Premature ejaculation and depression: it’s a big deal

Men with premature ejaculation are prone to anxiety and depression. So what stops them reaching out for help?

Anxious, depressed man sitting at his desk

Ben is a 42 year-old software developer. He looks younger, and tells me that he’s just started going to the gym for the first time in his life and is hoping for those early gains. Ben had several sexual partners before he was 20, but noticed a pattern. Sex didn’t last very long.

He remembers reading a tip from Liam Gallagher in the NME: “when you’re doing it man, imagine turning off a big tap so nothing can come out”. It didn’t seem to work.

I hoped I’d get better as I got a bit more experienced. Alcohol seemed to relax me a bit, so I remember trying to drink at least a couple of pints before having sex. I felt like I had to cure myself somehow, like nobody would be able to help me with this.Ben

Ben had longer-term relationships during his 30s, but sex was still lasting less than a minute. When he was 35, he fell in love with a girl who had a voracious sexual appetite. She really seemed to enjoy sex with Ben, but he put himself under pressure to perform. He became obsessed with his perceived lack of stamina. He felt paranoid about her faking orgasms and humouring him, convincing himself that she would go looking for other guys. Ben couldn’t open up about this, and after some difficult conversations they decided to end the relationship.

He hasn’t had a girlfriend since and has become used to living alone. He’s experienced bouts of depression, has had to take time off work and often feels a sense of bitterness towards women. He’s considering counselling for the first time and wants to make some changes, though getting back into dating feels a long way off.

Men are wired to identify and fix their own problems, not sit around talking about it. Jill Berger PhD, who studies the psychology of masculinity, explains why men avoid seeking help of any kind, including medical advice and therapy. Society expects men to be tough, independent and unemotional. We tell each other to “man up”. Ben couldn’t just fix his premature ejaculation, so he had to tough it out and avoid the problem. Therapy feels like too soft an option.

It’s true that there is no easy fix for premature ejaculation, or you wouldn’t be reading this. So when we don’t get help and we can’t cure the problem ourselves, what gives?

Ben’s story isn’t unusual. I’ve spoken with men who have always struggled to make sex last, right from their very first sexual encounters. Some are married, some have children. Yet they have all battled with the frustration and insecurity, for decades in some cases. And premature ejaculation has compromised many aspects of their lives.

Like any embarrassing issue, premature ejaculation is often considered a bit of a joke. Maintaining a sense of humour about such things can certainly help, but the potential fallout for our mental health is no laughing matter. Studies show that nine out of ten men don’t like to trouble the doctor or pharmacist unless they have a serious problem. Let’s consider how serious this particular problem can become.

Sex is an integral part of our identity and the fundamental connection with our partners. Men with premature ejaculation can’t fully enjoy sex, or enjoy it at all. Intimacy makes them anxious. They make excuses to their partners, for avoiding sex or for yet another disappointing ‘performance’. When they do have sex, they stick to the same routine and are afraid to explore. There’s an elephant in the bedroom.

I end up apologising to my wife after sex. Sometimes before sex. It’s not sexy, I know, but I can’t help it. I suck in bed and truly don’t know how my wife puts up with it.Kieran, 38

Some men substitute sex for the internet, watching porn to get their needs met. All that porn is not going to help with insecurity about premature ejaculation. Watching scenes of ‘real men’ having sex for hours further programs us with the message: you can’t do this. Porn sex is edited and unrealistic, of course, but we will inevitably make unhelpful comparisons between the male performers and ourselves.

There is a real risk that sexual anxiety can snowball into depression. Ben’s frustration grew into shame, hopelessness and resentment. As the elephant in the bedroom expands, it begins to fill the whole house. Anxiety about our sexual performance eats away at our overall confidence and self-image. We worry that we’ll never satisfy our partners and they will leave or cheat on us. Our sleep and productivity suffers. Relationships get wrecked, replaced by addictions or sabotaging behaviours. The elephant is out of control, stomping all over our lives.

Men with premature ejaculation are more likely to smoke cigarettes and marijuana, drink alcohol or consume illegal drugs than those without premature ejaculation. This was the finding of a 2012 study conducted by the Swiss Institute of Social and Preventive Medicine. In attempting to fix their own problem, they are also more likely to self-medicate and order online medications without a prescription. Men who reported any sexual problems tended to have poorer mental health than men who reported no sexual problems. The study identified a clear link between premature ejaculation and depression.

What about the men who do seek help?

Explaining our sexual limitations to the doctor isn’t easy. Even after overcoming the initial embarrassment, men with premature ejaculation are less likely to be honest about it. Martin, a father in his mid-30s, described how he presented the problem and retracted it again in a single appointment:

In hindsight, my doctor was interested and said nothing negative at all. He was just being professional. But in my mind, it felt like he was judging me… my self-respect totally drained. It felt like the lowest point. I literally changed the subject, and told him about my sleeping difficulties instead. When he asked if this was related to sexual problems, I said no… definitely not.Martin

So we’ll never know whether Martin’s doctor could have helped. But premature ejaculation is still widely misunderstood by health professionals. Men tell me about therapists at a loss to provide any practical advice, opening up childhood memories and early masturbation habits for possible solutions to the mystery. OK so as teenagers, we got ourselves off in a frenzy before our privacy was busted by mum coming upstairs. We felt embarrassed and scuzzy about it too, unfortunately. How do we use these insights to move on and address the problem today? A good therapist will provide techniques for working in the here and now.

In terms of progress, doctors are increasingly likely to prescribe medication. SSRI pills, originally intended for the treatment of depression, can help some men to achieve a precious extra minute or two. And that might be a significant improvement. But SSRI medication risks significant side-effects, especially when taken over the long term. One of the noted side effects is reduced libido, which has put some men in the unenviable position of taking Viagra and an SSRI at the same time. Stop taking the SSRI pills and the problem comes right back, reportedly worse than before. This is not an optimal way to tackle the issue.

And then there’s the premature ejaculation industry: numbing creams, sprays, self-help apps, hypnosis videos and ebooks. The vast majority of these products simply don’t work. The men who invest in them end up feeling even more hopeless. There are helpful resources out there, but beware the marketing methods and dubious claims. Anything that contains “horny goat weed” or promises to transform you into a sexual athlete tonight is a no go.

So will premature ejaculation always be a source of anxiety and depression?

Writing about men’s reluctance to seek help, psychologist and masculinity researcher James Mahalik, PhD explains:

Men are more likely to seek help for problems that they think are normative – that is, problems that many other men share.James Mahalik

Mahalik believes that one way to convince more men to seek help is to convince them that the things they need help with are “normal.” As a researcher and trainee psychotherapist, I think the message is getting out there.

The Bang On Time project is dedicated to exploring scientific understanding of the psychological and physiological factors at the root of the issue, and the techniques to overcome it. It is essential that we raise awareness of just how common a problem this is, and tackle the remaining stigma head-on.

Note: For privacy, all the men who spoke about their own experiences have had their names changed in this article.

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