From premature ejaculation to control: can PE be reversed?

Lifelong premature ejaculation feels like a life sentence. But does PE have to be a permanent problem?

Man looking pensively at the words: permanent premature ejaculation

If you consistently ejaculate sooner than desired, are you stuck with the problem?

The short answer: no, you’re not.

Phew. But you probably need to brush up on your sex skills.

Lifelong premature ejaculation is a thing

Lifelong PE is a recognised medical definition. An estimated 1-in-5 men struggle with PE and most of them fall into the lifelong category.

But allow me to put this into context.

Lifelong means you have ejaculated sooner than desired, typically within two minutes, consistently since you became sexually active.

But lifelong PE is not a prognosis.

You may be naturally wired to ejaculate sooner. And your wiring, the natural tendency, is unlikely to change.

But for the vast majority of men, this inclination can be overridden. You have more agency over your ejaculation than you probably realise.

You might need to develop skills and put in a little more effort than some guys. You can also become a more adept sexual partner in the process.

So how do we go about this? How can lifelong premature ejaculation be reversed?

Biological factors we can influence

Research has identified differences in men who struggle to last and men who don’t. This includes subtle variations in brain structure, serotonin receptors, hormone balance and skin sensitivity.

Some of these factors may be genetic. And they may well be permanent too, unless medicated or altered by a significant medical intervention.

These days, SSRI pills are the most commonly used medication for premature ejaculation. They are taken daily, or the on-demand version dapoxetine (aka Priligy) is available in many countries.

SSRI medication is generally effective. After taking dapoxetine, guys can typically expect to last two or three times longer than usual. If guys opt for a daily dose of paroxetine (Paxil) or fluoxetine (Prozac), they may benefit even more.

But SSRIs come with side-effects. And this approach doesn’t cure anything. As soon as guys stop taking it, they return to their natural baseline duration.

Various surgeries have been attempted too, including circumcision, cutting of the frenulum band of tissue, injections into the glans of the penis to permanently disrupt sensitivity and using pulsed radio frequency to affect the penile nerves. These are experimental treatments and so far, they have had limited long-term effect.

To help remedy skin sensitivity, numbing creams, sprays and condoms are widely used. These can be moderately effective too.

But they require a fiddly pre-sex ritual of application and washing off, and the effect is temporary of course.

So we can influence our biology in this department, but only temporarily unless we resort to drastic surgery.

Does this mean guys are fundamentally stuck with PE and temporary workarounds?

No. Guys need to work on their bodily awareness. They probably need to adjust the way they have intercourse.

Men can’t manually change the gears of their arousal, but they can drive differently. And this requires skill development.

What gets in the way of building skills? The overwhelm of anxiety and stress around sexual performance. That’s not fun for anyone, and inevitably leads to avoidance.

Which brings us neatly to the psychological side of things.

Psychological factors we can change

Confusion from early experiences of sex, feeling less of a man, desperation to satisfy, fear of losing our partners.

Men with sexual difficulties experience conflicted feelings; they feel the excitement and desire to have sex with their partners, but deep-seated dread too.

Resourceful men go online and look for advice, and there’s no shortage of guides and techniques out there.

But remembering and applying techniques goes out of the window when they find themselves in bed with their partners. Dread has this effect.

That’s anxiety shutting down their resourcefulness. They are having sex in panic mode, with the brain fog and tension that compromises erections and accelerates ejaculation.

Anxiety around sex can be addressed through therapy and relaxation skills, rehearsed outside of the bedroom first.

Breathing, pelvic relaxation and relaxed movement can make a big difference in the body. The brain takes notice too.

Arousal awareness helps us to implement techniques in a timely manner. This sets up a positive feedback loop of body and mind cooperation.

A little real-world sex education goes a long way too. Reframing intercourse as not the be all and end all of sex takes the pressure off.

Often this means reversing the lessons learned from porn.

Social factors we can change

All of this impacts our relationships, of course.

Men can make significant progress by working on skills and techniques as a solo project. PE is awkward and embarrassing, so men naturally prefer to problem-solve this way.

But for men in relationships, I advocate open communication with their partners and tackling PE as a joint effort.

When guys feel stuck with PE, sex becomes a tense ritual for both partners. The grim prospect of dead bedroom looms.

One guy I worked with lived this scenario for 30 years of marriage. He’d tried various creams and distraction tricks, but never made progress. His wife knew, of course, but it just wasn’t up for discussion.

With a bit of encouragement, we opened things up between them. When they finally started to understand each other’s needs, actual progress was made. After 30 years of wrestling with PE and silent dissatisfaction.

Expectations we can change

A common PE sticking point is unrealistic sexual expectations.

Porn perpetuates the narrative that good sex means remaining rock-hard for 20 minutes and pounding through an array of positions.

To some degree, the PE self-help industry cultivates this expectation too. ‘Ultimate stamina tonight’ and ‘orgasm on demand’ is often promised.

This isn’t helpful. Remember that the average duration of sexual intercourse is 5.2 minutes, and this is perfectly enjoyable for many couples. Especially when you get sexually creative.

If you or your partner desire more, then by all means enjoy working on your game together. Communication, once again.

But if you worry about PE because you don’t last 20 minutes or don’t have total control over when you ejaculate, your expectations could be holding you back.

Skills are the permanent treatment for PE

So, yes – your body may well be inclined to ejaculate early.

This need not limit your sexual potential.

With some investment in your skills and your connection, you can be a more exciting partner than that guy who takes duration for granted.

You learn a lot more in the process, and partners appreciate this in all kinds of ways. That’s the best kind of problem reversal, as any therapist will tell you.

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