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Premature Ejaculation
How to Master the Sex You Love
Premature Ejaculation can always be treated. Through online sex therapy, I will help you regain control of your sex life, deal with any anxiety or shame you may be experiencing, and master any pressure you feel around performance and lasting.
Premature Ejaculation (PE) is far more common than initially thought. Statistics are less accurate than those for Erectile Dysfunction, but it is relatively certain that at least 1 out of 3 men experience Premature Ejaculation at some point in their lives. It is the most common sexual dysfunction in men.
Although Premature Ejaculation affects younger men more than older men, it is possible to suffer from PE at any point during one’s life.
PE is never something to be ashamed of. With the correct therapy, education, and counselling, Premature Ejaculation can always be treated effectively.
Psychosexual therapy is the cornerstone of any Premature Ejaculation Treatment. It should serve as the foundation and starting point for other treatments – if they prove necessary.
Please note that this entry is provided to inform you of potential treatment options – for psychosexual and physiological medical treatment. This information is not provided to advise you regarding your individual medical situation. If you would like to schedule a free initial telephone consultation with me, please click here.
I’ll work as an experienced central agent in your treatment. In therapy, we’ll work through the psychological causes and effects of Premature Ejaculation together, and continue counselling until you reach the point of confidence and reduced anxiety.
We’ll also investigate any physiological causes together. I’ll refer you to private or NHS medical professionals I know and trust in the way of identifying and treating the physiological aspects. Together, we’ll provide you with a range of options available to you, while eliminating any harm the condition may have done to that point.
Premature Ejaculation is often best treated through a process of education, counselling, and exploration. The keys are in understanding the sexual response cycle, your own body, realistic expectations (as opposed to what the media or porn tells us), and a process of exploring and discovering your own sexuality in a positive way. In counselling, you’ll have a safe space to discuss your concerns, and gain the information and confidence you need to flourish.
The traditional definitions of Premature Ejaculation don’t sit well with me. The condition is also incorrectly named, which is a contributing factor that leads to the misinformation and continuation of symptoms.
Ejaculation and orgasm, for most men, are simultaneous occurrences. However, they are separate and individual actions in the sexual response cycle, and can certainly be experienced independently.
Considering that it is possible for men to (learn to) orgasm without ejaculating, I believe it better to name the condition “Premature Orgasm” rather than “Premature Ejaculation”. That said, I will refer to Premature Ejaculation in this article for the sake of literary consistency.
In addition, the traditional definitions speak of vaginal intercourse only. Yet, an orgasm can be equally untimely for oral and anal sex.
Premature Ejaculation (Orgasm) can be defined as the tendency of a man to ejaculate (orgasm) shortly after penetration, without a feeling of control, in a shorter time than he would desire, and where it causes himself/his partner distress.
Premature Ejaculation can be divided into Lifelong PE (LL-PE) and Acquired PE (A-PE). PE can affect many men from when they become sexually active and for the duration of their entire lives. For other men, it may have an onset and end period.
Both Lifelong and Acquired Premature Ejaculation can be treated successfully. No man has to suffer from the effects of lost control and confidence.
The simple answer is that anyone with a penis can be affected by PE. Even men who have had adequate control and normal sexual response for the entirety of their lives can still enter periods of Premature Ejaculation without warning.
Premature Ejaculation disproportionately affects younger men more than older men. Although not limited to, sexual inexperience and increased sensitivity due to youth can be contributing factors. However, simply ‘braving it’ is not the correct option. There are effective strategies that men can learn and employ to master control and gain confidence without having to face embarrassment or anxiety. During counselling, we will look at these strategies, and work together to make sure you have the knowledge and skill required.
Regardless of your age, there is no reason to be ashamed of suffering from Premature Ejaculation. The condition is extremely common and can be treated successfully by a skilled professional.
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For the purposes of this information, we will treat orgasm and ejaculation as simultaneous occurrences. It is important to note, however, that many men learn to separate orgasm from ejaculation, so as to allow themselves to experience multiple male orgasms.
Orgasm is affected by a variety of factors. In order to assess the reasons that you may be suffering from PE, these areas are where the start of our work will be focused on.
