Performance Anxiety

Self Distraction.
If your arousal levels are getting too high and a climax is beginning, take a deep breath and think about something else, something very boring if possible. When you are less aroused but maintaining an erection you can then continue. Performance anxiety may be the major cause and talking to your sexual partner about your feelings may well help. Remember it is a common experience for men and women. Relax more and the problem often goes away

Desensitizing Cream
Creams can be used to desensitize the end of the penis. They act like a local or tropical anesthetic. Thicker condoms (or two condoms) can also desensitize by decreasing sensitivity and therefore stimulation, thus prolonging the sexual act. …….Not suggested

More Foreplay
Stimulate your partner to a state of high arousal before you have your genitals touched, that way ejaculation and orgasm can be achieved about the same time.

Masturbation
Practice different methods by yourself. Getting to know your feelings and sensations gives you the chance to gain confidence. Remember getting good at sex and overcoming premature ejaculation can take a bit of time. Practice makes perfect. If you find that things are not improving then help is available from sex therapists who are experts in this field.

Biofeedback therapy

Biofeedback treatment enables a man to become aware of the muscles that control ejaculation and relax them. While men were able to delay ejaculation with this technique, male patients were reluctant to stimulate themselves with something in the rectum.

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Recently there have been reports in the urology literature of successful treatment of premature ejaculation through the use of low dose antidepressants including Anafronil, Prozac, and Zoloft.

In recent years, it has also proved possible to treat PE with antidepressant drugs. But  antidepressants are well known for the side-effect of delaying male climax. Antidepressants that are commonly used for this purpose include clomipramine (Anafranil), fluoxetine (Prozac) and sertraline (Lustral). But please be warned: these are powerful drugs, lasting a long time in the body, and with a considerable list of potential side effects. Before going on to one of them, talk it over carefully with your doctor.

One of the known side effects of these medications when used for depression is significantly delayed ejaculation. In the studies, extremely low doses of the antidepressant medication have prolonged ejaculation by at least 5-10 minutes with very few side effects.

Currently these medications are the most popular treatment. The medication is given approximately four hours before intercourse and will result in a significant delay of ejaculation. Few patients have described any side effects with this treatment. On certain occasions, the medication is given on a daily basis. It should be pointed out that this medication is not approved by the FDA for treatment of premature ejaculation. When combining the medication with the exercised,  a man can begin to take control over his ejaculation time.

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Researchers have noted that men who suffer from premature ejaculation have a faster neurological response in the pelvic muscles. Simple exercises commonly suggested by sex therapists can significantly improve ejaculatory control for men with premature ejaculation caused by neurological factors. Often, these men may benefit from anti-anxiety medication

Kegel exercises, which consist of flexing the pelvic muscle, also play an extremely important role in achieving ejaculatory control. A person can learn to flex his or her pelvic muscle by abruptly stopping the flow of urine while going to the bathroom.

Kegel exercises can be performed at any time. The exercises vary, but their aim is to strengthen the pelvic muscle. The male might flex his pelvic muscle for ten seconds, relax for ten seconds, and then repeat the cycle for as long as he can. Or he might flex the muscle ten times, relax, and flex it ten more times, and so forth. Eventually he will be able to flex his pelvic muscle for longer periods of time. Together with these exercises, he should practice learning to release all pressure from the pelvic muscle, which enables the relaxation necessary for sexual satisfaction. The male might also benefit from performing these exercises while erect. While Kegel exercises are helpful in overcoming premature ejaculation, they have been shown to improve the sexual response in both men and women.

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By far the most common exercise is the so-called start-stop technique. While the technique varies, the purpose is to get the male accustomed to maintaining an erection for an extended period of time while gradually increasing sexual tolerance. In doing this exercise, the male obtains an erection through self-stimulation, or masturbation. After achieving an erection, he stops stimulating himself until he begins to lose his erection; at that point, he begins to stimulate himself again. Gradually, over a period of several weeks, he is able to stimulate himself for longer periods of time, eventually gaining ejaculatory control.

Stop-start involves the partner stimulating the man’s penis, except that when the man instructs, the partner stops stimulating the man’s penis before ejaculation becomes inevitable. Then as he feels he regains control, he instructs the partner to begin stimulating his penis again. This procedure is repeated three times before allowing the man to ejaculate on the fourth time. The couple repeats this exercise three times a week, until the man has good control, then they progress to stop-start with lubrication, and then intercourse with the woman on top and the man not moving. He again instructs her to stop moving when he senses he is losing control.

This involves sexual stimulation until the man recognizes that he is about to come; the stimulation is then removed for about thirty seconds and then may be resumed. The sequence is repeated until ejaculation is desired, the final time allowing the stimulation to continue until ejaculation occurs. For example If you find yourself nearing climax withdraw your penis from your partner and allow yourself to relax enough to prevent ejaculation. By starting and stopping sexual stimulation you can learn to prolong the sex act.

