William Aiken

Premature ejaculation (PE) may be managed by a number of methods with varying degrees of success.

Some wine

Prior to seeking medical help, some men discover and report that a number of behavioural adjustments seem to help in ameliorating the condition. These include drinking alcoholic beverages such as wine in moderation (two glasses) prior to engaging in sexual intercourse. This depresses the ejaculatory reflexes thereby prolonging intercourse and has the added benefit of loosening inhibitions. Too much alcohol, however, will depress not only ejaculation but also erections and becomes self-defeating.

Ejaculating some time prior to intercourse through masturbation may make subsequent ejaculation during intercourse more difficult and may prolong intercourse long enough for both partners to experience sexual satisfaction. However, if this is improperly timed too close to the 'main event' then the refractory period (the length of time after ejaculation in which the man is unable to get an erection no matter how much he is sexually stimulated) will prevent sexual intercours and would again be self-defeating.

Some men compensate for their PE by ensuring that their partners are adequately stimulated to the point of orgasm prior to intercourse through manual and/or oral stimulation. Yet others have found that frequently stopping intercourse and changing sexual positions allows sexual tension to decline at intervals, thereby prolonging the time to ejaculation.

Medicated condoms

It is felt by some experts that strengthening of the male pelvic floor muscles through repeated Kegel's exercises helps ejaculatory control if these same muscles are voluntarily contracted as ejaculation nears.

Condoms, medicated with desensitising gels, decrease the intensity of the stimulation experienced by the man, thereby allowing him to take a longer time to build up to the point of ejaculatory inevitability (point of no return). Similarly, local anaesthetic creams or sprays may be applied to the head and shaft of the penis to decrease its sensitivity, successfully prolonging intercourse. However, it's important not to allow these chemicals to get in contact with the vagina as this sex organ may become desensitised as well.

Exercises

Therapeutic interventions include masturbation exercises in which the man focuses on his bodily (primarily genital) sensations as he approaches that point of ejaculatory inevitability and stopping just short, he continues for at least 15 minutes whereupon he may ejaculate if he wishes. The squeeze technique is a modification of this, in which pressure is applied to the crown of the penis after stopping stimulation.

These exercises require a highly motivated man and have not been shown to produce durable results in treating PE. If the man successfully masters these exercises he then graduates to partner-related exercises.

Medication

Concurrent with or in lieu of these exercise assignments, the man may be prescribed a class of drugs called selective serotonin reuptake inhibitors which increase serotonin levels and are highly successful in treating PE, notwithstanding the presence of some distressing side- effects. In treating PE, these drugs are commonly combined with Viagra which offsets their tendency to impair erectile function, especially in the older man. Another drug which is helpful is clomipramine (Anafranil) but tends to be of limited applicability because of unpleasant side-effects such as frequent yawning, drowsiness, upset stomach and tremors.