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If there's any one physical skill that makes men great lovers, it's staying power. And if there's any one aspect of their sex lives men usually don't want to discuss, it's the absence of staying power.
Premature ejaculation is the most common male sexual difficulty, far more common than erectile dysfunction (ED), the subject of massive advertising campaigns on TV.

Just how common is premature ejaculation? Ending sex too soon was even mentioned in the Kama Sutra, written between 1300 and 1700 years ago. The Hite Report, surveying 7,000 men in the United States, stated that 70 per cent of American men answered "yes" to the question "Do you ever reach orgasm too soon when having sexual intercourse."  Although only 21 per cent of men said they climaxed before entering their partners or after only 60 seconds of penetration, nearly 2/3 of men reported that they could not sustain intercourse for more than 5 minutes.[1] Famous American sex researchers Masters and Johnson found that over 50 per cent of men reached their sexual climax before their partners.[2]

Premature ejaculation is defined as ejaculation before penetrating one's partner, or before the man wants to ejaculate inside his sexual partner. There is no standard time limit for defining premature ejaculation, but there is general agreement that the ability to sustain sexual intercourse for at least three minutes is a good indication that there is not a problem. Medical treatment for the condition usually occurs after the partner sees a doctor about sexual inadequacy.[3]

Occasional premature ejaculation indicates psychological issues.

When premature ejaculation is a sometimes thing, the cause is usually psychological. Men who are afraid of getting caught tend to ejaculate very quickly, sometimes even before penetration. Men having their first sexual experience also tend to ejaculate very quickly, before penetration. If premature ejaculation is occasional, and it is not coupled with erectile dysfunction, what is really needed is to be having sex with the right partner in the right setting at the right time. Getting rid of outside stresses, and avoiding situations about which the man feels guilty, are enough for normal sexual performance. [4]

Shapiro, and later Godpodinoff classified premature ejaculation into two types:

  • lifelong (primary) and
  • acquired (secondary) premature ejaculation.

Lifelong is a syndrome characterized by a cluster of core symptoms including early ejaculation at nearly every intercourse within 30–60 seconds in the majority of cases (80%) or between 1–2 minutes (20%), with every or nearly every sexual partner and from the first sexual encounters onwards [5]. On the other hand, acquired premature ejaculation differs in that sufferers develop early ejaculation at some point in their life, which is often situational, having previously had normal ejaculation experiences. The main difference between these two syndromes is the time of onset of symptoms.[4]

Chronic premature ejaculation indicates physical issues.

When premature ejaculation happens all the time, however, the underlying problem is usually physical. As the tip of the penis is stimulated, before or after intercourse begins, a group of nerve fibers known as the Krause finger corpuscles sends signals to three centers in the brain that control ejaculation.[6]

When dopamine levels in the brain are high, as they are in a guilty or highly expectant emotional state, the nerves in the brain send a signal to the penis to force semen out very quickly. When serotonin levels in the brain are high, as they are when men take antidepressants of the serotonin reuptake inhibitor class, the nerves in the brain send the ejaculation signal to the penis very slowly or not at all.

First, there is a signal to build up the amount of seminal fluid in the penis. Then there is a signal to ejaculate, and finally there is orgasm. It is possible to build up semen that then rolls backwards into the prostate rather than forward out the penis. It is also possible to ejaculate without orgasm, and to have orgasm without ejaculation. All of these variations in sexual performance, of course, can have a devastating effect on a man's self-esteem, so that a physical problem becomes an emotional problem, too.

What men can do about premature ejaculation?

Men who suffer premature ejaculation, and men who just want to be able to have sex with more staying power, can improve their sexual abilities by following three simple words: Practice, practice, practice.

In the bedroom, men can try a stop-start technique for slowing down ejaculation. With a cooperative partner, the man asks for "loosening" of the vagina (or other orifice) until he loses a sense of sexual tension. Then he asks for greater tension so he is again fully aroused, and stops the act of intercourse a second time.

