Ask the Doc: Ejaculating Too Soon

Good afternoon Dr. Queen,

I have found the courage to email you about the problem I am facing… I would really appreciate any help. Premature ejaculation causes a lot of sexual problems in my relationship. The past years with different partners was not a problem…I was again ejaculating very early but after a few seconds I was back ready again. Now , though after ejaculation, I’m done…In addition, the past years I have been through a lot of problems, therefore probably that affected me as well..

Could you please suggest any possible ways that I can try to save my relationship and my sexual life…?

–Struggling with PE

CQ replies: In general, though a lot of men may think of themselves as “premature ejaculators,” many can last varying lengths of time—it’s one reason why some sex therapists don’t use the term at all any more, preferring to say things like “not lasting as long as you or your partner want.” Men and their partner sometimes have differing ideas about how long sex “should” last, which adds to the confusion. Rapid ejaculation like yours does fit the textbook definition of PE [premature ejaculation], though. It’s not entirely clear what causes it; some have cited anxiety, learning to masturbate very quickly as a youth (in other words, training oneself to come that fast), and as I research, I’m also seeing association to neurological factors. There are also many ways to address this issue, and some strategies will likely work better for some men than others.

Before I get into these, let me say something about the way sex is often, in our society, put into a framework that puts extraordinary focus on penile insertion into a vagina. Of course that is, for many people, a highly pleasurable and desired part of sex—but some guys who ejaculate quicker than they want to may develop especially high levels of anxiety about this because for them, intercourse is the sexual activity, not one of many ways to enjoy sex. So one way to be a good partner and to hopefully minimize this anxiety as much as possible is to understand how many ways there are for partners to please each other erotically; you may already have focused more of your erotic skill-building on pleasing your partner via oral sex, trying sex toys, etc., but it’s also possible you haven’t enjoyed a no-intercourse zone partly because you associate all of it with PR and this raises anxiety.

As I like to say to heterosexual couples for whom vaginal insertion is an issue, “Hey, millions of lesbians can’t be wrong!” I’m not attempting at all to make light of your and your partner’s desire to have intercourse for a longer length of time (nor am I suggesting that all lesbians avoid the vagina, only that lesbian sex can be awesome without penile insertion)—I’m only seeking to remind you that there are many sexual options, and having issues with one of them should certainly not be a reason to ignore all the other ones. If anything, having more frequent sex and feeling comfortable doing so, even if intercourse stays off the menu for a period of time, can give you the opportunity to become more comfortable in an aroused state with a partner; if you, like many men with PE, avoid sex out of worry about the outcome, this very avoidance can increase anxiety and make matters worse, so adding erotically pleasurable time with your partner into your repertoire is actually a very good thing.

Now then, on to some of the ways rapid ejaculation is treated. You have written to me, but I wonder whether you have ever mentioned this to a medical doctor; a sex therapist, of course, is another professional with a lot of experience; one study estimated that sex therapy techniques are helpful in 90% of cases. Just talking with a professional can sometimes be helpful, since so many men keep ejaculation (and erection) issues very much to themselves.

Some men who ejaculate quickly choose to work on the problem solo. Since some sex therapists blame an excess of pelvic tension and weak pelvic floor muscles for at least some cases of rapid ejaculation, Kegel exercises can help, and trying intercourse positions that involve less muscular tension can, too. Missionary position is just about the worst; try side-by-side or partner astride positions instead. Also, so many men avoid ejaculation because they have this hair-trigger response that actually coming more frequently is a trick that sometimes works. As you found in earlier days, having a quick ejaculation sometimes allows you to regain an erection (it’s called the refractory period) and carry on; you can do the same thing via masturbation. Some men masturbate as shortly before a date as they can. If you’re really comfortable with your partner, you can even do it during sex play. You didn’t tell me whether you ejaculate as rapidly during masturbation with a partner, but some guys who deal with PR are not regular masturbators. This might be worth a try.

Look up Squeeze Technique and Stop-start Technique online to get directions for the other techniques a sex therapist would teach you – or visit such a therapist yourself, if you’re able. (Your partner can come along with you and that might be good too.)

Desensitizing topical creams are NOT recommended, because (for one thing) they can rub off on your partner. Plus they don’t do anything about the pelvic tension and Kegel muscle issues.

Some MDs are prescribing SSRIs – anti-depressants – for PE. This may be a good strategy, but as you consider your options, please remember that these are powerful chemicals that affect your brain chemistry and that are often very difficult to stop taking if you don’t like their side effects. Do ask your doctor about side effects if you try this route, and know that they do not always give men a lot of extra time before ejaculation—lending extra credence to the idea that brain chemistry is not all there is to it!

Update, 4/15/14: I had no sooner posted this reply to my most recent question when a couple of news articles came across the wire stating that a European research team has had very good results in men with PE ( < 1 minute to ejaculation) with –ta da!– pelvic floor exercises! So this strategy is certainly worth a try.

–Carol Queen, PhD, Good Vibrations Staff Sexologist

Dr. Carol Queen

Carol Queen has a PhD in sexology; she calls herself a "cultural sexologist" because her earlier academic degree is in sociology: while she addresses individual issues and couple's sexual concerns, her overarching interest is in cultural issues (gender, shame, access to education, etc.). Queen has worked at Good Vibrations, the woman-founded sexuality company based in San Francisco that turned 35 years old in 2012, since 1990. Her current position is Staff Sexologist and Good Vibrations Historian; her roles include representing the company to the press and the public; overseeing educational programming for staff and others; and scripting/hosting a line of sex education videos, the Pleasure-Ed series, for GV’s sister company Good Releasing. She also curates the company's Antique Vibrator Museum. She is also the founding director of the Center for Sex & Culture, a non-profit sex ed and arts center San Francisco, and is a frequent lecturer at colleges, universities, and community-based organizations. Her dozen books include a Lambda Literary Award winner, PoMoSexuals, and Real Live Nude Girl: Chronicles of Sex-Positive Culture, which are used as texts in some college classes. She blogs at the Good Vibes Magazine and at SFGate's City Brights bloggers page and contributes to the Boston Dig. For more about her at carolqueen.com.

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