The marital relationship

There are many definitions of premature ejaculation (PE). Some say it's when a man can't prolong intercourse long enough for his wife to climax. Does this mean a man who can last half an hour is premature if his wife does not climax? Does it mean the man who never lasts two minutes is not premature if his wife usually climaxes? (Both such couples exist.) The usual medical definition is a man who ejaculates less than two minutes after entering the vagina; but the reality is three minutes is not enough time for the vast majority of women to reach climax. The best definition we have found deals not with the woman's climax, or how long intercourse lasts, but with the man's ability to control his ejaculation most of the time, climaxing only when he chooses. Admittedly this is a subjective measure that cannot be quantified for use in studies, but it is a good real world standard.

How many men deal with PE? We’ve seen estimates as low as 2% and as high at 70%! Some of these are high because they ask if men have ever experienced PE. A variety of relation issues, as well as not having had sex in a long time, affect how long a man can last, so such a question is of little use. The best studies put the number of men who can’t last two minutes at 11% to 14%. The number of men who don’t have real control is higher than this – possibly as high as one third of all men. 

Originally, it was thought that rapid ejaculation was the result of mental issues such as anxiety, fear, anger, or embarrassment. Based on this, treatment was to deal with the mind via psychoanalysis. In 1970, Masters and Johnson said PE was a result of self-learned behaviours: rapid masturbation or hurried sex resulting from fear of discovery. This theory resulted in trying to cure PE by behaviour modification – retraining a man to make sex last longer.

While all the things listed above may be factors in some cases of PE, there is growing research-based understanding that some men are "hard wired" to ejaculate quickly during intercourse (most men can last much longer during masturbation and other sex acts – intercourse is different). Studies of twins have suggested heredity is involved, studies of penile sensitivity have found that men with PE have greater sensitivity than those without, and several studies have found certain genes to be more common in men with PE. This new understanding of PE has brought about the search for ways to treat PE with medication, and studies of medications have further supported the idea that PE is not “all in the head” by showing that the placebo effect is very weak for PE.

PE is divided into two categories. If a man has always climaxed rapidly during intercourse, he has primary or lifelong PE. If he started to have problems after a period of good control, he has secondary or acquired PE. Secondary PE is far more likely to have a psychological component. Secondary PE is also common in men who develop erectile difficulty, with almost half of such men reporting PE. Anxiety about losing an erection causes men to speed up so they can climax “before it’s too late”. In this case, the solution is to deal with the ED so the man can take his time.

Rapid ejaculation is very much a couple issue. It clearly affects the man and the woman, their sex life, and their marriage as a whole. It is also unlikely that a man will be able to succeed in changing without the loving support and help of his wife. Women should understand that most men find PE shameful; he feels like he is not really a man, and he does not want anyone else, even a doctor or counsellor, to know of the condition. It's common for a man to refuse to seek help because of his embarrassment. In such a situation, the wife should lovingly but firmly communicate to her husband that she will not accept him ruining their sex life because of fear or pride.

We will begin with ways for a couple to train the man to have control of when he ejaculates, then suggest other alternatives for those who find this does not work. Studies of men with primary PE find that 80% ejaculate after less than half a minute of intercourse, with the rest averaging two minutes or less. A man who regularly lasts three or more minutes probably does not have a predisposition to ejaculate quickly, and as such can likely learn to last longer. Men who always climax in less than a minute can try to learn to last longer, but most in this group will be unable to make a change. Don’t beat up on yourself (or your husband) if you can’t learn to last longer – genetics may be against you. There are other ways to deal with PE.

Learning how to control it

Ejaculatory control is a learned skill, so don't despair if you're having trouble with it. There are several issues involved in gaining control: being able to feel what is happening, accurately knowing how close you are to orgasm, and knowing how to slow down when you are close but don’t yet want to climax.

Being able to feel what is happening

If you have negative feelings about sex or your sex organs, you may be keeping your mind from focusing on your penis, and on the sensations you are experiencing during sex. If your orgasm "takes you by surprise," shame or negative attitudes may be something you need to address. God gave you a penis for many reasons, including giving and receiving sexual pleasure with your wife. It is good and right to focus on your penis during sex - to concentrate on and fully experience the pleasure of sex.  

Some men have unintentionally trained themselves to ignore the signs of approaching orgasm. A man who has repeatedly masturbated in a hurry (for fear of being caught), or engaged in hurried sexual contact before marriage (again out of fear of being caught), can develop the habit of ignoring the "warning signs" and going full speed until climax occurs. Similarly, if a man has been with a woman who wanted him to get sex over as fast as possible, he learned to hurry as a necessity. In these situations what seems to be PE is actually just a habit, and as with any habit, it can be unlearned.  

One thing that will help you is exercising the muscles that contact during ejaculation. Making these muscles stronger will help you gain control, and exercising the muscles will help you learn to feel what is happening in that area of the body. So start by learning to do Kegels to build up your pelvic muscles.

Knowing how close you are

Imagine your arousal/stimulation level as a number between 0 and 100, with 1 being just barely erect, and 100 being the point where orgasm occurs. It's not enough to just know when you get to 99, because at that point you will have neither the desire nor ability to stop; you have to learn to tell the difference between 50 and 70, and between 80 and 90.

Learning to gauge your level of arousal requires paying close attention to your body during sex, and it's going to take some trial and error. It's much easier to learn to feel the signals of arousal level during manual stimulation than during