The couple progresses over subsequent times to the having the man move, then side by side intercourse. Instead of stopping and starting, the couple may progress to merely slowing down to enable the man to regain control of his urge to ejaculate. The therapists counseling patients using this stop-start technique report a 90 percent success rate in delaying ejaculation.

While exercise methods are effective, they both rely on the cooperation of the man’s partner, which in some cases may be a problem. In order for this technique to be successful, the male should avoid feeling discouraged if he ejaculates rapidly; instead, he should use his sexual responses to learn how to vary the technique in a way that most benefits him. The male can choose to integrate his partner into these exercises.

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The “squeeze” method Developed by Masters and Johnson, involves sexual stimulation until the man recognizes that he is about to ejaculate; at that point, the man or his partner gently squeezes the end of the penis (where the glans meets the shaft) for several seconds, withholding further sexual stimulation for about 30 seconds, and then resuming stimulation. This method has the partner stimulate the man’s penis until he is close to ejaculation. At the point when he is about to ejaculate, the partner squeezes the penis hard enough to make him partially lose his erection. By circling the hand just below the head of the penis, a squeeze will prevent ejaculation. The sequence may be repeated by the person or couple until ejaculation is desired, the final time allowing the stimulation to continue until ejaculation occurs.

The goal of this technique is to teach the man to become aware of the sensations leading up to orgasm, and then begin to control and delay his orgasm on his own. This technique progresses from manual stimulation to motionless intercourse to intercourse with both moving.

Masters and Johnson reported that 98 percent of couples who learned and used these techniques had success treating premature ejaculation.

The stop and start method can be used with the squeeze method as well.

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Premature Ejaculation – Proven treatments

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There are several treatment choices for premature
ejaculation: psychological therapy, behavioral therapy,
and medications. Be sure to discuss these treatments
with your doctor and together decide which of the
following options is best for you:

• Psychological therapy addresses feelings a man may
have about sexuality and sexual relationships.

• Behavioral therapy makes use of exercises to help
a man develop tolerance to stimulation and, as a
result, delay ejaculation.

• Medical therapy includes oral medications that can
cause a delay in the time it takes from the beginning
of sexual stimulation until ejaculation occurs. These
oral medications are the same medications that are
commonly used to treat depression. But in men with
premature ejaculation, they are used to improve
the problem of premature ejaculation, not to treat
depression. In addition, topical anesthetic creams
may be used to increase the time it takes from the
beginning of sexual stimulation until ejaculation
occurs.

Psychological therapy

Psychological therapy can be used as the only
treatment or can be used together with medical
therapy or behavioral therapy. The focus of
psychological therapy is to help you to identify
psychological difficulties that may contribute to the
premature ejaculation and/or to solve problems in
your relationships that may have added to the cause
of premature ejaculation. This therapy can also
help couples to talk about problems with intimacy
that occurred after premature ejaculation began.
Psychological therapy can also help a man learn to be
less anxious about his sexual performance and have
greater sexual confidence. Typically, a man will receive
specific advice on how to enhance his and his partner’s
sexual satisfaction.

Behavioral therapy-

Behavioral therapy can play a key part in the usual
treatment of premature ejaculation. Certain sexual
maneuvers can be effective; however, they may not
always provide a lasting solution to the problem. Also,
they rely heavily on the cooperation of the partner,
which in some cases, may be a problem.
With the squeeze method, an exercise developed by
Masters and Johnson, the partner stimulates the man’s
penis until he is close to ejaculation. At the point when
he is about to ejaculate, the partner squeezes the penis
hard enough to make him partially lose his erection.
The goal of this technique is to teach the man to
become aware of the sensations leading up to orgasm,and then
begin to control and delay his orgasm on his
own.

With the stop-start method, the partner stimulates
the man’s penis until just before ejaculation. The
partner should then stop all stimulation until the urge
to ejaculate subsides. As the man regains control, he
instructs the partner to begin stimulating his penis
again. This procedure is repeated three times before
allowing the man to ejaculate on the fourth time. The
couple repeats this exercise three times a week, until
the man has gained good control.

Medical therapies

Although not approved by the U.S. Food and Drug
Administration (FDA) for this purpose, pills used for
depression and anesthetic creams have been shown to
delay ejaculation in men with premature ejaculation.
Medications are a relatively new form of treatment for
premature ejaculation. Doctors first noticed that men
and women who were taking drugs for the treatment
of depression (antidepressants) also had delayed
orgasms. Doctors then began to use these drugs “offlabel”
(this implies using a medication for a different
illness than what it was originally manufactured for) to
treat premature ejaculation. These medications include
antidepressants that affect serotonin such as fluoxetine
(Prozac®, Sarafem®), paroxetine (Paxil®), sertraline
(Zoloft®), and clomipramine (Anafranil®).

