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The Longer Lasting Lover A Review Of Premature Or Rapid Ejaculation Possible Causes Of Rapid Climax In Men A) Physical 1) The hypersensitive penis Over the years many researchers have attempted to explain premature ejaculation in terms of hypersensitivity of the penis. These experiments have been conducted by applying a vibrator to various parts of the penis and measuring the level of nerve cell excitation which results. This is taken as an indication of how responsive a man's penis is to sexual stimulation: the presumption being that the more sensitive, the more likely he is too reach orgasm quickly during intercourse. While some researchers have claimed an inverse correlation between penile responsivity to vibration and a man's time to climax, this may or may not be an indication that men who have primary PE have penile hypersensitivity. It is, however, an interesting finding. We also know that men who experience rapid ejaculation during sexual intercourse also tend to ejaculate quite quickly during masturbation: on average, about twice as fast as men who do not experience PE. This certainly is strongly suggestive that something is different in the nervous system of these men, although whether the short time between sexual stimulation and ejaculation is indeed due to penile hypersensitivity is far from certain, because other research on vibratory thresholds of nervous excitation in the genitals seems to demonstrate no connection between penile sensitivity and rapid ejaculation. It's much more probable that men who come quickly have somehow conditioned themselves to respond sexual stimulation with a rapid climax: and it's not hard to imagine how this might happen through a process of conditioning, which may even begin early in puberty when a boy trains himself to reach orgasm rapidly through masturbation. (For reasons of fear of discovery, sexual shame, anxiety and so on.) We also know that men who experience PE often report that they are unaware of their impending ejaculation, which suggests their awareness of their body's signals that they are reaching the point of no return (scientifically called the "point of ejaculatory inevitability") is somehow blocked, or that they are unaware of their movement from the plateau phase of sexual activity into the orgasmic phase - or that this transition is so rapid that they cannot control it. The latter explanation is certainly not incompatible with the conditioning theory offered above. All in all, the idea that the men with PE suffer from hypersensitivity of penis is far from proven. In fairness it has to be admitted that the fact that American men report a much longer IELT than German men (13 minutes and 7 minutes respectively) might suggest that the widespread practice of circumcision in America has resulted in men whose penile sensitivity is much lower than it is in uncircumcised men. This is nothing more than indirect and circumstantial evidence which may or may not indicate that penile sensitivity has some influence on the speed with which a man reaches his climax. To prove it or not, much more work would have to be done on exploring the incidence of PE in American men by age range; this would indicate whether or not older men, who have a lower penile sensitivity than younger men due to the comparatively longer time for which their glans has been exposed to the process of keratinization, experience less PE. (More information: PubMed ) 2) Anomalies of brain chemistry We know that anomalies of brain chemistry do cause some emotional illnesses, so it's not impossible that they could also cause conditions like premature ejaculation. The physical process of ejaculation involves emission and expulsion: emission is the first phase, in which seminal fluid from the ampullary vas deferens, seminal vesicles, and prostate gland is deposited into the posterior urethra. The second phase is expulsion, in which the bladder neck closes, after which the urethra rhythmically contracts through action of the pelvic-perineal and bulbospongiosus muscle, and intermittent relaxation of the external urethral sphincters. It is believed that the neurotransmitter serotonin (5HT) plays a central role in modulating ejaculation. Several animal studies have demonstrated its inhibitory effect on ejaculation. Therefore, it is perceived that low level of serotonin in the synaptic cleft in these specific areas in the brain could cause premature ejaculation. One observation that seems to support this point of view is that the administration of a class of antidepressants known as selective serotonin reuptake inhibitors or SSRIs (these are drugs which inhibit the uptake of serotonin and thereby increase its level in the synapses of the brain) to men suffering from anxiety or depression impacts on their ability to ejaculate, sometimes leading to a much slower ejaculation, and sometimes preventing it all together (anejaculation). But while the balance of dopamine and serotonin in the brain therefore obviously does have an impact on a man's capacity to control his progress to climax, it seems a little risky to administer drugs which alter brain chemistry so dramatically as a treatment for a sexual dysfunction. Leaving that aside, it seems that low serotonin levels are linked in some way to rapid ejaculation, and SSRIs have an impact on this sexual dysfunction. The pharmaceutical industry has not been slow to respond to this observation, and has been developed an SSRI called Dapoxetine which has