Male Orgasm is affected by:
- Psychosexual Factors
- The CNS (Central Nervous System)
- Hormones
- Prostate
- Sexual / Erectile Function
A host of psychosexual factors impact our ability to reach orgasm, the speed at which we orgasm, and the extent to which we enjoy orgasming.
The extent to which we feel sexually confident, attractive, experienced, and relaxed determine our sexual pleasure to a large extent. How stressed, anxious, tired, or depressed we are, also play essential roles in our ability not only to orgasm but to enjoy the journey to sexual release.
Psychosexual causes of Premature Ejaculation (like those of Erectile Dysfunction) are incredibly complex to decode. Pinpointing the exact factors that trigger the anxiety and stress can only happen through a process of reflection and skilled counselling.
Neurotransmitters are chemicals in the brain that are responsible for directing and transmitting information through your brain and spinal cord. All neurotransmitters can affect orgasm; however, the two that most affect orgasm are called Seratonin and Dopamine.
Serotonin:
Based on current research, Serotonin is the central neurotransmitter that is responsible for regulating orgasm. Serotonin’s impact is to delay orgasm and, as such, any medication that increases Serotonin will assist in delaying orgasm. The main class of medicines that works to increase Serotonin is called Serotonin Selective Reuptake Inhibitors (SSRIs), and are usually used as anti-depressant medications.
Dopamine:
Dopamine also has a crucial role to play in regulating orgasm and seems to have the opposite effect of Serotonin. By increasing Dopamine, we can increase the orgasmic effect, making it happen quicker, and with greater ease.
Testosterone:
Testosterone plays a pivotal role in all male sexual function. Low Testosterone levels cause a cascade of sexual and emotional difficulties in men, including decreased libido, depression, anxiety, erectile dysfunction, fatigue, and orgasmic abnormalities. Erectile Dysfunction often has a linked effect to Premature Ejaculation and, as such, is important to rule out testosterone deficiency as a causal factor.
Thyroid Hormone:
Thyroid hormones also play a large part in regulating orgasm.
Increased levels of thyroid hormone may enable Premature Ejaculation, whereas decreased levels may cause difficulty and delay orgasm.
It is essential to rule out thyroid hormone abnormalities in the treatment of PE.
The prostate plays a significant role in orgasm and ejaculation. In some cases, men can reach orgasm through prostate stimulation alone. One-third of the ejaculate is also made of a clear fluid produced by the prostate.
Men who have prostatitis often experience an increase in Premature Ejaculation. Once the prostatitis is treated, PE usually subsides, returning to normal function.
Premature Ejaculation and Erectile Dysfunction are often linked, with either preceding the other.
Men who have Erectile Dysfunction often develop Premature Ejaculation. Although there isn’t any research that explains precisely why this happens, we hypothesise that a reason might be that men with ED are worried about losing their erections and, therefore, hyper-excite themselves or rush to orgasm. Over time this behaviour could become habit-forming, leading to Acquired Premature Ejaculation.
On the other hand, men who suffer from Premature Ejaculation often develop Erectile Dysfunction. The most likely cause is due to a lack of confidence and an increase in anxiety that occurs due to PE, which in turn leads to psychosexual difficulties with ED.
Medication that promises to regulate Premature Ejaculation is now freely available from a variety of sources at vastly reduced costs. However, many of these medications do not provide long-term solutions, and several could have debilitating side-effects when used incorrectly or for an extended period. Additionally, using medicine to treat psychosexually induced PE might give immediate aid, but will worsen the condition in the long term.
It is vital to heal the psychological damage already caused as well as to safeguard against any future psychological damage that would have been done.
During the counselling process, we’ll discover underlying causes in your past and present, and devise practical strategies to resolve them together. This process may not be instant, but it is certain to work.
Simultaneously, through a process of careful elimination, physiological causes must either be identified or ruled out and treated in parallel with psychosexual issues.
Like Erectile Dysfunction, Premature Ejaculation always encompasses a psychosexual element that must be addressed to ensure successful and permanent treatment.
Simultaneously, we must identify whether any physiological factors contribute to the condition and, if so, treat them in parallel to psychosexual counselling.
It’s vital to address both aspects to give you the confidence and pride that you deserve.
Our initial consultation should last around 30 – 45 minutes. We’ll have the opportunity to discuss your primary concerns and reasons for seeking treatment, and what the outcomes are that you’d like to achieve.
