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Premature or Rapid Ejaculation
(05/04/2004) by Robert W. Birch, Ph.D.
A lot of men and/or their partners wish they were able to prolong their
sexual encounters. Lack of ejaculatory control might, in fact, be the number one sexual
complaint among men under the age of 50. The details of the complaint vary greatly though.
Concerns range from the man who will ejaculate within seconds, at the first touch or just
prior to penetration, to the man who is able to receive oral and manual stimulation
without ejaculating, but with intercourse will orgasm within a minute. There are men who
report being quick to ejaculate from their very first sexual encounter and remain so.
There are men who report having been quick during early sexual encounters but somehow
gained control until suddenly losing control again. Then there are men who seem never ever
to have been bothered by an untimely ejaculation. Obviously there is not just one type of
ejaculatory concern.
"Premature" or "rapid" ejaculation is also relative to the man
and/or his partner's expectations. There are men who are able to thrust for 5 minutes
before ejaculating and complain because they had hoped to last another 25 minutes. There
are men who last 20 minutes but their partners complain that they did not wait for her --
or worse yet, draw comparisons with her last lover who had set a record for marathon
thrusting. Consider another couple who plays for an hour after a very romantic evening. In
the course of love play the man manually and then orally stimulates his partner who, in
response, has three orgasms. He then mounts, thrusting hard and deep, and ejaculates in
about 45 seconds. This couple then holds each other in the afterglow of their intimate
exchange, telling each other how wonderful the lovemaking had been. Does this man have a
problem? Not if both are happy with the encounter. What if he moves on to another
relationship and the next woman is not comfortable receiving oral stimulation to orgasm
and expects 10 minutes of coital thrusting! These examples make it clear that a man's
expectations and/or the expectations of his partner(s) have something to do with his
labeling himself as having a problem.
In the past, premature ejaculation was defined by the percent of times the man
ejaculates during intercourse before his partner does. There is, however, a major problem
with defining a man's ejaculatory control in terms of his partner's orgasmic frequency
during intercourse. It has been clearly demonstrated that the majority of women (perhaps
around 65%) are unable to orgasm with the stimulation of intercourse alone... never could
and probably never will. For most women the vagina is significantly less sensitive than
the clitoris, which is not always stimulated in most coital positions. A fair number of
the roughly 35% of women who can make it during intercourse do so by combining clitoral
stimulation with what they are experiencing vaginally. It is fortunate that some positions
that work best for the woman are the same in which a man might exercise better control of
his ejaculatory process. I have illustrated these positions in my book, MALE SEXUAL
ENDURANCE: A Man's Book about Ejaculatory Control but I
will say more of the advantages of the female superior position later.
You might now ask, "What is normal or typical?" Let's first, however,
consider the question, "What is natural?" In nature the purpose of sex is
procreation, and this process is accomplished by the deposit of sperm deep in the vagina,
independent of the time it takes to do so (or, for that matter, the partner's
satisfaction). Our primate cousins, the apes, chimps and monkey, ejaculated in seconds.
As human beings, however, sex is more often for recreation, typically with great pains
being taken to prevent pregnancy. Sex for humans is an expression of love, a sharing of
intimacy, a form of communication, and often we feel it is an expression of our manhood or
womanhood. We have a certain investment in being good at it! However, it appears natural
for a man to move toward vaginal intercourse, thrust upon penetration, and ejaculate
quickly.
This brings us to the question, then, about normalcy. It is my position that it is
normal for men to sense an urge to ejaculate quickly and feel the need to exercise some
control. We'll finally look at the question now of "What is typical?" Although
averages stated vary a bit from study to study, it would appear safe to say that the
average healthy male under 30, with steady vaginal thrusting, will ejaculate in 1 to 3
minutes, not 15 minutes as most men would wish.
There are factors that influence how quickly a man will ejaculate. The younger the man,
the more likely it is that he will ejaculate quicker. The more excited the man, the
quicker he is likely to be, and related to this, the more novel and exciting the partner,
the greater the tendency to orgasm rapidly. Also, the longer the time since his last
ejaculation, the greater the loss of control. Furthermore, the more active and rapid the
thrusting, the sooner he is likely to reach the point of ejaculatory inevitability - that
point of no return. It also seems clear that the more worried or anxious the man, the
shorter his fuse will be. In summary, the man at greatest risk of ejaculating quickly is
the young man who is with a new partner after a long dry spell and is very excited, but
very nervous, as he penetrates and thrusts steadily and rapidly.
Men have tried many things to slow themselves down. Makers of the desensitizing creams
have made fortunes because men believe that if they numb the end of their penis they will
last longer. However, most men are disappointed with these over-priced creams, as the
ejaculatory reflex is much more complicated than just superficial nerve endings. Someone
once said that our largest sex organ is not between our legs, but rather between our ears.
There is a lot of complicated neurology between the end of a penis and the top of the
man's brain! More recently, physicians have been prescribing medications that have been
found to have ejaculatory retardation as a side effect, but as a behavioral therapist I
have a problem with this. Even if such medication does work (and it often does not), it
will "cure" nothing. The man can't take it for a lifetime, and in relying on the
magic pill will never learn how to manage his ejaculatory process in a way to prolong the
pleasure both he and his partner experience. Condoms might help (and should always be worn
in the practice of safer sex), but in a long-term committed relationship, condoms may be a
nuisance unless being worn for contraceptive purposes.
