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04 Nov 2002

He always orgasms before me...leaves me unsatisfied!
Hi there

My husband has a very high sex drive and me too, but the problem is that he seldom spends enough time on me to help me reach an orgasm. He gets so worked up that he penetrates me and thrusts away, and after cumming he looses all interest in sex for a while - he doesn't even want to cuddle! This situation leave me highly frustrated and unsatisfied, because I need him to spend a bit of time on ME to help me to reach orgasm! I have spoken about this to him, but he says it is something I'll have to live with because it is in his nature to get totally overwhelmed and that he can't stop himself and that he can't help it if he looses interest after he has cum. What can I do?
Answer 237,421 views

01 Jan 0001

On average it takes a man 3 minutes to orgasm, and the woman 14 minutes. So go figure, somewhere in this process we are going to miss each other completely. He is long gone to sleep, when you are left feeling frustrated. My definition of Premature ejaculation is if the man has orgasmed before the woman.

Premature ejaculation (PE):

PE 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 PE:
PE can be caused by physical, psychological or a combination of both factors.

Physical causes of PE:
Through the years many physical causes were linked to PE. However, there are very few medical reasons that have been documented as causing PE.

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 PE.

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 PE 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 PE.

Psychological causes of PE:
For the majority of men with PE, the origin is psychological. It may stem from a first sexual experience, where there is an enormous amount of pressure to perform and PE 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 PE:
Various urban legends exist that claim to treat or cure PE. 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 PE is a treatable condition even though it seems to most men to be a huge problem. Various proven techniques exist for treating PE.

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 goals 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 become 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 the 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 PE through the use of low dose antidepressants including Anafranil, 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 – 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 had proved successful.

Frequently, marital and relationship issues may be an underlying cause of PE. These issues should be addressed in counselling 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 of 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 woman 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 orgasms to get the whole thing over. The benefits of foreplay and clitoral stimulation cannot 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.

Dr Elna McIntosh

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