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Effects of Premature Ejaculation On The CoupleAs we've seen on the page of definitions about premature ejaculation, there has always been a large element of subjectivity in classifying men as premature ejaculators (or not). But most men who can't delay climax will be very well aware of that fact. And of course there are also some men who can maintain intercourse for a very long but still believe that they are ejaculate too soon. Problems often arise because a woman believes she should reach orgasm during intercourse, and when she does not do so, she blames her man and his supposedly inadequate sexual performance (an idea which he swallows whole, since men want to impress and please women in bed). That said, this page is about the effect of premature ejaculation on a couple's relationship, and I want to point out how the subjective element of any definition of PE can influence a couple's perception of their sexual performance. Continued below the video. Sidebar: Video - overcoming ejaculation with multiple orgasms
Let us suppose that a couple rigidly adhere to the belief that a man who ejaculates in a minute or less is coming too quickly. So what would happen to them if they couple engaged in up to an hour of completely satisfying and rewarding erotic massage, manual genital stimulation, oral genital stimulation, and at the height of their arousal the man entered the woman and came after 30 seconds of extremely pleasurable thrusting? Most couples would probably be highly satisfied with a sexual encounter like this, achieving feelings of fulfillment and pleasure. Even so, if a man and woman believe that a man who is unable to delay his ejaculation for more than, say, 2 minutes has a serious problem, it's entirely possible that their pleasure would be considerably diminished. In other words - it may well be nonsensical to consider a man as suffering from premature ejaculation if he comes in under 2 minutes on certain occasions. Time or delay or length or slowness is not really the issue - the issue is really about control. About choice - in other words, about having the ability to choose when to ejaculate (at least most of the time - extreme horniness excepted). How To Delay PleasureThe concept of control also plays a part in every couple's perception of their sexual performance. Consider a man who is able to maintain 10 minutes of thrusting in his partner's vagina before he ejaculates. Could he be described as suffering from premature ejaculation? No? Well, what if the 10 minutes' delay before he comes is the result of using emotional and mental tactics which reduce the amount pleasure he and his partner get from sex? I'm thinking here of things like avoiding foreplay, avoiding any stimulation of his genitals or his partner's genitals or breasts before penetration, or distracting himself by thinking about something remote from the sexual encounter with his partner (taxes, baseball, and the like), avoiding any sexual fantasy, perhaps using an anesthetic spray on his penis to reduce sensation, or wearing more than one condom during intercourse. Other strategies might be lying still while the woman moves on top of the man, taking intercourse very slowly, and so on… Indeed using any strategy that could delay ejaculation but which diminishes the quality of the couple's sexual experience leaves us in a quandary as to whether the man is a premature ejaculator or not. Surely if he can only endure for a reasonable duration of intercourse by degrading the quality of pleasure that he and his partner gain from sexual intercourse, then his sexual performance is clearly inadequate, but is he a man with PE or not? It's clear, therefore, that the any discussion of PE causes, effects and treatment need to be conducted with an awareness of the couple's needs and wishes around sex. I have seen couples presenting for treatment where both the man and the woman believe that the man's ejaculation occurs far too soon despite the fact that they typically enjoy between 20 and 30 minutes of foreplay and 10 or 15 minutes of vigorous thrusting during intercourse. What I've discovered over the years is that in the majority of these cases, the woman wishes to experience orgasm during intercourse, without having her partner stimulating her clitoris. In general, most couples in this situation have a faulty belief that long-lasting intercourse can actually give a woman an vaginal orgasm regardless of whether or not she receives stimulation of the clitoris. Video: how do women orgasm - vaginal sex or clitoral stimulation?