If one medication fails to work, a second one is usually
recommended. If the second one fails, trying a third
medication is not likely to be beneficial. An alternative
is to combine medication with behavioral therapy and/
or creams.

For use in premature ejaculation, the doses of
antidepressants are usually lower than those
recommended for the treatment of depression.
Though side effects are not inevitable, when they do
occur, the most common side effects of antidepressants
include nausea, dry mouth, drowsiness, erectile
dysfunction and reduced desire for sexual activity.

These drugs can be taken either every day or
only taken before sexual activity. Your doctor will
decide how you should take the medication based
on the frequency of intercourse and the effect that
they produce for you. The best time for taking the
antidepressant medications before sexual activity
has not been established, but most doctors will
recommend from two to six hours depending on the
medication. Because premature ejaculation can recur
when the medication is not taken, you most likely will
need to take it on a continuing basis.

Local anesthetic creams can be used to treat
premature ejaculation. These creams are applied to
the head of the penis about 20 to 30 minutes before
intercourse to lessen the sensitivity. Prior to sexual
intercourse, a condom (if used) may be removed and
the penis washed clean of any remaining cream. A
loss of erection can occur if the anesthetic cream
is left on the penis for a longer period of time than
recommended. Also, the anesthetic cream should not
be left on the exposed penis during vaginal intercourse
since it may cause vaginal numbness.

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Treating premature ejaculation

As to treating premature ejaculation, here are a list of things that DON’T work:

9. Tranquilizers

So,  How to treat a PREMATURE EJACULATION? What can be done for PE?

Depending on severity, chronic premature ejaculation can be significantly reduced, or completely cured. Most sex therapists prescribe a series of exercises to enable the man to gain ejaculatory control. While the exercises are intended for men who suffer from premature ejaculation, other men can use the exercises to enhance their sex lives.

There are legitimate ways, to treat premature ejaculation

A: Very mild cases (‘last’ a good five minutes but would like to last 10)

If you have very mild PE (for instance, if you can ‘last’ a good five minutes but would like to last 10), there’s probably no point in going to a doctor. Why? Because you should be able to improve matters by simple ‘distraction techniques’. This means turning your mind to something else when you sense that a climax is near. For instance:

•  

  • think very hard about something totally unconcerned with sex.

  • pinch yourself hard.

  • bite the pillow.

  • Some men try to treat themselves with a local anaesthetic gel. This product is advertised to the public as a good way to ‘damp down’ sexual sensation in the penis. But we do not advise using it firstly, because the local anaesthetic can ‘dull’ the sex sensation for the partner, and secondly because it can sometimes cause a distressing skin sensitivity reaction.

B:  Getting help for more severe cases

1. The squeeze method developed by  Masters-Johnson

The “squeeze” method Developed by Masters and Johnson, involves sexual stimulation until the man recognizes that he is about to ejaculate; at that point, the man or his partner gently squeezes the end of the penis (where the glans meets the shaft) for several seconds, withholding further sexual stimulation for about 30 seconds, and then resuming stimulation. This method has the partner stimulate the man’s penis until he is close to ejaculation. At the point when he is about to ejaculate, the partner squeezes the penis hard enough to make him partially lose his erection. By circling the hand just below the head of the penis, a squeeze will prevent ejaculation. The sequence may be repeated by the person or couple until ejaculation is desired, the final time allowing the stimulation to continue until ejaculation occurs.

The goal of this technique is to teach the man to become aware of the sensations leading up to orgasm, and then begin to control and delay his orgasm on his own. This technique progresses from manual stimulation to motionless intercourse to intercourse with both moving.

Masters and Johnson reported that 98 percent of couples who learned and used these techniques had success treating premature ejaculation.

The stop and start method can be used with the squeeze method as well.

2. The stop-start method

By far the most common exercise is the so-called start-stop technique. While the technique varies, the purpose is to get the male accustomed to maintaining an erection for an extended period of time while gradually increasing sexual tolerance. In doing this exercise, the male obtains an erection through self-stimulation, or masturbation. After achieving an erection, he stops stimulating himself until he begins to lose his erection; at that point, he begins to stimulate himself again. Gradually, over a period of several weeks, he is able to stimulate himself for longer periods of time, eventually gaining ejaculatory control.

Stop-start involves the partner stimulating the man’s penis, except that when the man instructs, the partner stops stimulating the man’s penis before ejaculation becomes inevitable. Then as he feels he regains control, he instructs the partner to begin stimulating his penis again. This procedure is repeated three times before allowing the man to ejaculate on the fourth time. The couple repeats this exercise three times a week, until the man has good control, then they progress to stop-start with lubrication, and then intercourse with the woman on top and the man not moving. He again instructs her to stop moving when he senses he is losing control.

