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Erectile Dysfunction Radio Podcast

Premature ejaculation is covered on today’s episode of the podcast. We define premature ejaculation and describes the different ways it is treated. We also explore the connection between premature ejaculation and erectile dysfunction while providing advice for men dealing with these issues.

The Erectile Dysfunction Radio Podcast is dedicated to educating and empowering men to address erectile dysfunction, improve confidence, and enhance the satisfaction in their relationships. This podcast is hosted by certified sex therapist, Mark Goldberg, LCMFT, CST.

Transcript of Episode 29 – Erectile Dysfunction and Premature Ejaculation

Casey: My name is Casey, I am the podcast producer here at ED Radio. Today we’re going to be discussing premature ejaculation and how it relates to ED. Please define premature ejaculation.

Mark: This is a tricky question. I’ll explain why. Premature ejaculation has gone through a number of definitions, so let’s start with two definitional pieces, or lack of definition rather to the term premature ejaculation.

The diagnostic criteria for premature ejaculation takes on an idea that is based on penetrative sex, the amount of time it takes from the point of penetration until a man reaches ejaculation is the period of time that we are looking at, which in and of itself is a little bit limiting because there are many forms of sexual activity that do not include penetrative sex that a man can also experience forms of premature ejaculation.

That has not been included in the official definition. This is something that I do believe over time will change if it has not been changed already. That’s number one.

The other definitional piece is, how much time are we talking about? What exactly constitutes premature ejaculation? Now, I’m aware that there’s a lot of anxiety that men generally can experience with regard to how long they are supposed to last, so there are no exact definitions, that’s the truth.

There is no exact time period, so there are several different research bodies and other overseeing organizations that have put certain time stamps on to define what would be considered premature ejaculation and what will be outside of that range, and I would say that largely the time ranges from about one minute or less to three minutes or less.

Some of the lower ranges under one minute would be premature ejaculation, anything above that diagnostic, diagnostically would not be considered premature ejaculation, and there are other things that range up as high as three minutes and under would be considered premature ejaculation. Anything more than three minutes would not fit the definition of premature ejaculation.

Casey: What would you say is the root cause of premature ejaculation, or what are some of the causes of it in general?

Mark: Premature ejaculation definitely has both physical and mental components, there are a number of sub-categories of premature ejaculation that I think will be helpful if we better define, so we can make sense of what seems to be a little bit more medical or what seems to be a little bit more mental related.

First category is considered lifelong premature ejaculation, which means that a man has been experiencing this from the time that he has begun sexual activity throughout his life, and he consistently experiences premature ejaculation. Generally speaking, there’s a medical component to that, it doesn’t mean there’s anything wrong.

It could mean anatomically, it could mean something in the pelvic floor, it could mean something in the endocrine system, it could mean a lot of different things that are not necessarily problems, but might just be a way of being.

That’s called lifelong premature ejaculation and that tends to have more of a medical component, and it tends to be a little bit less mental, at least in terms of where it comes from. The second category is called acquired premature ejaculation, which means that at some point, a man begins to experience premature ejaculation when he had previously not experienced it.

So there are two ways that I look at this. These are the sub-sub categories that I think of, there’s a quick onset, which certainly needs a medical consult with a doctor, there could be multiple reasons why a man goes from having, let’s say, a satisfactory time period from the time that he engages in sexual activity until he reaches ejaculation and that rapidly stops.

That could be an indicator of some medical conditions and that would definitely have to be examined by a doctor.

Now, the other category that I think of is a slower onset, so this is something that over time, a man sees what’s called clinically, the ejaculation latency period, which is the time from sexual activity start until ejaculation, that that slowly begins to get smaller, so that oftentimes has mental components to it.

The third category is subjective premature ejaculation, which means that a man may not ejaculate beyond that one minute to three-minute mark, so he doesn’t categorically fit into the premature ejaculation construct, but he’s distressed, this is a distressing condition, so it could be either him or potentially a partner is distressed by the amount of time it takes to ejaculate.

That oftentimes is a couple’s issue, could be a couple’s therapy issue, it could be an individual issue, a lot more often that is a mental health or a mental-related issue as opposed to a physical issue.

