Sunday, May 29

How to Manage Premature Ejaculation

I'm in a new sexual relationship and am surprised that I have premature ejaculation at the age of 63. My partner is accommodating, but it bothers me. What could be of assistance?

A. In older men, premature ejaculation is common, especially when starting a new relationship. Premature ejaculation can occur in men with erectile dysfunction (ED), who have difficulty getting and maintaining an erection. It's wonderful that your partner is so understanding, and it's in your best interests to be open about the problem and discuss your options together.

Premature ejaculation is defined as uncontrolled and unwanted ejaculation within a minute or less of penetration. This definition is too restrictive. Men must, of course, be realistic about their expectations for staying power. But a man should see his doctor if he keeps ejaculating before he wants to and it makes him feel bad.

However, there are two techniques that you and your partner can try right away that may be beneficial. The methods are known as "stop-start" and "stop-squeeze."

With a stop-start, you begin sexual intercourse and continue until you are close to orgasm. You stop all sexual activity until the feeling goes away, at which point you can start again.
Stop-squeeze is comparable. When you get close to orgasm, you pause and use your thumb and two fingers to gently apply pressure just below the head of the penis for about 20 seconds. Then let go of the squeeze and resume your sexual activity. Both techniques can be used as many times as necessary.

Another option is to numb the head of the penis with a topical numbing agent. Sprays containing lidocaine or a similar anaesthetic product are the most convenient. You should put this to the test to see if it irritates your partner. (Using condoms may also help by decreasing sensation.)

Antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs), can help prevent premature ejaculation because delayed orgasm is a common side effect. Some studies suggest that paroxetine (Paxil) may be the most effective, but any of the other SSRIs, such as fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa), and escitalopram, should also be effective (Lexapro). They must, however, be taken on a daily basis because they do not work on an as-needed basis.

Men who have both ED and premature ejaculation should treat their ED first. Typically, this entails taking sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), or avanafil (Stendra). Following that, they can add an SSRI.

Pexel photo of a man holding a woman
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