His nervous fingers unrolled the condom down his shaft. Oh God, he felt it start. He squeezed hard and prayed. He watched the condom fill with semen. "You're some lay," his partner said.
Intro
When doing research for my book, The Ins and Outs of Gay Sex: A Medical Handbook for Men, I looked up the medical definition of premature ejaculation. One text said that it was when you ejaculate before you enter a woman's vagina; according to this definition, most gay men have nothing to fear. Another definition considered an ejaculation premature if you came before you wanted too. Uh oh. According to this description, most gay men have a problem.
What is it?
A normal ejaculation should occur within 3 to 5 minutes of continuous thrusting (minutes, not hours). If you come much quicker than that, you probably suffer from premature ejaculation. It happens to most of us at some point in our lives -- remember your first time with a guy -- but it only becomes a problem when it becomes the norm rather than the exception.
Premature ejaculation is often very episodic; it occurs without explanation in some situations and not others or it can be a problem for days to weeks and then disappear suddenly.
Ejaculation has three distinct phases: the emission phase (when you have an erection and pre-cum seeps out of your penis) followed by closure of your bladder and then propulsion of your semen out of your body. Premature ejaculation occurs because your emission phase is shortened and you rapidly progress to ejaculation. Treatment of premature ejaculation focuses on prolonging the emission phase.
Diagnosis
There is no fancy test to diagnose premature ejaculation. You and/or your partner will recognize it.
Symptoms
Ejaculation with little stimulation.
How is it acquired?
For most men, premature ejaculation has a strong psychological component and this may include stress, anxiety, manic moods and heightened sexual excitement.
How to treat it?
Masters and Johnson popularized a treatment technique called "desensitization". The process worked by gradually teaching you to prolong your emission phase of excitement. In short, you work yourself to the point where an orgasm and ejaculation feel imminent and then you stop all stimulation.
Some therapists combine this with contracting pelvic muscles or squeezing your penis to abort the orgasm. (Once an orgasm begins you can't stop it). Once you cool down, you begin stimulating yourself again -- working to the same point and then stopping. This process is repeated over and over again, until you cum. The idea is that you gradually desensitize yourself so that it takes longer and longer to cum.
Most men find that desensitization works with 60 to 95 percent noting improvement. An understanding partner can go a long way to help you work through this problem. The downside of desensitization, however, is the high relapse rate with about 75 percent of men finding that the problem returns within three years. Combining desensitization with sex therapy also helps.
Some men self treat premature ejaculation by using condoms to decrease sensitivity. You can also buy many anesthetic creams, gels and sprays that decrease sensation. Beware, if you use them and have unprotected oral sex, you'll numb your partner's mouth. Also check the labels carefully because many contain oils that can damage latex condoms.
Doctors can also prescribe medications to treat your premature ejaculation. The most common drugs prescribed are antidepressants which -- when taken in low doses -- may help end your problem. Often you can take the drug on an as needed basis, even in the morning before an anticipated evening of sex, and it works well. The most common medications used include Prozac (fluoxetine), Zoloft (sertaline) and Anafranil (clomipramine). Anti-anxiety medications such as Valium (diazepam) and Xanax(alprazolam) have also been shown to be effective in treating premature ejaculation. (They really work and just don't make you less upset because you cum too fast.) If you have this problem, see your urologist. You can be treated, and you'll be much happier (and so will your partner) because of it.
Myths dispelled
Here are some facts to clear up some common misconceptions.
You can treat premature ejaculation with medication. Men should normally ejaculate after three to five minutes of constant thrusting.
Prevention
If premature ejaculation happens on occasion, try not to worry too much about it; the more worked up you get over it the worse it will become.
Sex
Premature ejaculation can be extremely variable. Sometimes it occurs with one partner and not others, or during some sex acts and not others (oral sex is fine but during anal sex you pop your load). You can have the problem for days or weeks and then it may go away only to haunt you again at some future point.