PREMATURE EJACULATION COUNSELLING

Premature ejaculation (PE), rapid ejaculation, or cumming too soon, is the term used for the lack of ejaculatory control. It is one of the common sexual issues faced by men. Premature ejaculation can occur for any man at any time. However, for some men premature ejaculation is persistent problem resulting in embarrassment and sexual dissatisfaction for the individual and his partner. Premature ejaculation can occur before penetration (during foreplay or oral sex) or not long after penetration. Some men may experience premature ejaculation only with a partner, while other men also experience premature ejaculation during masturbation.

Some men may experience premature ejaculation during times of high stress. This times maybe characterised by stress at work or in the relationship, or even other daily pressures. Other men may experience premature ejaculation during a period extreme (high) arousal as a result of nervousness with a new partner or different sexual activity. One off occurrences of premature ejaculation are not a problem and can be quite common. If the premature ejaculation persists contact Dr Christopher Fox to discuss your options.

In a majority of the cases premature ejaculation has a psychosocial element. Premature ejaculation means that you do not yet know your ‘point of inevitability’ – the signs that tell you that you are about to orgasm. As a result, you might ejaculate before penetration, or soon afterwards.

If you would like premature ejaculation counselling and believe you are achieving orgasm too soon (premature ejaculation) and this results in distress to you and/or partner, you need to talk to Dr Christopher Fox.

Use the links below to learn more about premature ejaculation and its treatment.

HOW IS PREMATURE EJACULATION DIAGNOSED?

There are no real tests for premature ejaculation. Initial diagnosis is based on the man’s self-reporting. Many men who present at my clinics report having PE, yet on further exploration the individual is lasting around 7-10 minutes and is achieving orgasm before their partner – this is not to be confused with PE. In this situation I work with both partners to improve their sex life.

The Diagnostic and Statistical Manual defines PE as:

Ejaculation occurring, without control, on or shortly after penetration and before the person wishes it, causing marked distress or interpersonal difficulty1.

This definition does not include the intravaginal [anal] ejaculatory latency time (IELT), or the time from penetration to ejaculation, which some believe is an important element. The International Society of Sexual Medicine therefore offers the following criteria for diagnosis:

Ejaculation that always or nearly always occurs before or within about one minute of vaginal penetration; and inability to delay ejaculation on all or nearly all vaginal penetrations; and negative personal consequences, such as distress, bother, frustration and/or the avoidance of sexual intimacy2.

The Premature Ejaculation Diagnostic Tool

The following questions may help you decide if you are experiencing PE. These questions do not diagnose the presence of PE only provide a guide. You need to discuss your issue with Dr Christopher Fox.

Not at all difficult Somewhat difficultModerately difficultVery difficultExtremely difficult
How difficult is it for you to delay ejaculation?01234
 Almost never or never
0%
Less than half the time
25%
About half the time
50%
More than half the time
75%
Almost always or always
100%
Do you ejaculate before you want to?01234
Do you ejaculate with very little stimulation?01234
 Not at allSlightlyModeratelyVeryExtremely
Do you feel frustrated because of ejaculating before you want to?01234
How concerned are you that your time to ejaculation leaves your partner sexually unfilled?01234

Pfizer Ltd ©: 27 July 2005; Simmonds et al. (2007) 3

Add up your score.

Understanding your score

If you scored:

11 or higher – is commonly found in men with PE. This score is not, on its own, adequate to diagnose PE without a professional assessment, it is suggestive of PE. Please call Dr Christopher for further assistance.
8 or 9 – may be found in men with PE. This is considered a “borderline” score. You may gain from talking to someone – give Dr Christopher a call today.
8 or less – suggests that a man does not have PE.

Primary or Secondary PE?

Diagnosis with PE is accompanied with the terms primary (or lifelong), or secondary (acquired). Lifelong or a primary diagnosis is as the term suggests the presence of PE since the first or early sexual experiences.

Acquired or secondary diagnosis is when PE has been present at some point later than the first or early sexual experiences.

HOW LONG SHOULD I LAST?

There is no definitive answer. Each person is different and each time we have sex or masturbate is different. The research of Alfred Kinsey in the 19740s, suggests that approximately 48% of men and 52% of women achieved orgasm through intercourse within five minutes4. Around 23% of men and 19% of women reported lasting longer than 10 minutes. These data are old and many questions have been raised about Kinsey’ work and its validity.

A survey of Canadian and American sex therapists ideas about how long sex “should” last, reported that average time for heterosexual intercourse was around 7 minutes, with 3 to 7 minutes considered adequate5. One to two minutes was considered to be too short while 10 to 13 minutes was considered too long.

A recent Australian study results indicate that of 420 men who reported on time to ejaculation, approximately one-quarter (n = 101) reported ejaculation within two minutes of penetration and three-quarters of the participants reported lasting two minutes or more. The following table contains data about duration of penetration to ejaculation.

Duration of penetrationLess than 1 min1-2 mins2-5 mins5-10 mins10-20 minsLonger than 20 mins
%10142230176

Adapted from Harrison et al (2013)6

Given the variety in sexual functioning, sexual need, and that each person and time we have sex is different, there is no answer. It is more important to focus on satisfaction of both partners and to remember sex is an experience and is more than just intercourse – foreplay is important too.

    HOW COMMON IS PREMATURE EJACULATION?