The right approach here may be to simply give the couple some information about the techniques by which a woman can become sexually aroused before intercourse, and can enjoy her orgasm during intercourse by adopting the coital alignment technique or by having her partner stimulating her clitoris as he makes love to her. It is also extremely important to consider whether or not the man's tendency to fast ejaculation is "global" or "situational". These are rather pretentious scientific terms for two scenarios - (1) the man ejaculates rapidly in every sexual encounter he has, and (2) he comes too soon in encounters with one specific partner, or one specific place (like a woman's vagina). The Effect Of Premature Ejaculation On A CouplePE will obviously have an effect on a couple's relationship if the man ejaculates quickly every time he attempts vaginal intercourse with his partner. Equally, if he has a reasonable degree of control when masturbating or being fellated by his partner, but none during intercourse, the situation is bound have a different impact on the couple than if the man ejaculates quickly on every occasion. This is because most men lose interest in sex, at least for a few minutes, if not for longer, after they have ejaculated. There is a fundamental question here, of course - why is a man unable to delay his ejaculation? How come he does not know how to delay his sexual responses? A very common pattern of sexual activity is for a woman to give her man oral and manual foreplay before he penetrates her – and, if he ejaculates so quickly that he comes before he's even entered her, and certainly before she's had an orgasm, the level of sexual satisfaction in on the woman's part is bound to be very low. This will have a considerable impact on the harmony of their relationship outside the bedroom. As an aside, I always recommend couples in this kind of situation to ensure the man focuses on the woman's sexual pleasure before taking his own. You can see how to ensure the woman has pleasure first here. That way she isn't deprived of pleasure of an orgasm; it appears that women are more willing to accept short lived or non-existent vaginal intercourse if they've already had an orgasm and feel intimate or close to their partner. It's also quite a good strategy for men who can last long enough (whatever that may mean) during masturbation or oral sex, but who come quickly during vaginal intercourse. In all cases, the harmony of the relationship outside the bedroom is maintained much better if the woman achieves sexual pleasure before the man penetrates her and comes quickly, turns over and goes to sleep.... The effect of PE on a couple's relationship might also depend on whether a man's early ejaculation is lifelong or acquired. As you may understand from these terms, lifelong premature ejaculation starts from the man's first sexual encounter - and it's comparatively rare for men not to improve their sexual "performance" i.e. increase intravaginal ejaculatory latency time or IELT) as they get older. However, a significant number of men still ejaculate quickly in their 40s, 50s and beyond. Back in the 1950s, Alfred Kinsey demonstrated that 75% of men ejaculated within 2 minutes of starting intercourse on more than three quarters of the occasions on which they have sex, and it's my belief, as a practicing sexual therapist, that nothing much has changed since those days. If a man who has previously enjoyed good ejaculatory control suddenly develops "acquired premature ejaculation", there may be good reason for his partner to suspect that something significant has changed either within their relationship, or within the boundaries of the man's sexual conduct. In my experience, acquired premature ejaculation is accounted for in about 50% of cases by prostatitis or other functional disorders, and in about 50% of cases by emotional issues between the couple. For example, the man may come to see that he does not feel emotionally connected to, or intimate with, his partner, or he may not even wish to engage in intercourse with her. It's not hard to see how rapid ejaculation can serve as a means of shortening a sexual encounter for a man who basically feels averse to any sexual activity with his partner but cannot tell her how he feels for some reason. There's no doubt that premature ejaculation is disruptive to a couple. One of the reasons for this is that it's popular culture has come to hold extended intercourse in high regard. Despite what I said above about my opinion on Kinsey's research, it is a fact that in recent years researchers such as Hunt have conducted large-scale studies of American men and found that the average duration of intercourse is now as much as 10 minutes. Hunt concluded that the differences between his findings and Kinsey's could not be accounted for by methodological or definitional differences, but that they must be the result of cultural change. He concluded that American culture had come to hold extended duration of intercourse in high regard… "A dramatic and historic change has taken place in the practice of marital coitus in America." And of course that would be true as feminism empowered women and raised their expectations of sexual intercourse. What may be less obvious is the fact that these higher