Hello and welcome to Healthcare Magic. Thanks for your query.

I will certainly advise you regarding your problem. In order to understand your problem better, please provide the following clarifications...

How long have you been having this problem?

Does this happen every time you have sex or only in certain situations?

Are you married? If so, how is your relationship with your wife?

Can you give me a brief sexual history...

Do you practice masturbation? If so, do you have any problems associated with that?

Do you keep worrying that you may be sexually inadequate or do you have any anxiety or guilt regarding your sexuality?

Do you have any other symptoms like feeling low, decreased energy, lack of interest, negative thoughts, poor sleep and appetite?

Do you consume alcohol or any other substances of abuse?

Do you suffer from any known medical problems or are you under any treatment currently?

Please get back to me with these clarifications, so that I can guide you in a better way.

- Dr. Jonas Sundarakumar
Consultant Pychiatrist

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Hello again and thanks for your clarifications.

Your sexual problem, pre-mature ejaculation is a very common problem in young males, especially, in the recently married. Now, the good news is that in more than 90% of persons with this sexual problem, there is no medical abnormality found. Most of the times, the underlying subconscious anxiety / fears / doubts about inadequate sexual performance (called as "performance anxiety") or a hypersensitive response of the penis or inproper sexual arousal are the underlying causes.

Treatment of this problem is using behavioural techniques as well as using medication, in some cases. Usually medication is kept only as the last resort as most of the problems will resolve with proper behavioural techniques.

I would suggest the following tips to overcome this problem:

1) Firstly get rid of thoughts that you may be sexually inadequate or your doubts that you may not be able to perform properly. Like I mentioned before, performance anxiety, feelings of sexual indequacy, self-doubts, guilt, past negative sexual experiences, poor communication / understanding with the partner, etc. can all affect sexual functioning and performance. So, removing the person's doubts and fears, and improving his self-confidence levels will definitely help in improving sexual performance. Remember that sex is not just a physical act but also a psychological process involving an expression of emotions, intimacy and love. So, just involve yourself in those feelings and stop focussing on your "performance" alone. Once you do that, then I assure you that your sexual performance will automatically improve.

Most importantly, performance anxiety soon becomes a "viscious cycle" That is, anxiety leads to poor performance and poor performance then leads to further anxiety and this keeps on increasing. So, the key is to break this cycle at some point of time and take control of yourself.

2) The second cause for pre-mature ejaculation is hypersensitivity of the penis to touch sensations. Now, there are certain specific sexual techniques which can reduce this hypersensitivity. The "stop-start technique" or "squeeze technique" have been proven to be successful in increasing the ejaculatory time.

In the stop-start technique, the penis is stimulated (by sexual intercourse or by masturbation) till a point when you feel close to orgasm. At that point, the stimulation is stopped for some time and after a small gap, it is continued. This process is repeated repeated a few times.

In the squeeze technique, the penis can be stimulated by hand (by masturbation or by your partner) till a point when you feel close to orgasm. At that point, the lower part of the head of the penis is squeezed tightly with the index finger and thumb around for a few seconds till the erection decreases. Then the stimulation is restarted and the process is repeated a few times.

Both these techniques, if practised regularly can increase your time taken for orgasm.

3) The third problem responsible for erections getting weak and early ejaculation is inadequate sexual arousal. When the person is not properly aroused, the blood flow to the penis is not maximal, and so, after a few strokes, the erection weakens. The way to tackle this is not to rush into intercourse quickly, but wait till you get fully aroused. So, increase and spice-up your foreplay. Make sure that you initiate penetration only after both of you are fully turned on. Good foreplay not only arouses you but also sparks off the mood in your partner. So, when she is also aroused and involved, then things keep flowing smoothly and effortlessly, and you don't have to be constantly anxious if you are satisfying your partner or not.

4) Improve your communication with your partner - this means both verbal as well as non-verbal communication. Each person has his or her own ways of getting sexually aroused or feeling sexual pleasure. So, this verbal and non-verbal communication will let each of the partners understand each other's needs and thereby make sex both relaxing and enjoyable.

5) Distract yourself stop "monitoring" your sexual performance. Try putting on some romantic music or mild lighting while you make love. Think about the things that turn you on. Taking your mind off of your sexual performance can remove the worries that are stopping you from getting excited.

6) There are also certain medication like Dapoxetine (Prilyxet), which can help you with this specific problem of premature ejaculation. Certain pther medication can improve the blood flow to the penis and promote better erection, such as Sildenafil, Vardenafil and Tadalafil. But like I mentioned before, medication should be kept only as a last resort after trying the behavioural methods and sexual techniques.

It is also important to eat a healthy & balanced diet, exercise regularly and try to stay positive and stress-free.

Wish you all the best.

- Dr. Jonas Sundarakumar
Consultant Psychiatrist

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