation that always or nearly always occurs prior to or within about one minute of vaginal penetration;
  • inability to delay ejaculation on all or nearly all vaginal penetrations;
  • and negative personal consequences, such as distress, bother, frustration and/or the avoidance of sexual intimacy.

To say that it’s tough to talk about PE is an understatement. Most guys don’t want to admit that they’ve got any kind of sexual problem, especially one as sensitive as ejaculating too soon. It doesn’t help that stereotypes about PE tend to label it as a problem limited to  teenagers (just take a look at movies like "American Pie" or "Fast Times at Ridgemont High") or selfish jerks (Lorena Bobbitt famously claimed, after cutting off her husband’s penis, “He always has an orgasm and doesn’t wait for me”).

The truth is that PE can happen to anyone. It doesn’t matter how old you are, how much experience you have, or how much you know about sex. What was once believed to be an anxiety disorder is now thought to include not just psychological factors but biological origins as well. Most guys with PE have chronic PE—they’ve never known any other way.

Do you suffer from chronic PE?

1.      Are you unable to control how long you last during sex?

2.      Do you climax within a minute or less of starting intercourse?

3.      Have you tried various methods to deal with PE, only to have your hopes dashed?

4.      Are you dissatisfied with your sex life?

5.      Do you often worry about pleasing your partner?

6.      Does even foreplay often lead to “end of play?”

7.      Do you avoid intimate situations because they could lead to premature ejaculation—so why even bother?

8.      Has PE damaged your relationships with women?

If you answered “yes” to most of these questions, you could have chronic PE. And you’re not alone.

Although the stereotype of PE tends to be a  teenager who can’t control himself, nothing could be further from the truth. Because lifelong PE is chronic, it’s a problem in young and old men alike. It’s true that your ejaculatory control does get a little better with age, but that’s because your body is getting older, not because your PE is improving. In fact many older men with PE face the double whammy of erectile dysfunction.

Researchers now believe there well may be a genetic basis for chronic PE, not unlike congenital heart problems and other conditions present at birth. Studies of twins show an increased risk of PE in families, and one Dutch study found that men with PE were likely to have at least one first-degree relative (such as a father or brother) with PE, too. This tells us it’s possible that PE is has a genetic basis and that your risk for it may be inherited, just as your risk for heart disease and some types of cancer.

In my book Overcoming Premature Ejaculation the  program I recommend is biopsychosocial, or combination therapy, which combines behavioral, medical, and interpersonal approaches. That means there are:

1.      Behavioral techniques - things you can do during sex. For years sex therapists have been advising men that PE can be cured with two techniques that focus on arousal-awareness and postponing climax.  But  in fact, those techniques have limited efficacy. If anything, they often interrupt sex. Instead, I suggest a unique series of sexual positions that allow men to maintain sexual interaction without the interruption of more commonly recommended techniques.

2.      Medical therapies - medications such as SSRIs that  help to delay ejaculation and other medical approaches that are on the near horizon. While pharmaceutical solutions shouldn't be relied upon on their own, they can help guys to get a jump-start on managing PE and developing sexual self-esteem.

3.      Interpersonal methods  - changes to the way you relate during and around sex. For example, many women don't understand PE and often think that men with the condition are sexually selfish. In fact, this couldn't be further from the truth. Men with PE care greatly about their partners' sexual satisfaction, and need to be able explain the issue without shame and develop alternative paths to pleasure with their partners.

For best results, you need a combination of all three. While we can’t cure PE – because there frankly is no cure – we can learn to manage and ultimately “overcome” it.

Ian Kerner is a sexuality counselor and New York Times best-selling author. Read more from him at his website, GoodInBed.

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