expectations will of course increase the stress and distress experienced by men who define themselves as premature ejaculators. I don't think that even if the woman has an orgasm before the man enters her it can overcome the impact that PE may have on a couple. In many cases this really does matter because it makes both partners frustrated and unhappy. I've met plenty of couples who regard intercourse lasting less than 10 minutes as being far too short. And even when I find that their expectations are incorrect - often they believe that a woman can orgasm from thrusting alone - it can be quite difficult to change their beliefs and expectations. You can try PE exercises to deal with this. In some cases this rigidity around expectations about sex can threaten a relationship, ruin a marriage, and certainly spoil the sex lives of both partners. To be more specific, the man's lack of control leads to a sense of dissatisfaction, a suspicion – or even a certainty – that something is missing from their relationship, and in particular a diminished sense of intimacy. Unresolved PE can lead to an increase in irritability, interpersonal difficulties, and the deepening of an emotional disconnection between the couple. This is why it's important that any treatment recognizes a lack of delayed ejaculation as the couple's problem, not just as the man's alone. You see, the point is that the effective sexual dysfunction is not just simple physical effect, but it's the meaning that the couple ascribed to it. Obviously these meanings are constructed by the individuals within the context of their relationship and culture. But what researchers have demonstrated is that both men with PE and their partners feel that the man's degree of control over his ejaculation delay is the central issue. So far, so unsurprising. But this lack of control leads to dissatisfaction, and a reduction in intimacy. Typically, after the man has come too soon, he will feel ashamed and embarrassed, while his partner feels frustrated and angry. And instead of communicating about this, the couple remain separate and silent, and whatever intimacy existed during the sexual encounter will end prematurely and perhaps in an atmosphere of disharmony. It's certainly the case that for most couples who have problems with early ejaculation, difficulty in communicating about it is the norm. Furthermore, many of the techniques that men use when learning how to delay their ejaculation may actually make the situation worse: typically, a man will use distraction techniques to try and remove his awareness from his increasing arousal and impending ejaculation, but the consequence of distractional thinking is a reduction of his awareness of his partner and his sense of connection to her, which she will undoubtedly sense, and probably resent. Even those highly recommended interrupted stimulation techniques such as the stop start technique will have an impact on woman's sexual satisfaction because her level of arousal will decrease every time intercourse is interrupted for the man to regain control.
Perhaps
unsurprisingly, up to 40% of men with PE have said that they actually will resort
to alcohol to reduce anxiety, which is obviously an implicit admission that the
relationship is not one in which the man feels completely self-confident, and
another 17% will resort to using recreational drugs for the same purpose. This really is quite extraordinary when you think about it. Sex is an activity which two people engage in by mutual consent, and any dysfunction that arises within the context of the sexual relationship needs to be addressed by both partners. A man who presents with lifelong PE may have a low sex drive, or a low level of sexual desire, either because of the relationship he's in (i.e. he is getting low levels of sexual stimulation) or because that's his biological nature. Men like this are, in general, going to respond less well to treatment than men with a high sex drive. Equally, when treating men who have acquired PE it is important to understand what has changed in the recent past, and to explore the man's perception of what may have caused the situation to change. If a couple are not able to communicate reasonably well it's highly unlikely a man will talk freely if his partner's present, even though the partners' cooperation is necessary for effective treatment. Masters and Johnson got round this by interviewing the couple separately at first and then together, so they could establish exactly how each member of the partnership saw the problem. Some terms that have been in the etiology of PE tell a story in themselves: for example, "symptom inducer" and "symptom carrier". These terms are an implicit recognition of the fact that hostility and anger on the part of the woman, or a desire for short lived intercourse on her part, can be expressed by psychological transference that results in a man ejaculating quickly. In summary, it's necessary to find a treatment that includes an approach that will not only improve the obvious physical symptom of quick ejaculation but the quality of erotic connection between the partners, the variety of their sexual behavior, and ultimately the erotic and sexual satisfaction of both man and woman.
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