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Allan Schwartz, Ph.D.Allan Schwartz, Ph.D.
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The Problem of Premature Ejaculation

Allan Schwartz, LCSW, Ph.D. Updated: Nov 22nd 2013

The Problem of Premature EjaculationOne of the most frustrating sexual problems some couples face is what is known as premature ejaculation (PE). While any man can experience this problem from time to time it is when it's persistent that it's a problem. Dr. Dombeck, clinical psychologist and former director of Mental Help Net defines premature ejaculation as: "Persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it."

Little is known about what causes premature ejaculation (PE). However, there are many theories that range from the psychological to the biological.  For example, it is suspected that PE may have something to do with serotonin in the brain. Serotonin is a neurotransmitter or a brain chemical that has a lot to do with feelings of pleasure. If there is an over or under supply of serotonin it could be a causal factor in PE. On the other hand, it's thought that, for some men, premature ejaculation may have been somehow learned or conditioned into becoming a problem. For example, the theory goes that, if a boy was masturbating and was doing it very fast so as not to get caught, his quickness might have caused PE. There is no evidence to support that theory or that it is a learned behavior. It is also thought that depression or anxiety may be a causal factor but, here to, there is little evidence to support that theory.

Whatever the causes, it is thought that at least one out of five men experience this sexual dysfunction. It can happen to anyone at any age in life. Contrary to popular belief, older men can experience this problem as much as younger men.

In terms of treatment, there are several approaches that can be taken. Because there is the possibility that the brain's neurotransmitters may be implicated in PE, medications such as the SSRI's have been prescribed. These are among the class of drugs used to treat depression. One of the side effects of the SSRI's is that it is more difficult for the patient to orgasm. It's possible that this negative side effect may actually help those with PE by delaying ejaculation.

It's also important to know that medication treatment is accompanied by behavioral therapy. This is referred to as sex therapy. There are licensed sex therapists who provide this type of therapy. This therapy is used to teach several techniques that help the couple delay the male's ejaculation. Therefore, it's important that the therapy be conducted with couples rather than the man alone. One method that the couple learns is for the female to squeeze the penis when her partner is about to ejaculate, forcing a delay of the orgasm. This is repeated several times until penile sensitivity is reduced, giving the male greater control to delay the process.

There are also self help techniques that a couple can use. Fore example, the male can masturbate two to three hours prior to having sex resulting in the reduction of penile sensitivity and, therefore, delayed ejaculation during intercourse. In addition, after an occurrence of PE it is suggested that the couple try again. Here, too, with reduced sensitivity, the male becomes better able to control and delay ejaculation.

It is most important that, in coping with this problem, that couples have patience with one another. Most certainly, PE arouses much anxiety and tension for couples struggling with this problem. There is help available and the first place to start, if professional help is needed, is with a medical doctor. That can and should be followed up with behavioral therapy that includes sex therapy.

Allan N. Schwartz, PhD

Allan Schwartz, LCSW, Ph.D.

Readers who live in the Boulder, Colorado metro area, or in Southwest Florida may contact Dr. Schwartz for face-to-face consultation. He is also available for psychotherapy through Skype video for those who are not in Florida or Colorado. He can be reached via email at for details.

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