It’s estimated that 30 percent of men between the ages of 18 and 60 will experience premature ejaculation (PE) at some point in their lives. Characterized by ejaculation which always (or nearly always) occurs prior to or within one minute of penetration, PE can have several causes. Often to blame are psychological factors such as stress, depression, relationship issues, or performance-related anxiety—though physical conditions such as diabetes, high blood pressure, thyroid problems, or prostate disease can also be the cause, says New York City-based sexual health specialist Michael Reitano.
In short, it’s not fun and can sometimes lead to the premature ejaculator avoiding sexual intimacy altogether. There are, however, a raft of relatively simple interventions that have proven effective in its treatment. Here are some of them.
Start living on the edge
Ever heard of “edging" in order to last longer during sex? It means building up to what’s called “ejaculatory inevitability”—the orgasmic point of no return—then standing down for a minute or so before restarting the action. If you have a penis, it’s likely that you already know what the point of no return feels like. If you’re the partner of someone with a penis, it’s the part when they start making that face.
“Ejaculatory inevitability refers to that point during the lead-up to ejaculation when contractions in the vas deferens and the prostate moves semen out of the tubes where it is usually stored and into the urethra,” Reitano says. “Once there, ejaculation follows as the rhythmic contractions of pelvic muscles—about every .8 seconds—release semen in waves from the penis.”
The key to becoming good at edging—and mastering control over when you orgasm in any situation—involves knowing what the moment just before that moment feels like. If you’re a penis owner, you can start this training regimen when you’re home alone with some time on your hands.
Instead of watching porn, concentrate on the sensations you feel in your body. When you reach the tipping point, wrest control over the almost irresistible urge to spill. Using what what Florida-based sex educator Lawrence Siegel calls “stop-start” you can even edge with a partner. Stop-start is a sex therapy technique that Siegel endorses as “effective treatment for lasting longer.”
Similar to the solo regimen, when the moment approaches, stop the stimulus that’s in danger of making you pop your cork and turn your attention to pleasuring your partner or simply take a break. Don’t worry if your erection subsides, there’s almost always another one right behind it.
Once you get comfortable with knowing where your tipping point is, you can cruise along in the danger zone without all the time-outs. Becoming an accomplished edger has other advantages: A staggered and drawn out path to climax should make your orgasm that much more powerful.
“Not only will the quantity of semen readied for ejaculation on orgasm will be increased, the pleasurable contractions that occur with that release will be increased as well,” Reitano tells me. explaining that the gradual increase in emotional and psychological tension leads to increasing levels of pleasure so the orgasm experienced is intensified.
Consider a pill
Dapoxetine is the first compound developed specially for the treatment of premature ejaculation. Sold as Priligy, Westoxetin, and other brand names, it’s been approved and sold in many other countries for some time but it in the US has been lurking in development purgatory since 2004. There are however, a number of FDA approved medications whose side effects include delayed orgasm including phosphodiesterase type 5 inhibitors like Sildenfil—the active ingredient in Viagra.
“Oddly, the drugs that treat erectile dysfunction and give men more robust erections can cause delayed orgasms,” Reitano says, explaining that for millions of men who experience both erectile dysfunction and PE, it’s a twofer.
A 2007 study showed that sildenafil is both a safe and effective way to treat premature ejaculation, while research published in early 2000 found that sildenafil shortened the refractory period by an average of 11 minutes for men who are around 32 years old.
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Reitano says that the benefits of using oral medications for PE over other methods is that they allow people to enjoy sex without imposing the restrictions of decreased involvement, decreased sensation or techniques requiring an interruption to intimacy. The downsides? They are medications with effects not restricted to their use in PE and any number of side effects are possible, “though only ones associated with the medication itself."
Get comfortably numb
If there’s a nuclear option for people looking to delay their orgasm, it’s getting your hands on a product designed to temporarily desensitize your penis. For many people, using a regular old condom will do the trick. Durex and Trojan offer condoms that contain between 4 and 5 percent benzocaine, a numbing agent that will reduce your penis’s sensitivity and enable you to slow down the clock during your next session.
If you aren’t using condoms, the penis can be desensitized with a topical wipe that contains 4 percent benzocaine, an ester local anesthetic. In 2017 the interim results of a randomized, double blind trial demonstrated as much with most of the fifteen trial participants achieving an intravaginal latency time of over two minutes after a two month period. (At the start of the trial, all 15 participants were reporting sex consistently lasting less than two minutes after penetration.)
Numbing sprays can also be effective. Ian Kerner, psychologist and author of She Comes First, recommends Promescent which contains another type of numbing agent—lidocaine. “You spray it once or twice on the head of the penis, and it absorbs really well, so a woman isn’t going to experience residual numbing,” he says.
Squeeze and please
In the '60s, sex research pioneers William Masters and Virginia Johnson looked at several methods to help men delay ejaculation. Among the most effective was the "squeeze technique," in which the man's partner lent a hand to delay ejaculation and prolong the length of sexual intercourse. They told women—who were apparently the only partners of penis havers back in the '60s—to place the thumb, index, and middle fingers around the tip of his penis, and squeeze immediately before a man was reaching ejaculatory inevitability and keep squeezing until that feeling had subsided and his body relaxed before slowly release the pressure.
In their rather harshly titled 1970 book “Human Sexual Inadequacy,” Masters and Johnson reported the treatment of 186 cases of premature ejaculation with only four failures. Writing in the Australian and New Zealand Journal of Psychiatry, contemporaneous psychiatrists Michael Clarke and Laurel Parry suggested that the success of the technique derived from a “reduction of anxiety in the coital situation and a strengthening of trust and confidence in the relationship between the marital partners.”
Do your kegels
Men, like women, have a pelvic floor muscles which consist of the puborectalis, the pubococcygeus and iliococcygeus muscle. They provide support to the pelvic organs, including the urethra, bladder, and bowel. They also contract rhythmically during orgasm. Performing what are commonly known as kegel exercises can make these muscles stronger. "Men possess the same muscles that help so many women gain control by doing kegel exercises and men can benefit equally from strengthening them," Reitano says.
The easiest way establish control over this trio of muscles is to stop the flow of pee when you use the bathroom. Once you’ve established the mind-muscle connection, clench and release the pelvic floor muscles repeatedly for ten seconds. Do three sets, with a ten-second break between sets. Once you’re into a good routine, you can start busting out your new skill while having sex. “By repeatedly flexing those same muscles a few times per day, control can be developed that can be used to delay orgasm,” Reitano says, adding a word of caution: “Stopping repeatedly while urinating can lead to urethral irritation. You have to be careful about this. Learning about the muscles by stopping urination is helpful but not something to do consistently.”
Talk it out
If you try all of items above and sex still doesn’t last as long and you and your partner would like, it might be time to consult a therapist, alone or with a partner. “Sexual dysfunction can be rooted in psychology rather than physiology and this is particularly true of the sudden onset of PE and situational premature ejaculation,” Reitano says. A 2013 study published in Japanese Psychological Research looked at 15 people experiencing PE who underwent eight to twelve sessions of therapy and found that the changes that took place were “statistically significant with a tendency towards improvement.”
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This article originally appeared on VICE US.