This involves sexual stimulation until the man recognizes that he is about to come; the stimulation is then removed for about thirty seconds and then may be resumed. The sequence is repeated until ejaculation is desired, the final time allowing the stimulation to continue until ejaculation occurs. For example If you find yourself nearing climax withdraw your penis from your partner and allow yourself to relax enough to prevent ejaculation. By starting and stopping sexual stimulation you can learn to prolong the sex act.

The couple progresses over subsequent times to the having the man move, then side by side intercourse. Instead of stopping and starting, the couple may progress to merely slowing down to enable the man to regain control of his urge to ejaculate. The therapists counseling patients using this stop-start technique report a 90 percent success rate in delaying ejaculation.

While exercise methods are effective, they both rely on the cooperation of the man’s partner, which in some cases may be a problem. In order for this technique to be successful, the male should avoid feeling discouraged if he ejaculates rapidly; instead, he should use his sexual responses to learn how to vary the technique in a way that most benefits him. The male can choose to integrate his partner into these exercises.

Therapists counseling patients using this stop-start technique report a 90 percent success rate in delaying ejaculation.

3.Kegel exercises

Researchers have noted that men who suffer from premature ejaculation have a faster neurological response in the pelvic muscles. Simple exercises commonly suggested by sex therapists can significantly improve ejaculatory control for men with premature ejaculation caused by neurological factors. Often, these men may benefit from anti-anxiety medication

Kegel exercises, which consist of flexing the pelvic muscle, also play an extremely important role in achieving ejaculatory control. A person can learn to flex his or her pelvic muscle by abruptly stopping the flow of urine while going to the bathroom.

Kegel exercises can be performed at any time. The exercises vary, but their aim is to strengthen the pelvic muscle. The male might flex his pelvic muscle for ten seconds, relax for ten seconds, and then repeat the cycle for as long as he can. Or he might flex the muscle ten times, relax, and flex it ten more times, and so forth. Eventually he will be able to flex his pelvic muscle for longer periods of time. Together with these exercises, he should practice learning to release all pressure from the pelvic muscle, which enables the relaxation necessary for sexual satisfaction. The male might also benefit from performing these exercises while erect. While Kegel exercises are helpful in overcoming premature ejaculation, they have been shown to improve the sexual response in both men and women.

4. Drug Therapy

Recently there have been reports in the urology literature of successful treatment of premature ejaculation through the use of low dose antidepressants including Anafronil, Prozac, and Zoloft.

In recent years, it has also proved possible to treat PE with antidepressant drugs. But  antidepressants are well known for the side-effect of delaying male climax. Antidepressants that are commonly used for this purpose include clomipramine (Anafranil), fluoxetine (Prozac) and sertraline (Lustral). But please be warned: these are powerful drugs, lasting a long time in the body, and with a considerable list of potential side effects. Before going on to one of them, talk it over carefully with your doctor.

One of the known side effects of these medications when used for depression is significantly delayed ejaculation. In the studies, extremely low doses of the antidepressant medication have prolonged ejaculation by at least 5-10 minutes with very few side effects.

Currently these medications are the most popular treatment. The medication is given approximately four hours before intercourse and will result in a significant delay of ejaculation. Few patients have described any side effects with this treatment. On certain occasions, the medication is given on a daily basis. It should be pointed out that this medication is not approved by the FDA for treatment of premature ejaculation. When combining the medication with the exercised,  a man can begin to take control over his ejaculation time.

Other Techniques to Prevent Premature Ejaculation

Performance Anxiety

Self Distraction.
If your arousal levels are getting too high and a climax is beginning, take a deep breath and think about something else, something very boring if possible. When you are less aroused but maintaining an erection you can then continue. Performance anxiety may be the major cause and talking to your sexual partner about your feelings may well help. Remember it is a common experience for men and women. Relax more and the problem often goes away

Desensitizing Cream
Creams can be used to desensitize the end of the penis. They act like a local or tropical anesthetic. Thicker condoms (or two condoms) can also desensitize by decreasing sensitivity and therefore stimulation, thus prolonging the sexual act. …….Not suggested

More Foreplay
Stimulate your partner to a state of high arousal before you have your genitals touched, that way ejaculation and orgasm can be achieved about the same time.

Masturbation
Practice different methods by yourself. Getting to know your feelings and sensations gives you the chance to gain confidence. Remember getting good at sex and overcoming premature ejaculation can take a bit of time. Practice makes perfect. If you find that things are not improving then help is available from sex therapists who are experts in this field.

Biofeedback therapy

Biofeedback treatment enables a man to become aware of the muscles that control ejaculation and relax them. While men were able to delay ejaculation with this technique, male patients were reluctant to stimulate themselves with something in the rectum.

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