    According to results of the Australian Study of Health and Relationship, 23.8% of the 8,517 men sampled reported they “came too quickly”7. The rate of reporting is consistent across the age groups with the exception of men between 16 and 19 years.

      Age Group16-19 yrs
      n = 395
      20-29 yrs
      n = 1,912
      30-39 yrs
      n = 2,271
      40-49 yrs
      n = 2,054
      50-59 yrs
      n = 1,735
      %15.323.625.624.025.7

       

      What Causes Premature Ejaculation?

      The causes of PE are different for each individual. For some individuals, the onset of PE is related to masturbatory and sexual techniques from their early years. The presence of lifelong (or primary) PE could also be a result of a chemical imbalance which leaves the man with lower ejaculatory threshold which means these men require less stimulation to achieve orgasm.

      The number one underlying cause is anxiety and sometimes performance anxiety. Although this could also be an outcome. A man with PE can be trapped in a cycle of anxiety affecting his performance and his performance affecting his anxiety.

      The presence of anxiety may or may not be related to sex. Performance anxiety is worry and concern about how one might perform sexually – Am I good Lover? Am I good at sex?. It can also be related to a new relationship or sexual partner, or specific or new sexual act.

      Sexual anxiety can also play role through beliefs about sex, knowledge of sex and sexuality. Anxiety may also be a result of religious beliefs – even though you might not be practicing your religion.

      Life stressors can also be an underlying cause of PE. Many men underestimate the impact of “life” on their sexual life. Remember a healthy life includes a healthy sex life. If a man is experiencing stress in his life it will impact on his sex life. Experiences of (temporary) depression, stress over finances, or work can result in PE. As can the presence of unrealistic expectations about life (or sex), sexual repression, and/or a lack of self-confidence or low self-esteem (or sexual esteem).

      Relationship issues also impact on PE. If there is stress in the relationship, hurt feelings or a lack of communication, a man may experience PE. The presence of PE can also be related to issues in the relationship and another cycle begins.

      The number one underlying is anxiety and stress. These may be sex-related or be about life more general. Through therapy you will learn to identify the “causes” and how to deal with them.

        WHAT DOES PREMATURE EJACULATION THERAPY INVOLVE?

        Through therapy I help you learn how to identify your ‘point of inevitability’ and manage your level of sexual excitement so that you can control when you ejaculate. The initial session is a history-taking session where I collect information to assist in the planning of therapy. We will discuss the issues, how long it has been present, what you have tried in the past, and how it is affecting you. In this session, you will also be provided with some information abut PE and be given some simple “home-work” exercises to take away with you.

        If you are in a relationship, and your partner is with you then your partner will also be part of the process. If your partner has not attended this initial session we will invite them in at the next or later session. Premature ejaculation also affects the relationship and your partner.

        After our first session I will discuss with you the “treatment plan” or how we will move forward. Future therapy may include stress management techniques, anxiety-management techniques, and relaxation. Therapy will also involve you doing other “home-work” exercises including masturbating exercises. Therapy will incorporate such techniques as “stop/start”, “squeeze” and breathing exercises and pelvic floor exercises to assist in increasing ejaculatory control and increase the sensitivity/arousal threshold.

        WHAT OUTCOMES AND BENEFITS CAN I EXPECT FROM THERAPY FOR PREMATURE EJACULATION?

        Through therapy for PE you may learn:

        • The underlying cause/s of PE
        • Techniques to improve ejaculatory control
        • Tools for anxiety management
        • Increased sexual and self-esteem
        • Techniques for improving your sex life
        • Stress reduction tools

        DO SELF-HELP BOOKS OR ONLINE THERAPY PROGRAMS WORK?

        The short answer is these resources may help. I have worked with men who first try to use a self-help book or purchased a subscription to an online therapy program for PE. These men have not reported success because without the the support of a therapist some of the necessary “work” does not happen. These resources often focus on behavioural techniques and exercises which will help with your “thinking”. Yet they cannot replace the important work of the therapist.

          FURTHER INFORMATION ON DELAYED EJACULATION

          Delayed Ejaculation @ Andrology Australia
          Delayed Ejaculation @ Medline Plus

          Delayed Ejaculation @ International Society of Sexual Medicine

          References
          Baum, N. (n.d.). Causes of Delayed Ejaculation. Accessed 12/01/14 from http://www.make-love-easily.com/index.html
          McMahon, C. (2012). Delayed ejaculation: A management challenge. Medicine Today, 13, 8, 50-57.
          Strassberg, D. S., & Perelman, M. A. (2009). Sexual dysfunctions. In P. H. Blaney & T. Millon (Eds.), Oxford textbook of psychopathology (2nd ed.), (pp. 399–430). NY: Oxford University Press
          Vorvick, L.J. (2012). Delayed ejaculation. Medline. Accessed 12/01/14 from http://www.nlm.nih.gov/medlineplus/ency/article/001954.htm

          DISCLAIMER: The information contained on this website should be read as general in nature and only provides an overview of the subject matter. It should not be used as a substitute for medical and/or other professional advice. Also consult a trained professional psychosexual therapist or other healthcare provider.

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          Experiencing difficulties in your sex life or relationship?

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          Dr. Christopher Fox and the team at Sex Life Therapy provide confidential and individualised sex therapy and relationship therapy to individuals and couples at two locations: Collingwood and Frankston (Mornington Peninsula/Bayside).

          Contact the team on (03) 9005 5213 or use the form to request a confidential chat.

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