I’ll explain more about myself, my professional experience, and how we’ll work to achieve your goals. We’ll go over the costs of treatment and make sure that an option is available to you that is affordable and sustainable. I’ll also explain a little more regarding the technical aspects of online counselling and explain the best ways to set up the software options available.
We’ll consider your full medical history. Below is a sample of the types of questions that we’ll be exploring:
- How long has the premature ejaculation been occurring?
- Describe what happens when you have intercourse?
- What happens when you try to masturbate?
- Do you last longer when masturbating?
- Do you have morning erections?
- Do you have difficulty achieving or maintaining your erection?
- If so, at which point do you lose your erection?
- What is the level of your libido like at the moment?
- How rigid are your erections?
- Does your penis have a bend, twist, or curve when it’s rigid?
- Have you ever had any serious testicular trauma?
- What medications are you currently taking?
- When last did you have your hormone levels examined?
- How regularly do you check your blood pressure?
- Do you often have palpitations?
- Have you before, or are you currently using any drugs (including cannabis)?
- Do you take any opiate pain killers (or have you before)?
- How much alcohol do you consume?
- Do you smoke?
- How regularly do you attend a prostate examination?
- Are you currently overweight?
- How would you describe your level of fitness?
We’ll discuss your history and background, along with questions that relate more specifically to PE. A sample of the questions we’ll focus on are:
- How much stress are you currently experiencing?
- Do you have difficulty maintaining a relationship?
- How would you describe your current relationship?
- When did the Premature Ejaculation begin?
- Can you control the duration of play when masturbating?
- How long do you take to orgasm during masturbation, on average?
- How frequently do you have unsatisfactory erections?
- Do you feel your chest tightening when you think of sex?
- How has your relationship(s) been going?
- Are you worried about performing sexually?
- How often do you wake up with an erection?
- Do you have spontaneous erections throughout the day?
- How would you describe the quality of your sleep?
- Do you struggle to achieve or maintain an erection when you are alone?
- How much pornography do you consume?
- Do you sometimes have difficulty orgasming?
- How often do you orgasm prematurely?
- How would you describe your self-esteem?
- Have you experienced any sexual or emotional trauma in the past?
- Are you worried your partner might find you inadequate?
- How worried are you about rejection in general?
- Would you describe yourself as being depressed?
- How difficult is it to focus during masturbation?
- What are the thoughts/worries that your mind drifts to while masturbating?
- How would you describe the quality of the orgasm?
We’ll work together to formulate a practical therapy plan for counselling sessions. You’ll very quickly begin to feel better and see a rapid improvement in the quality of your sex life and emotional health in general.
Sexual function is almost always affected by the level of happiness we experience in the rest of our lives. As such, we’ll focus not only on the sexual hurdles you’re facing but also on improving the rest of your quality of life.
Depending on your circumstances, I may also ask you to conduct a blood test. This test is very affordable, can be done from the privacy of your home, and will remain entirely confidential. The results will show us a starting point for your general physical health. We’ll also find out whether your body is producing a sufficient amount of the correct hormones needed for sexual function.
In the case of Premature Ejaculation, counselling will be divided into two types of sessions.
The first type will be sessions focussed on the underlying psychosexual nature of the problem. We’ll identify and eliminate the issues that contribute to orgasming prematurely.
The second type will be sessions focussed on practical information and behavioural management of Premature Ejaculation. There are several advanced techniques that you can learn and master that will add control to your sexual experience. There are also sexual positions that will aid you in lasting longer. In addition, we’ll discuss medical treatment options of a temporary nature that you can employ to assist you along the way.
Treating Premature Ejaculation is largely the art of learning advanced sexual techniques, facts about sex, practising the methods privately and over time, while dealing with the underlying psychosexual issues in parallel.
Our work will ensure a vast improvement to your life in general, not just restricted to sexual function. There is no limit to the number of sessions we can have, but the process typically takes 12 – 16 sessions. We’ll work to overcome the obstacles you were facing, and explore the goals you’d like to achieve.
If a physiological component was an additional cause to the PE, I’ll continue working with you throughout the counselling process to find the correct medical support, and guide you through any treatment that you may require.
