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The Effect Of Premature Ejaculation
Premature ejaculation is one of the most common sexual complaints of men and their partners.
But this bald statement does not give us much sense about the detailed impact of the condition on the individual members of the couple, the couple as a unit, and the relationship between a man and a woman.
Here's what Rod Phillips has to say on the subject.
The simple fact is that premature ejaculation does have a negative impact on the quality of a couple's relationship and on their overall quality of life.
This was demonstrated by a research project by Hartmann and others (see below) in which subjects were asked to describe the effect of premature ejaculation on their self-image, sex life, relationship quality and everyday life.
Over two thirds of the men reported that their sexual self-confidence had decreased, and half of the single men said that they either avoided forming relationships or were reluctant to try because of the possible consequences of their PE.
The men already in relationships said that they were upset and distressed because they could not satisfy their partners, and some even worried that their female partner would be unfaithful because of the fact that they had PE.
We mentioned earlier that few men with PE actually go to see a doctor, and it transpires that the embarrassment it causes is the primary reason for this -- over two thirds of men say they were too embarrassed to consult a doctor.
Oddly, almost half of the men in this survey thought that no treatment for PE existed.
Research on men with PE has demonstrated that they are preoccupied with thoughts about sex, with thoughts about controlling their orgasm, and experience anxious anticipation of sexual failure.
They also anticipate the embarrassment caused by PE, and have worries about keeping their erection. Men who do not experience premature ejaculation problems, by contrast, focus on sexual arousal and the satisfaction provided by sex.
It's also no surprise to learn that intimacy levels are affected by PE. The men in this survey who had PE showed lower levels of intimacy in all its forms: emotional intimacy, social intimacy, sexual intimacy, intellectual and relationship intimacy. They also had lower levels of satisfaction in all areas of life than the men who did not experience early climax.
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Dramatic though this may sound, PE also affects the partner's quality of life. A recent study has demonstrated that there is a relationship between PE and lower partner satisfaction with sex in heterosexual couples.
It's not entirely clear whether this applies to all heterosexual couples, or just to those couples in which sexual activity finishes when the man ejaculates prematurely.
(There are strategies to deal with PE that basically change the couple's sexual behavior: these involve the man giving the woman an orgasm before any kind of penetrative sex takes place, so that she has achieved sexual satisfaction before he enters her and ejaculates too quickly.)
Even so, the fact that so many couples report distress because of the man's sexual performance demonstrates that PE is a very real problem for couples. Women are upset not only because early ejaculation exists in the relationship, and sex and intimacy are unsatisfactory in some way, but also because their partners are distressed.
In most cases, women's distress about PE stems from the fact that it represents an abrupt termination of intimacy: they're not as distressed by the simple fact that the man has ejaculated prematurely.
Women say they are angry with men who have PE because they do not feel that their concerns are being listened to, or that the man is taking account of how his rapid ejaculation affects them. They often do not believe the man is willing to resolve the problem.
The fact that there is little understanding between partners is demonstrated by the fact that men believe that their partners do not recognize the degree of frustration and humiliation that comes from the experience of premature ejaculation.
Effects of Premature Ejaculation
Further information on the effect of PE on couples can be found here: Symonds et al (2003), How does premature ejaculation impact a man's life? and in The Journal of Sex and Marital Therapy, 3(29), 361-370; Hartmann et al (2005), and in the article "Cognitive and partner related factors in rapid ejaculation", World Journal Of Urology, 23 93-101; McCabe (1997), Journal of Sex and Marital Therapy, 23(4) 276-290.
The fact that sexual partners are so disconnected about premature ejaculation generates considerable tension.
This means that for men who are in stable relationships rapid climax should always be recognized as an issue for the couple, not just for the man alone.
These and many other studies suggest that the psychosocial impact of premature ejaculation on a man and his partner can be profound, a fact implicitly recognized in attempts to define PE where one of the criteria is couple's distress.
In practical terms, the message is clear: if you are a man with a tendency to reach climax early during sex, you need to do something about it!
And while performance anxiety itself is generally not the cause of the initial episode of rapid ejaculation, it is certainly a major factor in maintaining PE.
By the time men go to see a clinician or therapist for some kind of intervention, the event that originally caused the PE is often disguised by the intensity of a man's performance anxiety.
It is painful for a woman who loves a man to witness him in this state of low self-esteem.
And the situation is confounded further by performance anxiety because this distracts a man from any awareness (or even stops him attempting to be aware) of his level of sexual arousal: and this in turn renders him unable to exercise voluntary control over his sexual arousal and the timing of his ejaculation. Indeed many men with PE believe that focusing on their level of arousal will actually cause them to ejaculate even faster.
Since men with PE are so embarrassed it can be extremely difficult and challenging when their partners or wives ask them to seek treatment. This only adds to the embarrassment and humiliation which they feel as they and protect their already fragile self-esteem.
One of the problems of therapy is that men with PE are often reluctant to reveal anything about their sex lives that may be embarrassing, shameful or indeed hurtful to them or their partner.
To have secrets like this is understandable because their origin lies in some traumatic childhood experience or some painful awareness of their unconventional sexual desires, fantasies or activities in adult life.
In some cases where guilt and shame from events like extramarital sex or experimentation with sex workers lies at the root of secondary premature ejaculation, the sense of shame or guilt, or the possible consequences of revealing the secret, may mean that there is no chance of the man being completely open either with his partner or with a therapist.
Hiding secrets from oneself is a consequence of repression or suppression: these secrets may emerge during treatment, provided the man finds it acceptable to reveal them. Examples of this might be an attraction to the same sex.
Secrets hidden from a man's partner would generally be of a different type such as extramarital affairs, cross dressing, child sexual abuse and so on.
These are almost always therapeutically difficult to overcome because a man may rationalize his feelings or fantasies, and conclude that there are unrelated to his PE and do not need to be shared.
In any event a man may lack sufficient trust, courage or motivation to deal with these dilemmas, or even reveal them, so therapy with the couple will be severely impacted. If a man refuses to reveal a secret that is relatively current and important to the relationship therapy may fail.
So although we have stated that PE is a couple issue, psychotherapy is best reserved for (1) couples where the precipitating factor in PE is clearly psychological, (2) situations where there are considerable psychosocial obstacles to overcome, such as performance anxiety or depression, (3) situations where the man's rapid ejaculation disguises sexual dysfunction such as anorgasmia in the woman, or (4) nonsexual situations such as a couple having a chronically unsatisfying relationship or where there is an unrealistic expectation that has not been addressed such as the woman claiming that the man should last 20 minutes because it takes that long to have an orgasm.
As mentioned before men often fear that by focusing on signs of sexual arousal during intercourse they will actually ejaculate even more quickly.
They may therefore adopt strategies to diminish sexual excitement such as wearing several condoms or using desensitization ointment on the penis, or masturbating before intercourse.
But these tactics inevitably reduce the pleasure of sex and intimacy within the relationship (and are almost always unsuccessful anyway). Knowing about lovemaking skills is much more helpful - see the advert in the right hand column of this page for more information.