No one welcomes embarrassing moments. Like when you notice a neighbour waving at you through the window and wave back with cheery enthusiasm—only to then notice they’re actually washing their windows.
Most of us are practically hard-wired to try and avoid awkward encounters. Which is presumably why so many men shy away from seeing the doctor if they’re struggling with premature ejaculation.
But there’s no reason to suffer in silence.
According to the Mayo Clinic, one in three men are likely to experience this problem at some stage. Doctors are used to dealing with this issue and have tried-and-tested ways to improve the situation.
Here’s a rough guide to what happens when you talk to a doctor about PE.
Defining the Issue
PE is loosely defined as a condition where you find yourself constantly ejaculating within one minute of penetration.
There are two main forms of this complaint.
“Primary” premature ejaculation is when a man has always struggled with this problem since the beginning of their sex life.
“Acquired” premature ejaculation, on the other hand, can suddenly emerge after a period of normal sexual activity. This type is often rooted in a psychological cause that might be anything from stress to performance anxiety.
In addition, premature ejaculation can also be an off-shoot of erectile dysfunction or some broader health issue. Lifestyle factors can also play a contributing role with the problem sometimes becoming intensified by alcohol or drug use.
This variety of possible causes means that any form of treatment should always start with a chat to your GP in order to identify the most effective course of action for you.
“Most of the questions that we ask are trying to establish a number of things related to premature ejaculation, as well as general health questions,” explains Sydney GP Dr Matthew Vickers.
“So with regards to your health, we want to make sure that there's no other issues that might be impacting on sexual dysfunction, as that can sometimes be the first sign of issues like heart disease or diabetes.”
The main aim of this discussion is to figure out whether your form of PE is primary or acquired. This categorisation is vital in order to determine the best course of treatment.
Men who suffer from primary PE that is not linked to erectile dysfunction will benefit from treatment that’s specifically designed to help them to delay ejaculation. One of the most effective is taking a form of antidepressant known as selective serotonin reuptake inhibitors (SSRIs).
These drugs are not prescribed because the patient is depressed, but because a noted side-effect of this medication is delayed orgasm.
“These medications have an effect on the neurotransmitters responsible for the ejaculation reflex,” Dr Vickers says. “We know that it delays that reaction.
"Those medications are used in a much lower dosage than what we would use to treat anxiety and depression. But they do help lead to a delayed ejaculation.”
While SSRIs are generally effective, the results may not be immediate. That’s why doctors will usually prescribe them in tandem with behavioural techniques to maximise the chances of a successful outcome.
The first one is practising the stop-start technique, which is commonly referred to as “edging”.
During sex or masturbation, as soon as you feel the initial sensation of ejaculation looming, the idea here is that you stop whatever form of stimulation you’re doing until the feeling subsides. Once the urgency has faded, you can then repeat the process.
“Continually doing that over a period of time will eventually lead to better control over the ejaculation reflex,” Dr Vickers says.
Another option is the squeeze technique. “When you start to get the sensation of ejaculation you squeeze the area between the glans or the head of the penis shaft until the ejaculation reflex goes away.”
Treating acquired PE
Alternatively, if you’re suffering from an acquired form of PE – a condition that’s developed later in your sex life – you’ll probably be advised to take a different course of action. “Acquired PE is most commonly due to erectile dysfunction,” Dr Vickers explains.
When you’re struggling with ED, your brain can overcompensate by forcing the body to ejaculate while there’s the slightest window of opportunity. Treating your ED as the root cause therefore can often take care of the premature ejaculation.
“In younger men, typically, erectile dysfunction is not due to any physical abnormality, it’s more often due to confidence and performance anxiety,” Dr Vickers says.
Doctors will often prescribe ED medication as a short-term treatment in order to tackle this mental issue, he adds. “After the man’s confidence increases with the medication then the ED issue often resolves itself quite quickly.
"And then, over time, the PE will get better shortly afterward, improving the time to ejaculation".
Other causes of ED
Yet before a doctor prescribes any medication, they’ll want to rules out other potential cause of ED. Many of these are lifestyle-related and include weight gain, smoking, excessive drinking, lack of exercise, low testosterone or a range of other symptoms.
ED can also have a psychological basis, too. Relationship problems or communication difficulties can sometimes precipitate difficulties, Dr Vickers admits. “We commonly see erectile dysfunction in people who have recently ended a long-term relationship and started having sex with a new partner.”
The upshot is that there are a host of reasons why you might be suffering from premature ejaculation. The sheer diversity of these causes mean that this is a tricky area for self-diagnosis.
That’s why if you want to resolve the issue as quickly as possible, your best bet is to speak to a GP who can help you identify the specifics of your problem and prescribe the most relevant treatment.
Don’t let PE sabotage your sex life. Speak to a doctor to unlock the best way to increase your staying power.