At the end of the counselling process, we’ll review the work we’ve done and the progress you’ve made. We’ll revisit any outstanding issues and discuss methods to ensure that your confidence and success remain in place.
3 – 6 months following the conclusion of your counselling, we’ll schedule a follow-up session to make sure that everything has been going well. We’ll take this opportunity to discuss any new concerns you might have, or conclude our work together.
The first-line physiological treatment of PE employs the use of topical numbing agents. These can desensitise the penis somewhat, in order to lengthen intercourse, but not too much, to prevent anorgasmia.
Topical Medications
Topical orgasm-delaying medications usually contain Lidocaine or Prilocaine (or a combination of both). These applications are available as numbing sprays, application creams, or rubbing gels.
The medication is applied 10-20 minutes before intercourse. The penis should be wiped clean from any residual medication to avoid coming into contact with your partner.
Over time and with counselling, many men who suffer from PE can achieve complete control and gradually decrease the usage of the topical agents.
Selective Serotonin Reuptake Inhibitors (SSRIs) are medicines normally used to treat psychiatric conditions such as depression and anxiety.
An increase in Serotonin levels also affects orgasmic response by increasing the amount of time between arousal and orgasm to some extent.
Unfortunately, most SSRIs can have rather serious side-effects, especially when used in the longer term.
Dapoxetine has the benefit of being a shorter-acting SSRI. Taken 3 hours before intercourse, it can help to increase the duration of the sexual response cycle. Additionally, as it is shorter-acting, the hope is that the extended duration of side-effects and longer-term harm can be avoided.
Other SSRIs that are used in the treatment of PE include Paroxetine, Sertraline, and Fluoxetine. Although all 3 are likely to assist with Premature Ejaculation, these drugs should be an extreme last resort and should only be considered when counselling is used in parallel.
Many individuals benefit from the anti-depressant and psychiatric effects of SSRIs. However, considering the plethora of side-effects, it is vital to only employ their use on balance of benefits by comparison to risks.
I have seen many clients who have been over-eager to use high dosages of SSRIs to treat PE. For a while, the treatment worked. However, due to bad management and over-use, they have moved from orgasming too quickly to not being able to orgasm at all.
Treatment with SSRIs can be successful if the cause of Premature Ejaculation is physiological and psychosexual. However, it is imperative to treat them with caution and employ their use sparingly.
Note that PDE5 inhibitors do not delay orgasm. However, I have worked with many clients who suffer from life-long PE. In these cases, it is essential to consider longer-term management strategies to control PE, in addition to seeking a cure. I provide my clients with the skills to learn advanced sexual and mental techniques that substantially extend their ability to continue intercourse.
Occasionally, more extensive physiological interventions are required. One example of such treatment is the use of PDE5 Inhibitors. For most (especially older) men, it becomes more challenging to maintain or re-engage an erection shortly after reaching orgasm. In addition, it also becomes easier to delay a second orgasm when a first has already occurred.
PDE5 Inhibitors can help to facilitate erections. As such, these men can take a PDE5 Inhibitor and act to reach orgasm shortly after, either privately or with their partners. The benefit of using the PDE5 Inhibitor is that they would then again (not immediately, but shortly after) achieve another erection. Intercourse then is much more likely to be more extended, leading to satisfied partners all-round.
Below is a table highlighted additional information of the 4 main PDE5 Inhibitors that are available:
Hypogonadism, or Testosterone Deficiency Syndrome, is a condition that affects many men of all ages. Most aren’t aware that they have the condition or what the cause is, but all who suffer from it are undoubtedly aware of the symptoms.
In the case of Primary Hypogonadism, a problem exists directly within the testicles, rendering them unable to produce the hormone in sufficient quantities. An example might be men who have suffered from testicular cancer.
With Secondary Hypogonadism, the cause lies outside of the testicles, usually in the hypothalamus or pituitary gland in the brain–the parts of the brain that signal the testes to increase production.