certain characteristics that make it a potential candidate for on-demand treatment of rapid climax in men. These characteristics include the ability to take it as needed one hour before intercourse rather than every day, a short half life, a low dosage, and limited side-effects. As we shall see in the premature ejaculation treatment section, Dapoxetine does indeed have the ability to double a man's IELT, although the significance of this is rather questionable, because in the controlled studies which were presented as evidence of the drug's effectiveness, the baseline IELT was very low indeed in most cases -- certainly under two minutes. (More information: Efficacy and tolerability of Dapoxetine in treatment of premature ejaculation: an integrated analysis of two double-blind, randomised controlled trials The Lancet, Volume 368, Issue 9539, Pages 929-937 J. Pryor, S. Althof, C. Steidle, R. Rosen, W. Hellstrom, R. Shabsigh, M. Miloslavsky, S. Kell) B) Psychological 1) Negative emotions around sex: anxiety (for example, performance anxiety, fear of sex, fear of not being good enough), fear, sexual shame and guilt Although we may see sexual arousal and emotional arousal -- i.e. anxiety, depression, anger and grief and so on -- as quite separate and distinct states of mind, they are mediated by similar neurological mechanisms. This means that the arousal which precedes orgasm may not just be sexual, it can be emotional as well. When we refer to "emotional arousal" we mean a particular state of mind and body which involves heightened awareness, heightened mental activity, a more active SNS (sympathetic nervous system), a raised heart rate, and various other physiological symptoms such as mild perspiration and a subjective sense of an emotional state such as anxiety. If you think about it for a minute, you'll see how similar these symptoms of emotional arousal are to the symptoms of sexual arousal. This link between a heightened state of emotional arousal and a heightened state of sexual arousal means that a man who is experiencing a high state of anxiety is quite likely to have a more rapid increase in his level of sexual arousal during sexual activity, and he may experience a much lower level of control over his progress towards ejaculation and orgasm. And sex can be a very anxiety provoking event: for a man, the most common fears around sex consist of: the fear of being judged as inadequate in some way either by his partner, or indeed by himself - this inadequacy may centre on a man's perception of his penis size, his ability to satisfy his partner (whatever that means for the couple concerned), or his ability to control his ejaculation; a fundamental fear of sex which originates in childhood shaming, where a boy has been shamed by his mother or father or both for exploring his own sexuality, particularly around masturbation, an association which makes sex in later life and anxiety charged event; and fear of intimacy, which again results from negative childhood experiences. Few of us approach sex without some degree of emotional arousal: for those who interpret this arousal is joy excitement or fun, sex tends not to be problematic; for those who interpret the emotional arousal as fear or anxiety, sex can become a highly charged event where an association between sex and anxiety can produce some kind of reinforcing positive feedback. For example, a man who fears coming too quickly will worry about this; this increases his level of anxiety; this increase increase feeds back to his conscious awareness, which makes him even more anxious about coming too soon. The end result, of what we commonly call "performance anxiety", is that he does indeed ejaculate far too quickly. And once this has happened he expects the same thing to happen again so his anxiety tends to be reinforced. There are various approaches to dealing with this type of anxiety which are covered in the section on treatment. Sexual shame and guilt work in essentially the same way: they increase a man's arousal and his level of anxiety so that he is more likely to ejaculate quicker than he otherwise would. Shame and guilt around sex stem from negative childhood associations which have rendered sex or sexuality into an anxiety-provoking entity. At some level, too, a boy who has been shamed for his very existence - what the TA therapists would call a "Don't Exist" script - may find sex threatening because it deals with life force energy. If he was punished for sexual activity such as masturbation or just simple sexual curiosity, the association between guilt and sex can be extremely anxiety-provoking. (More information on the role of anxiety in PE: The role of anxiety in premature ejaculation: A psychophysiological model Donald S. Strassberg , John M. Mahoney, Michael Schaugaard and Valerie E. Hale Archives of Sexual Behavior Issue Volume 19, Number 3 / June, 1990 Pages 251-257.) 2) Lack of sexual experience It stands to reason that the first time a young man has sex he's going to be very aroused and sexually excited: no matter how much porn he's watched, no matter how many books he's read, no matter how many pictures he's looked at, this is the real thing -- the thing he's been waiting for all his life. Not only is it naturally exciting, because we're all programmed to respond to the sight of the opposite sex, he is also extremely excited because of all the anticipation that's preceded this event. And, no matter how experienced we may be, such a high level of sexual excitation and arousal, will definitely shorten the time between penetration and climax. So, lack of sexual experience is a risk factor for premature ejaculation (in other words, something that will increase a man's chance of experiencing PE). Other risk factors include: not understanding male and female sexual responses; fear about causing woman to become pregnant; anxiety about contracting a sexually transmitted infection; anxiety about poor sexual performance; and interpersonal relationship problems between sexual partners. 