And the fourth is variable. So, variable premature ejaculation means that a man is experiencing premature ejaculation at times with certain settings, and other times not… sometimes men will experience this with one particular partner, but they don’t experience it if they’re with a different partner. This oftentimes has mental aspects to it in terms of what is causing a man to rapidly ejaculate in one setting while he doesn’t do it in another.

Casey: So how is ED…Erectile Dysfunction and premature ejaculation sometimes commonly just called PE… how are they intertwined and connected… if they are at all?

Mark: So I’ll answer the latter part of the question first. There seems to be a correlation between the two. I think there’s an estimate that 30% of premature ejaculation cases will result in erectile dysfunction, and it may be in reverse as well, that 30% of erectile dysfunction cases originally experience some level of premature ejaculation, so there’s about a 30% crossover between the two cases what the correlation exactly is, is subject of debate, so I’m hesitant to put forth any particular theory.

I have a way that I think about the overlap between premature ejaculation and erectile dysfunction. The one piece that I will say is, one of the things that I certainly am asking men that I’m working with who are experiencing both premature ejaculation and erectile dysfunction, is what came first?

I do think that there is significance when we’re looking at… if there’s some correlation between the two, if premature ejaculation came first, which led to the experience erectile dysfunction, that may mean one thing, versus a man had initially had erectile dysfunction and then ended up with premature ejaculation when he was still able to gain or maintain an erection.

That might mean something else. So there is a correlation between the two, whether they are being caused by one another is a subject of debate, but certainly if a man is experiencing premature ejaculation that has led to erectile dysfunction or vice versa first, it’s important that if you’re going to address these things that you have an awareness of what you experience first in order.

Casey: I want to talk more about the treatment options for a man facing premature ejaculation. What’s out there, what can be done?

Mark: There are a number of treatments available for premature ejaculation, I’ll break them down into four categories, so the first intervention is medicinal, there are a number of medications available, some of them are off-label use, but some of them are… they’re not off-label use, so they certainly are in clinical trials that do seek to extend the period of ejaculation, so one option is to utilize a medication and a doctor will be able to assist a man in trying to find out what medication would be helpful.

The second option available, there’s a series of numbing creams and sprays that are available. I would absolutely advise any man to consult with their doctor before using these. Some of them are very powerful. And they are effective.

I will mention that one of the downside is that this ultimately decreases a man’s pleasure because he can’t really feel much of anything, so the decreased sensitivity will help to increase the amount of time that it takes to ejaculate. It may also impact other things like libido because there isn’t a lot of pleasure involved in that activity, but that is a treatment option that is available.

Some men do find that to be satisfactory, other men struggle with the issue that I brought up. The third approach is behavioral, and what I mean by that is, there are a number of exercises that men can engage in to try to train themselves to delay ejaculation and increase that time period with again, physiological clues and by de-sensitizing themselves.

And some of them can be effective, a sex therapist can be helpful in helping to guide that part of the treatment process and helping to tailor these exercises in a way that makes sense in both an individual and in a partner during a couple setting. And the fourth is the mental aspects, so performance anxiety, anxiety are topics that we’ve already covered on the podcast, they do apply to ejaculation as well.

If a man is really worried that he’s going to be disappointing his partner, and all he’s thinking about is not to ejaculate, not to ejaculate, and he’s really preoccupied with that, oftentimes, he will ejaculate very, very quickly. He’ll feel a lot of pressure. He’ll be worried that the relationship might end as a result of the ejaculation, and all of that anxiety can work in the opposite direction and can be a part or a factor of what causes that ejaculation.

So, the fourth approach here is to address this with sex therapy, but looking a little bit less into behaviors and a little bit more at the emotional and cognitive or thought space that a man occupies when he’s engaged in sexual activity.

Casey: Is premature ejaculation purely mental or is there a physical component involved?

Mark: So just like with ED, like any other sexual dysfunction, it’s hard to say that anything is purely mental, it’s a physical experience, it’s a physical activity, it involves muscle contractions, it involves a whole slew of physical components, so I would be hesitant to say that anything is purely caused by a mental component.

