Dear Dr G,

I’m 48 years old, married and have a professional job. On the surface, I lead such a perfect life. In reality, I’m having trouble between the sheets.

Every time my wife and I have sex, the intercourse lasts for less than two minutes.

Naturally, I feel ashamed about myself, and also cannot help feeling sorry for my wife.

I’m an active person, but I can’t understand why I still come too fast.

I have tried some supplements recommended by my friends, but still see no improvement.

I’ll like to put Dr G on the spot – Can you tell me why is premature ejaculation happening to someone like me?

From the past articles, I understand you often recommend medication for premature ejaculation.

I am not so keen on drugs, can you recommend exercises or alternative treatment to improve my sex life.

I am really grateful for your help.

Edward

Premature ejaculation (PE) is a sexual dysfunction when a man experiences orgasm ejaculating with minimal penile stimulation, within a shot interval of intercourse. Such sexual dysfunction is termed ejaculatio praecox documented in the historical literature more than one hundred years ago. PE is also coined early ejaculation, rapid climax or premature climax.

Despite medical literature reporting of PE for more than a century, there is no uniform consensus of the cut-off defining “premature”. The “typical” man has the ejaculatory latency of approximately four to eight minutes. The International Classification of Diseases (ICD-10) initially applied the cut-off of 15 seconds from the point of sexual penetration.

However, the International Classification Society for Sexual Medicine (ISSM) endorsed a definition of around one minute of intercourse for PE sufferers. With no clear-cut diagnosis of PE, many men are left confused with their “short cumming”. The exact causes of PE are unknown, and many theories have been proposed.

Some psychologist suggested PE was the result of masturbating quickly during adolescence to avoid being caught. Others highlighted the link of PE with performance anxiety or passive aggression of having too little sex. However, there is really little evidence to support any of these theories, and the sufferers of PE continue to feel frustrated with tremendous degree of guilt and self-doubt.

Research has identified certain parts of the brain as having physiological control of ejaculation, including serotonin neurotransmitter involvement. There is also scientific evidence supporting genetic predisposition, elevated penile sensitivity and nerve conduction defectiveness in men suffering from PE. Hence, various medical developments evolve around such understandings.

In recent years, psychological analysis reported emotional and relationship distress for men suffering from PE. Compared to men, women actually consider PE less of a problem in a relationship. PE-related embarrassment is commonly resulting in sexual avoidance and distancing of relationship, creating unnecessary tensions in the relationship.

Many drugs have been proven to delay orgasm. Despite Dapoxetine being the only approved medication for the treatment of PE, other medications such as anti-depressants and painkillers have been used in the PE intervention with reasonable success.

Culturally, PE sufferers are still reluctant to accept taking medications to enhance sexual experience; many would rather opt for non-pharmaceutical treatment or no intervention at all, until their relationship has reached the point of no return.

Weak pelvic floor muscle is also believed to impair the ability to delay ejaculation. Hence, exercises to strengthen the pelvic floor have been known to improve sexual dysfunction such as PE.

The pause-squeeze technique is another manoeuvre that may come handy to delay the ejaculation. The technique involves beginning sexual activities as usual until one feels almost ready to ejaculate, then pause and having the partner to squeeze the end of the penis at the point where the head joins the shaft. Maintain the squeeze for several seconds until the urge to ejaculate passes. Needless to say, such manoeuvre literally encourages “potong steam” and not so welcumming!

When Dr G is put on the spot, his advice is to accept all interventions with an open mind.

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