Good Morning Doctor. You are a psychiatrist and you handle cases of Premature Ejaculation (PE). My first question is, why a psychiatrist rather than a sexologist?
Most men go to a General Practitioner and are referred to us. Premature Ejaculation has a huge psychological component and patients require counselling over a period of time. But many patients do go to sexologists as well.
So PE is mainly a psychological condition?
No. PE is both psychological and physiological. The average time for a man to last is 1 to 3 minutes. The calculation is from the time a man enters the vagina to ejaculation. It is PE only when ejaculating in less than 1 minute or before entering or on merely touching the vagina.
A man will approach us with a self-diagnosis problem of PE. He has heard his friends brag about how long they last. Or he has seen porn where men go on and on. Or he has read something on the Internet. So he is convinced he has PE if he can’t last 5 minutes or more.
Yesterday we heard from someone who's been suffering from Premature Ejaculation about the effect it has on his sexual life, as well as other aspects of his life (full story here.) Here's what the expert has to say.
Self-diagnosis is a huge problem. Once people believe
they have PE, they suffer both psychologically and
sexually. And about 80% of men who suffer don’t
actually have Premature Ejaculation.
Men believe sex is just intercourse, unlike women who consider foreplay, intercourse and after play as sex. Hence men are acutely aware of the time factor and are susceptible to falling prey to the notion that they are not ‘man enough’ if they don’t last long.
Porn fuels this belief. People forget porn is a movie…it is staged and edited. It’s not one take. It is shot over many sessions stitched together as one episode of intercourse.
Is porn the only thing fuelling incorrect self-diagnosis?
Often, lack of satisfaction and contentment is interpreted as PE, whereas the reason might be poor quality of sex life. A couple might be experiencing other issues that lead to either partner being dissatisfied. While couples might express the dissatisfaction, they do not talk about sex per se. This often leads to misinterpretation.
Some sex-related myths cause PE too. Many men believe that too much masturbation when young makes the penis sensitive and causes PE. This leads to guilt and shame and that fuels PE.
What about men who do suffer from PE? What are the symptoms and how does the condition affect them?
As I said, ejaculating in less than a minute is considered PE. It is caused by stress, anxiety, performance pressure, overexcitement, overstimulation, or sex after a long time. In a very few cases it is physiological – heightened nerve sensitivity in the penis.
This condition affects men is various ways. It’s not just sex life that suffers. Male pride is deflated because it is so intertwined with ‘lasting’. Their confidence is shattered and they start seeing themselves as ‘weak’. Their self-worth nosedives. They start avoiding sex, which fuels stress, which worsens the condition.
Shame and self-hatred become dominant emotions and
lack of confidence often gets transmitted to other areas
of life completely unrelated to sex.
So how do you treat the condition?
Sex education is always the first step. Most people are misinformed. For some men, getting correct information helps. Understanding that sex is more than just intercourse, especially for women, dramatically improves performance and satisfaction. It helps reduce sex-related stress and that has a positive impact.
We also tell people how to last longer by managing sex positions. Avoid the missionary position, as it provides maximum stimulation. The ‘woman on top’ position is very useful, because stimulation is reduced and the woman can control the thrusting.
Another technique that helps delay ejaculation is the squeeze and start-stop technique. The man should pull out when he feels like ejaculating and let the partner squeeze the penis. Then he can continue after a while.
This will require an understanding partner…
Indeed. A partner who understands and is willing to help is a must. Making fun of the man is counterproductive. PE is frustrating for both partners and both will benefit from working to manage it.
Another technique for the man is to distract himself, think about ‘unexciting things’. This lowers arousal. The idea is to take attention away from your sensations. Sensations can also be lowered by using condoms with thicker walls, or ones especially made to reduce sensitivity and delay ejaculation.
One very important thing couples can do is to leverage the Latent Period between ejaculation and the next erection. A man can masturbate 15-20 minutes before sex. The organ takes an average of 15 minutes to be re-stimulated, and the second ejaculation is a delayed one.
What about men who have sensitive nerves?
For such men – a minority – we prescribe medicines that help manage the condition.
On an average, men take 3 months to learn and practice various techniques. But most who think they have PE improve after they are given information. Sex education is key.
Dr Manu Tiwari is Senior Consultant Psychiatrist,
Fortis Escorts Heart Institute, Delhi.