Dr. Manu Tiwari, consultant psychiatrist at Fortis Healthcare was happy to answer a few questions for us about the same.
What is Premature Ejaculation?
Premature ejaculation is a sort of sexual dysfunction. Due to various causes, a man may orgasm and ejaculate way faster than is pleasant for both him and his partner. Premature ejaculation causes may be both physical and psychological. Premature ejaculation treatment may, thus, include either therapy or medicine, or both. While a common condition, PE is still rarely discussed and often goes untreated. It is also treatable in most cases. We tell you everything you need to know about getting the right help.
You are a psychiatrist and you handle cases of Premature Ejaculation (PE). Why is this condition treated by 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 counseling 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 upon 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. 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.
Causes of 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 or achieve the big O too soon. 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 this dissatisfaction, they do not talk about sex per se which is the real problem. 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.
Symptoms of Premature Ejaculation
Shame and guilt often shroud discussions around PE. This means men are often inclined to repress their feelings and avoid discussing their condition and, hence, sexual relationships altogether. Often, there is a refusal to accept their condition, which makes it that much harder to treat. Their PE makes them disinterested in sex.
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 very few cases, it is physiological – heightened nerve sensitivity in the penis. This condition affects men in 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’ and not as the alpha male anymore. 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.
Treatment of Premature Ejaculation
Once the symptoms of premature ejaculation are recognized, it’s time to seek professional help. Sex education and therapy usually go a long way in treating the condition. In rare cases, though, medicinal help may be required.
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 the 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. If your partner has PE, 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 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.” It’s clear that premature ejaculation is not an uncommon problem or something that one should be ashamed of. With techniques and medication – the issue can be managed to a great extent. Sexual awareness, education, understanding and openness is essential in this regard. If one is truly bothered by it, one should also consider going to a sexologist or discuss the same with their partner.