Unfortunately, much effort by well-intended sex therapists has been wasted, for many of
my colleagues have not understood the dynamics of the natural ejaculatory response nor the
important learning components of gaining better management of the process. In part, the
difficulty has been with them viewing rapid ejaculation (a term I prefer over premature
ejaculation) as a pathological condition rather than a natural one. Rapid ejaculation has
been grouped with the sexual dysfunctions, even though it is quite common and the majority
of young excited males will ejaculate rapidly at least in the early encounters with a
responsive and novel partner. Calling it a dysfunction is essentially turning a natural
process into an illness. In the medical model of thinking, if there is an illness, there
is hopefully a cure. Thus we find many self-help books promising a cure in from 4 to 8
weeks! If it is a natural and fairly typical response, what is there to cure? I am not
surprised to learn that a three-year follow-up study has shown that a significant number
of the men thought to be "cured," end up right back where they started from
before beginning treatment. Something is missing in the routine prescription of behavioral
homework given with the promise that faithful compliance will effect a lasting life-long
remedy. Just doing the prescribed exercises will not change anything over the long run if
the man does not learn something new.
It may well be that some men are just more sensitive than others. There is no cure for
what is just one more of the multitude of individual differences we find among people.
However, I had mentioned earlier two very common features of men who consistently
ejaculate rapidly: High sexual excitement and high psychological anxiety. If a man is to
learn an effective strategy for managing his ejaculatory response, he must not allow
himself to become overly excited. Yes, ejaculatory control will cost a man something, for
he cannot get caught up in crazy-wild passion without dashing uncontrollably toward that
point of ejaculatory inevitability. Increasing the frequency of ejaculation, either with a
partner or through self-stimulation can help. Also staying relaxed both in mind and body
is very important.
There is a series of step by step exercises "prescribed' by sex therapists called
the start-stop method, but it is not simply starting and stopping that helps a man gain
control. The man must focus in on his steady progression toward the inevitable, that point
of no return. He must identify all the internal indicators that he is approaching that
threshold where his body will automatically take over and propel him to orgasm. This
requires relaxation and concentration. He cannot be thinking of his partner's response nor
even looking at her body. He must stay within himself and feel his process unfolding. Then
he must stop before reaching the point of ejaculatory inevitability. Typically the
instructions are to start and stop four or five times before "letting go" and
ejaculating. I always remind men to identify what that psychological/physical
"letting go" really involves. The start-stop procedure works best with a
committed and giving partner whom is willing to take the time to help. Typically the
"homework" starts with manual stimulation with a dry hand.
After a few such encounters, a lubricant is introduced, but the stimulation is still
manual. If all is going well, after several such episodes oral stimulation is suggested if
the woman is comfortable performing fellatio. Remember, with each of these steps, the
stimulation is started and, as the point of no return is approached, the stimulation is
stopped. The man must not allow his partner to begin again until he is absolutely sure he
is back under control, even if this means he is beginning to lose some of his firmness. It
is just as important to know when to start in again as it is to know when to stop! Time
and space does not allow a full and more detailed description of the behaviors and
attitudes recommended in this exercise, but more information can be found in written
accounts such as MALE SEXUAL ENDURANCE: A Man's Book about
Ejaculatory Control and in videos, such as You
Can Last Longer.
I strongly endorse oral stimulation for the woman and feel that this is a wonderful
gift a man can give in exchange to the partner who is patiently doing her part in the
start-stop exercises. My book, ORAL CARESS: A Loving Guide to Exciting a
Woman, talks at length about this intimate act of
giving.
Once a man feels that he has learned to anticipate the point of inevitability, feels
that his excitement is more controlled, and has learned to relax, he should begin the next
step. While lying on his back perfectly relaxed and motionless, as before, but now, after
one or two starts and stops with manual stimulation as the partner straddles his legs, she
should rise up, lift and insert the penis, and sit down on her partner as she incorporates
him into her vagina. She should not move, nor should he! This is likely to be very
exciting and they must wait until the man is absolutely sure that he is back under
control. The woman should then begin to move as the man lies quietly, keeping track of
where he is in his progression toward orgasm.
Many therapists will not be any more specific, allowing the woman to figure out on her
own just how she should move. My recommendation is always that the woman not move up and
down, but rather to lean forward and slide from front to back. In this way the stimulation
received from the tighter opening of her vagina is concentrated at the base of his penis,
as opposed to it sliding up and down the length of it. The man must stay still,
concentrating on his progression. In this female superior position, the woman can now
focus on her clitoris to determine if she can, in sliding, receive clitoral stimulation as
she controls the movement.
Most self-help books would say something like "After 4 to 8 weeks of this
homework, ejaculatory control is gained." At this point many men believe they must be
cured, forget anything that they might have learned and begin thrusting away as though
they should now last forever. Once they again feel out of control their anxiety returns
and it's down hill from there. It is my belief that men must learn to monitor their
ejaculatory process as standard procedure during any sexual encounter, from now until they
die or reach the age when sex becomes unimportant. It is my belief that the male superior
position in which the man is on top and thrusting with long rapid strokes is great fun,
but it will be brief and the majority of woman are not going to orgasm with this. The
couple who work at mastering the female superior position, starting and stopping as
needed, are more likely to prolong intercourse and it is more likely that the woman will
find more clitoral pleasure... and perhaps orgasm in the process. Some couples have found
over time that the woman actually will orgasm in this position before the man, at which
point he may elect to finish in his favorite position. The rapid ejaculator is and always
will be the master of quickies and when a partner says "This one's on me," it's
dealer's choice!
In my book I endorse the use of vibrators during intercourse and have several
illustrations of positions in which the woman can be stimulated while the man waits,
casually thrusting until his partner signals she is about to climax. The rapid ejaculator
typically has no problem catching up to join her in a simultaneous orgasm. This article appears in the following topics:
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