Patients who suffer from a Testosterone Deficiency usually present several, if not all, of the following symptoms:
- Erectile dysfunction (obtaining OR maintaining an erection)
- Desire Disorders (Low Libido)
- Orgasmic Disorders (Premature Ejaculation/Delayed Orgasm/Anorgasmia)
- Difficulty making decisions or concentrating
- Increase in body fat
- No results from exercise regimens
- Loss of lean body muscle
Loss of bone density - Depression
- Extreme fatigue
- Poor work performance
- Changes in the cholesterol profile
- Mood swings
The sad fact is that testosterone deficiency is very seldom diagnosed correctly. Most doctors receive little to no training on optimal hormone levels for men unless they specifically opt to specialise in that field.
A common concern I hear from my patients is that their GPs tested their Testosterone (Total) levels, only to find a “normal” result. Yet, their patients present with most/all of the symptoms.
A “normal” testosterone reading means nearly nothing. When I suspect that a client may suffer from a testosterone deficiency, I request that they have the following lab work done:
- Testosterone, Total
- Testosterone, Free
- Testosterone, Bioavailable
- Oestradiol (Sensitive)
- Steroid Hormone Binding Globulin (SHBG)
- Dihydrotestosterone (DHT)
- Full/Complete Blood Count (FBC/CBC)
- Follicle Stimulating Hormone (FSH)
- Luteinising Hormone (LH)
- Prostate Specific Antigen (PSA)
- Metabolic panel
If your GP is hesitant to prescribe the correct tests on the NHS, or if you prefer to handle the testing privately, I work with a reputable laboratory that will conduct the tests for you. Please contact me to order a finger-prick test kit (circa £150) that can be done from the comfort of your own home. Based on the results, I can refer you to a network of physicians I know, trust, and have experience working with.
Even if you aren’t suffering from a testosterone deficiency at the moment, knowing your healthy baseline may be extremely helpful in the future.
Unfortunately, testosterone testing is littered with inconsistencies. Testosterone levels vary throughout the day. The most accurate method would be to collect urine for testing over a 24 hour period, or to hand in blood samples at 3 different times during the day, over multiple days.
However, even if you did that, the information might still not be valuable. The results might indicate that you have ‘normal’ testosterone levels. Except that what’s ‘normal’, might not be normal for you.
Very few men had doctors that were conscientious enough to do the correct tests during their twenties to establish what their individual, healthy, baseline levels were. As such, we should focus on providing treatment based on the symptoms, rather than obsessing about a particular blood level.
Testosterone injections provide the most effective treatment against the effects of hypogonadism. However, some men prefer other methods of application, such as testosterone cream, gel, pellets, or supplements.
Testosterone Replacement Therapy (TRT) causes very few side effects when taken in the correct dosages. TRT is contraindicated for men who currently suffer from prostate cancer. However, TRT will not cause cancer. In rare cases, TRT can also cause a condition that results in the thickening of the blood. Although this poses an increased risk, the condition is very easily detected and even more easily treated.
TRT will reverse almost all of the effects of hypogonadism. However, it is no magic bullet. Only men who genuinely suffered from a Testosterone Deficiency will see results. Although some results will become evident within a few weeks, others may take months or even years to correct.
Men who suffer from hypogonadism and have ED as a symptom usually begin to see results within 3 months, with the benefits gradually incrementing over time afterwards.
If you’d like more information on the successful treatment of Premature Ejaculation, please contact me to schedule a Free Initial Consultation.
Client Feedback:
“I had become depressed and frustrated by sex. After suffering from Premature Ejaculation for many years, I finally decided that I needed help and to get treatment. A close friend told me about James and after my first telephone chat, I knew it was worth a try.
James helped me to understand the nature and causes of the problem, and I learned the correct techniques to address them. He also referred me to a fantastic doctor who helped me to make sure that nothing was wrong physically.
The treatment plan worked wonderfully and I have gained confidence and reduced my anxiety. My sex life is excellent and my relationship with my other half has never been better!”
Alex, Essex, UK
Erectile
Dysfunction
Erectile Dysfunction can always be treated. Find out how I can help you.
Desire
Differences
Learn to navigate libido in your relationship. Rediscover intimacy and passion.
Porn
Addiction
Heal from porn saturation. Renew your sensitivity and reset your fantasies.
Erectile
Dysfunction
Erectile Dysfunction can always be treated. Find out how I can help you.
Desire
Differences
Learn to navigate libido in your relationship. Rediscover intimacy and passion.
Porn
Addiction
Heal from pornography saturation. Renew your sensitivity and reset your sexual fantasies.