I think there are situations that the solution to the problem can be addressed just by looking at mental factors, in other words, medications, sprays wouldn’t be necessary, because the mental components are powerful enough that if a man successfully addresses those, he will be able to satisfactorily extend his latency period.

Like I was saying before, there are situations where a man knows that in setting A, he doesn’t have any problem in terms of the time it takes to ejaculate, and in setting B, he experiences rapid ejaculation, that would tend to not be a tremendously physical problem, it would carry more mental components, if that makes sense?

Casey: I want to talk about the role, or the possible role of sex therapy in all of this, can it help men that are facing premature ejaculation, can sex therapy help?

Mark: I think with premature ejaculation in particular, I think sex therapy is a very appropriate service to be incorporating into the treatment, and I’ll explain why.

Premature ejaculation oftentimes is a partner-driven condition, meaning if a man is ejaculating quickly on his own with masturbation, generally it’s not overly distressing, it doesn’t mean it’s like that for everybody, but generally, if it takes a minute or a minute and a half, or two minutes, it still creates a very sexually satisfying experience.

Where premature ejaculation becomes a challenge, very often is in a partnered setting. Men will look for a solution so that their partners are not upset, but oftentimes when premature ejaculation has already occurred in a relationship, it already begins to impact the relationship, it impacts the way a man thinks about himself in the context of the relationship.

It can really open up the door to a whole slew of more complex anxieties and relationship challenges that sex therapy is really able to be there, both for the individual male who was struggling and to incorporate his partner to be able to come up with a plan to address the premature ejaculation.

But also to ensure that the relationship is not only protected from potential damage, but can also thrive and grow through that process. That’s something that you only get through sex therapy and through a more broad process as opposed to just addressing the medical aspects of this condition.

Casey: That makes a lot of sense. I want to ask about broaching the subject of premature ejaculation, it’s one thing to listen to a podcast about it, but then it’s a whole different story to actually have discussions about it face-to-face with someone or maybe over a Zoom call now that we’ve entered a new era in the way therapy is conducted.

What would you say to men that may be a little embarrassed to admit that they have an issue with premature ejaculation, and they’re not really sure where to begin seeking help or where to start talking about it with someone that might be able to help them?

Mark: I’ll just make mention of the technology that has become available to us. I think that is something that is actually very helpful. I think it takes down some of the intensity and some of the awkwardness.  I do think Zoom therapy opens up the door for many people to be able to access services that they one otherwise would not be able to access or would feel uncomfortable directly face-to-face with somebody. I think that that is ultimately going to be helpful moving forward as we progress in different ways that we treat these conditions.

If a man is feeling embarrassed, I get it, I understand these are really hard things to talk about. Certainly when it comes to premature ejaculation, it’s important that men understand, this is very common, there is not necessarily anything wrong with you, there’s nothing wrong with your head, there’s nothing wrong with any of that.

This is really an opportunity to make things better, it’s an opportunity to enhance your relationship, it’s an opportunity to not experience the discomfort and the anxiety, and to be able to get back to a pleasurable sexual experience, it could be awkward to talk about these things.

What I found is, for the overwhelming majority of men who actually make it to my office or get on a Zoom call to do a session, they find it to be surprisingly not awkward and surprisingly comfortable. And it’s difficult to get over that initial hump. But there are people out there that can really help make a huge difference and help things just permanently be a whole lot better if you’re just willing to take that initial risk and reach out.

Casey: It’s very well said, it can feel very intimidating until you actually do it, like so many things in life, once you’re actually doing it, it’s not as bad as what you had originally thought or feared. Do you have any other final thoughts for us on today’s topic?

Mark: If a man notices this pattern, notices that he’s experiencing premature ejaculation, the earlier you reach out for help, the easier it is to make the changes.

I would encourage any guy who’s struggling with this to reach out. Find a therapist, find a sex therapist, somebody who has an expertise in this area, make that connection earlier, because if you make those changes earlier on in the process, you’re going to avoid compounding anxiety, relationship problems, and you’re going to be able to get this resolved to a satisfactory point a whole lot quicker.

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