Usually, at this point, both partners are ready to stop practicing and they conclude intercourse. The practice of starting and stopping the sex act, however, lengthens the time for the brain to send signals to the penis to ejaculate. Men are able to keep going longer and stronger the more they practice this technique.

Learning to control other muscles involved in sexual intercourse.

Men can also benefit from Kegel exercises. The purpose of these exercises is to strengthen the pelvic muscles that hold semen in the prostate, or push semen out of the prostate. Unlike the muscles that control ejaculation, these muscles are under voluntary control. With practice, men can learn how to keep semen back until they are ready to conclude intercourse. Mastering this technique also helps with control of the smooth muscles in the penis.[7]

The simplest way to do Kegels is while urinating. A man starts the flow of urine, and then stops it. Then he forces out as much as he can, and stops the flow again. Repeating this process over and over again strengthens the muscles in the pelvis that a man can use to slow or speed up the flow of semen.

Condoms as a method of increasing sexual power

As wearers of condoms know quite well, condoms reduce sexual stimulation. This is not, however, always a bad thing.

When men have a problem with climaxing too soon, a condom slows down the process. Doctors may even prescribe condoms lined with lidocaine, the same compound the dentist injects into the gums before working on your teeth. If there is too much lidocaine in the condom, however, the man may lose his erection.

Medical approach to controlling premature ejaculation

At the present time, only one drug (dapoxetine) is licensed for the treatment of premature ejaculation. Dapoxetine has been approved for treatment for the treatment in New Zealand, Sweden, Austria, Finland, Germany, Spain, Italy, and Portugal, and other European countries are expected to follow. However, dapoxetine is not approved for marketing in the United States. Dapoxetine is a short-acting SSRI and is designed to be taken only when needed, approximatelly 1–3 hours before sexual intercourse is anticipated. Dapoxetine is well tolerated, but long-term side effects have not yet been presented because randomized trials are not yet available.[8]

There are other drugs described below can also be used, but they are not licensed for the treatment of premature ejaculation: 

  • Tricyclic antidepressants (clomipramine) [9] follow up with reports of improved sexual satisfaction but have some side effects such as fatigue, dizziness, dry mouth and hypotension.
  • SSRIs unlicensed (escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline) have been shown to be effective by delaying ejaculation. The results can be seen within days of the starting SSRIs, with the best effect reaching after 4 weeks of use. Possible side effects include fatigue, yawning, mild nausea, loose stools, and perspiration.[9
  • There are other local anesthetics available on the market — some of them are prescription only, others are available over-the-counter, and some of them can be purchased online. These local anesthetics desensitize the penis prior to coitus and mostly come in the form of creams although topical sprays are also available. These desensitizing agents mostly contain SS Cream, Benzocaine, prilocaine, and lidocaine.[8] There is an Asian herbal alternative to lidocaine called Severance Cream. This product does not cause loss of erection, but it can slow down ejaculation a great deal, so that sexual intercourse to climax may take 20 or 30 minutes. Men need to be physically fit enough to last 20 to 30 minutes without excessive strain on their hearts or suffering physical fatigue--which also can cause loss of erection.[8] Desensitizing creams and sprays do cause potential side effects, and some of them include: 
    • hypoanaesthesia of the penile shaft and numbing of the vaginal vault of the partner, unless a condom is used [10].
    • irritation and rare systemic effects [11]. 

What about Viagra, Levitra, and Cialis?

The role of PDE5 inhibitors, that are represented in sildenafil, vardenafil, tadalafil, in the management of premature ejaculation is controversial. Some studies suggest that sildenafil is recommended for premature ejaculation treatment [12], the evidence has still a lot to show in order to include PDE5-I in a standard treatment of premature ejaculation. 

Men who feel good about their sexual relationships, who aren't rushed, who don't need to be furtive, and who have sex regularly often find they don't really have any erectile dysfunction after all. Don't go to the doctor demanding the drugs you hear about on television. You may not need any medication, or you may need a low dose of a medication for your brain -not your penis.