Let’s face it, sexual matters in general are often an awkward topic for intimate partners to discuss.  But sexual matters related to a man’s performance in bed are among the most challenging to bring into the open.  Premature ejaculation (PE) is the most common sexual complaint among men, negatively impacting many relationships, and yet it is rarely discussed between sexual partners OR between medical professionals and their patients.

In this frank article, Shelley Imholte, a licensed counselor and doctoral candidate in Clinical Human Sexuality, talks to us about this difficult subject.

As the ‘mature’ couple dances across the kitchen, smiling and connecting, to the tunes of ‘Viva Viagra’ , the Cialis couple holds hands as they sit in separate bathtubs atop a beautiful overlook, seemingly blissful.  As Mike Ditka tosses a football through a tire to promote Levitra, a voice drones cautionary warnings about the dangers of these drugs if your doctor hasn’t OK’d you as healthy enough to have sex.  With pharmaceutical profits at stake, we are saturated with these kinds of media messages about erectile quality and availability.  As pharmaceutical companies’ profits rise, perhaps higher than the rate of erections, a man’s ejaculatory experience and his partner’s experience of ejaculation is sorely neglected.
 
And yet, premature ejaculation (PE) is the most common sexual complaint among men.  Achieving erection is not the problem, sustaining it is. The same pharmaceutical companies that have given rise to the limp penis are pursuing clinical trials in hopes of developing the next block buster drug to treat PE. If indeed the healthcare industry and the pharmaceutical industry stay bunkered down in the medical model, focusing solely on the biology of sex and neglecting the psychology of sex, men’s sexuality in general will continue to be unaddressed, while pharmaceutical companies’ profits will continue to skyrocket.  

I have a healthy respect for the medical benefits that may come from judicious pharmaceutical interventions, yet I am cautious about medicalizing sexual function, in either men or women.  I believe that we are far too quick to swallow a pill for a problem that has, and actually may require, alternative treatment options.
 
You might be surprised by the number of men who are prescribed Viagra or it’s offspring that still do not have a sexually satisfying life because of PE.  Let’s face it; PE is not a comfortable topic to bring out into the open.  For men PE can cause a loss of confidence, anxiety about sexual performance, intense fear of rejection, and feelings of hopelessness. In an effort to compensate for his perceived hopeless situation and alleviate his internal feelings of inadequacy, a man may turn his sexual focus to the sexual pleasure of his partner.  Initially his partner may welcome oral stimulation and tactile masturbation as the primary forms of sexual pleasure, but often, over time, the desire to be fully penetrated, for more than a few minutes, returns.
 
In heterosexual relationships women are often silent about their dissatisfaction with PE; after all her partner is achieving erection, which is most important, right?  The woman may initially personalize PE, see it as a reflection of her own sexual desirability or criticize her own sexual performance. Therefore, PE can have a complex impact on a couple’s sexual relationship.  The potential for a vicious cycle is present if PE is not openly addressed.
 
The first complaint is likely to be a decline in the couple’s sexual desire.  Low sexual desire is usually targeted at the female which she is often happy to initially assume because of the frustration and lack of satisfaction she is likely experiencing because of the PE.  The second complaint is typically a decline in sexual frequency usually a result of the female’s low sexual desire, real or not, while internally the man blames his ejaculation time for the change in sexual frequency but does not say that.  Lastly both members of the couple usually become complacent and quite frankly the possibility of celibacy loom on the horizon.  While silence may be the most comfortable reaction to this sexual dilemma, choosing silence only serves to perpetuate and contribute to the problem.
 
Men no doubt reap the benefits of Viagra and related medications, yet little do they know they are also experiencing an oppression of their sexuality, something women are familiar with.  If a man complains to his doctor that he is experiencing erectile issues, if healthy enough, he is likely to walk away from the clinic with a prescription in hand.  Instantly, I would guess, the sexual confidence level of that man rises  

A woman on the other hand does not have the ‘magic pill’ option and is usually encouraged to pursue counseling and/or therapy suggesting that her psychological state might be contributing to her sexual functioning, performance, and overall satisfaction.  The man, unlike the woman, is given permission to be silent about his sexual experience, sexual history, and sexual relationship which is further reinforced, at least initially, by swallowing, not only his psychological state, but a pill.  A woman is likely to benefit and grow from therapeutic intervention, not to suggest that men cannot, but when she grows in this way, and he does not, the relationship may eventually threatened.  It appears to me that addressing this cycle early would enable the couple to experience a sexual life that each member finds sexually satisfying.
    
Alleviating the stress and anxiety of PE for both partners is complex and most likely to require the services of a qualified professional to develop and sustain lasting change. However, taking the risk and talking about sexual functioning, performance, and overall satisfaction with a sexual partner is the first BIG step one can take.  Opening the lines of communication about sexuality can prevent a couple missing out on a limitless range of sexual and erotic experiences.
 
Other steps for changing your sexual experience include the ABCs below.  They are most effective when you pay attention to how you are feeling, inside and out, both when you are sexually aroused and sexually neutral.  Whatever you choose to do or not to do, your sexuality is a part of your human experience. If you find that creating a conversation about sexuality difficult, seek out assistance from a professional, ask friends, and most importantly NEVER GIVE UP!!!

A = Assess Muscular Tension
Learning to scan the body for muscular tension throughout the day will increase awareness of the amount of muscular tension you are likely bringing to your sexual experience.  If your jaw is clenched and your neck is in a knot most of the day it is likely that muscle tension is present when you are engaged with sexual activity.  Modulating muscular tension is vital source of information from the body and will allow one to recognize the body’s ejaculation inevitability (Carufel & Trudel, 2006).
 
B = Breathing
Breathing patterns also provide us with valuable information about how we might respond when we are sexually aroused. Sexual arousal increases heart rate and respirations and it is not uncommon for us to hold our breath during sexual arousal and to breathe from the thoracic (chest) region (Carufel & Trudel, 2006).  Abdominal breathing will allow the feelings of sexual pleasure to be more diffuse in the body experiencing pleasure throughout the body and not solely in the genitals (Carufel & Trudel, 2006).
 
C = Calisthenics
Exercise is essential for countless reasons but also because fatigue is a frequent culprit of sexual complaints in both men and women. Spend 20 minutes a day exercising, any kind of exercising, from stretching, walking, cycling, and running.  If you cannot find 20 minutes a day then explore how your lifestyle is contributing to your sexual life.

References
Carufel, F. D., & Trudel, G. (2006). Effects of new functional sexological treatment of premature ejaculation. Journal of Sex & Marital Therapy, 32, 97-114.

Shelley H. Imholte is a licensed social worker and doctoral candidate at Widener University in Clinical Human Sexuality.  She is an associate with SOL Associates in Austin, Texas, a group of counseling professionals.  To learn more about Shelley, go to her webpage:  www.shelleyimholte.com.