3) Habituated fast ejaculation responses learned during masturbation It's been suggested that a particular habit of masturbation developed during puberty can lead to rapid ejaculation in later life. A boy who is frightened of discovery, or feels guilt or shame around his sexual activity, may well seek the release of ejaculation and at the same time desire that the experience is as short-lived as possible because of the conflicting negative emotions which he is experiencing. But while there is a lot of evidence that idiosyncratic masturbation habits such as traumatic masturbatory syndrome can affect the ejaculatory competence of a man later in life, there is little evidence that rapid masturbation as a teenager is a factor in the development of early ejaculation as an adult. It's much more probable that sensitivity to sexual arousal, a factor which may be both biologically and psychologically determined, is the key to rapid climax; in other words, the factors which lead to rapid ejaculation during masturbation as a teenager may also be the ones which lead to rapid ejaculation during intercourse as an adult. The way to deal with this is to learn to appreciate a slower approach to sexual arousal, a relaxed form of sex play and more gradual sexual stimulation, to engage in a process of releasing shame and guilt and inhibitions around sex, and to use techniques to heighten awareness of the level of physical arousal and physical sensations in the body. All these approaches, which are used by sex therapists when dealing with PE, seem to be practical ways of reducing the rapidity of sexual arousal and slowing the rate at which a man approaches his point of ejaculatory inevitability. 4) Lack of awareness of the level of one's sexual arousal Although we generally regard sexual arousal as a process that is beyond conscious control, this is only true in the sense that, say, breathing is beyond conscious control: in other words, it is actually possible to exert some level of conscious influence over the autonomic functions of the body. Generally speaking, though, we're not aware of breathing, just as we're often not aware of our increasing sexual arousal. Taken to its extremes, this lack of awareness may well explain why a man may suddenly finds himself ejaculating even though he had no sense of approaching his point of no return. It follows that the first step in developing a level of control over ejaculation is learning to be aware of how aroused one is during sexual activity. As with all autonomic functions, one has to learn how to do this. In the initial stages it's simply a matter of paying conscious attention to one's level of arousal while continuing with sexual activity -- all this takes is the ability to pay attention to one's feeling. The next stage is to develop a higher level of control over the rate at which one becomes sexually aroused and excited. For that, other techniques are required, including relaxation, deep breathing, techniques of mental control, and possibly more making more fundamental psychological shifts such as lowering sexual performance anxiety, reducing sexual shame, and eliminating other negative aspects of sexual thinking and beliefs. This might include, for example, eliminating the belief that sex is about pleasing your partner rather than pleasing yourself, or changing the attitude which suggests that the needs of your partner are more important than your own needs. (The latter is a very common belief amongst men who are driven to satisfy their partners at all costs - a highly anxiety-provoking state in which to enter sex - after all, how can you ever fully satisfy someone else's needs? - and a sure-fire route to some kind of sexual dysfunction such as PE or delayed ejaculation.) Finally, any interpersonal relationship issues which may be getting in the way of trust and intimacy need to be resolved, since a couple who are resentful for some reason at any level will not be able to engage in the full expression of their deepest sexuality. For example, a man who is angry, either overtly or covertly, at some level with his partner is likely to experience sexual dysfunction including possibly premature ejaculation. This is discussed in the treatment section. 5) Hypersensitivity to sexual stimulation We've already discussed the possibility that a man may have a hyper-sensitive penis. But is it possible to just be too sensitive to sexual stimulation in your mind? Certainly we know that different people respond with different levels of arousal to the same emotional stimuli - and this seems to be because some people are naturally more sensitive. So it's not particularly challenging to imagine a similar mechanism at work in sexual responsivity. However, we can all adapt our natural emotional responses ands there is every reason to believe we can do the same with our sexual responses. In other words: it's your ability to control your arousal that's important, not how aroused you are in the first place.
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