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Sex Kvetch: What do I do about his premature ejaculation?

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Sex Kvetch is a new CJNews sexual health advice column, in which writer Mottel Walfstein (*not his real name) and urologist Yonah Krakowsky tackle your every sex-related question, no matter how technical or embarrassing – and hey, the weirder the better.


Dear Walfstein and Krakowsky,

I am in a committed and loving relationship with my partner, L., a kind, caring, and sensitive man. Our sex life has always been good – if not necessarily earth-shaking, then generally very satisfying. But a few years ago, seemingly out of nowhere, L. began suffering from premature ejaculation. I didn’t think much of it at first – I thought it might go away on its own. But the problem persisted. Now whenever we have sex, which happens less and less frequently, it is over before it starts. Sex has become a source of stress, rather than pleasure. L. is suffering – he is nervous, anxious, apologetic, and ashamed. It has wrecked our sex life and is threatening to wreck our relationship. I don’t know what to do. I don’t know how to talk to L. about this. On the one hand, I don’t want to make him even more nervous and ashamed than he already is. On the other hand, something must be done. Help!

Yours,

Worried in North York

ωωω

Dear Worried,

Let’s start out by emphasizing that there is nothing wrong with your partner. L. is not broken or cursed or any less of a man. We know you know this; it’s important that L. knows it, too. Premature ejaculation (PE) is nothing to be ashamed of.

But in order to treat the problem, L. has to acknowledge and articulate the problem. This can be a difficult and painful process. Be there for him. Sit L. down, hand him a cup of hot chocolate, tell him how much you love him and that you’ll be there for him no matter what. Then, with great compassion, encourage him to talk about his PE. He is likely caught in an anxious loop. (A glimpse into his mind: Every time the two of you have sex, he worries the PE will happen, then he worries it happens because he’s worrying, then he worries even more, and around and around you go.)

READ: ARE JEWS UNHEALTHILY FIXATED ON SEX?

Try asking him what he thinks about before sex, during sex; what he wishes were different. Keep in mind that he is likely disappointed in himself for disappointing you. Do your best to assuage that fear, without lying to him. These conversations can be difficult and uncomfortable, we know. But when it comes to sexual dysfunction, it’s critical to respond holistically, to address the person, not only the condition.

‘the goal shouldn’t be delaying ejaculation for some arbitrary number of minutes. The goal should be a fulfilling sex life’

It’s important that you hear him, and it’s important that he hears you. This condition affects both of you, and you shouldn’t have to hide your frustration about it. Be open and honest, even if it hurts. Obscuring your feelings will only make things worse in the long run.

This isn’t meant to scare you! PE is a common and treatable condition. (With the caveat that statistics in the field aren’t great, 20 to 30 per cent of men will suffer from PE at some stage in their life.) So while the condition should be taken seriously, it’s hardly a terminal diagnosis.

Onto the diagnosis: What exactly is PE? There is no operationalized definition of premature ejaculation – that is to say, there is no cut-off, no ‘normal’ length of time that intercourse is supposed to last. A commonly used threshold among clinicians is 60 seconds (measured from when the penis enters the vagina/anus until ejaculation). But a more honest, if vague, definition of the problem is this: PE is a problem if you consider it to be a problem. There are men lasting for one, two, or five minutes who seek treatment. (Though it’s worth noting that the average time to ejaculation is generally found to be between four and eight minutes.)

READ: A CASE FOR EATING BACON, FOR JEWS

The takeaway here is that when seeking to ‘cure’ PE, the goal shouldn’t be delaying ejaculation for some arbitrary number of minutes. The goal should be a fulfilling sex life. This may entail reworking and/or expanding your definition of sex to include things like foreplay, masturbation, oral sex, kink, etc. There’s a lot of fun to be had. We encourage you to explore.

ωωω

Now let’s get clinical.

We’ll be straight with you: PE is still something of a mystery. Most clinicians believe it is caused by a combination of psychological, social, and, possibly, biological factors.

Researchers in the 1960s, including Masters and Johnson, believed that PE was caused by deep-rooted feelings of guilt/shame surrounding sex, i.e. that some repressed part of you wants to be done with the dirty business as quickly as possible. This premise, however, generally isn’t taken seriously by contemporary urologists. Many men who suffer from PE have had healthy and shame-free sexual histories. Another theory holds that PE is the result of an excessively sensitive penis. But there isn’t much evidence to back this up. You can have a penis that’s normal-sensitive, or even low-sensitive, and still suffer from PE.

Given PE’s amorphous cause, treatment usually involves a combination of therapy, exercises/techniques, and medication. (There is also evidence that acupuncture helps.)

Therapy can take many forms, including sex therapy, psychotherapy and cognitive behavioural therapy (CBT).

Techniques include the stop-and-start method and the squeeze method, both of which help condition the body to delay an impending orgasm/ejaculation. These are simple exercises that can be learned online.

There are a number of medications that may help that are available off-label, i.e. the medication was initially approved for something else. Topical ointments applied to the penis can decrease sensitivity. Wearing condoms can have a similar effect. Antidepressants, specifically SSRIs, have long been known to cause delayed ejaculation.

We encourage you to encourage L. to talk to his doctor about his options. Some of the most promising research on PE focuses at oxytocin, a naturally occurring hormone in both males and females. A surge of oxytocin generally precedes ejaculation; it could be that one is able to gain some measure of ejaculatory control by manipulating or delaying that surge. Researchers are looking into it.

So, no, there is no magic bullet. We can’t say for sure what will work and what won’t, or how long treatment will take, or if the problem will eventually go away on its own. Your doctor will be more useful than we are in that regard. What we can say is that the road to recovery starts with open-hearted conversation. You and L. should talk.


Mottel Walfstein (*not his real name) is a Toronto-born poet and journalist who writes about sex, love, Judaism and occasionally, sports. Yonah Krakowsky is a urologist currently finishing his fellowship in sexual medicine and surgery at Harvard University. He plans on returning to Toronto this summer.

Got a sexual health question for Walfstein and Krakowsky? E-mail them using an alias at sevkvetch@gmail.com

  • Matt

    one of the best things I ever found to help with my PE was recommended by my Urologist. He gave me a sample of Promescent and told me to apply it 10 mins before penetration which wasn’t bad, gave us extra time for foreplay. now I order it online, its been a game changer plus it is kosher

  • Matt

    ..

  • Rex Humbard

    Why does the CJN need an online sex column, especially one that doesn’t seem to have anything to do with Judaism or Jewish law? Maybe that goofball HardCOR Snackie can do double duty…

  • fabrent

    Not only is this subject matter inappropriate for the CJN but it’s being given prominent play online.
    Where is its merit as news?
    You got sex problems, go to a therapist.

  • Van Owen

    I’ve struggled with PE for a long time I started using Promescent and it stop me from having the problem. I googled around before I found it, great reviews helped make my decision really easy.