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Premature ejaculation shame, pills and pain: I’m at the end of my rope

Luke just wants to have sex for longer. He explains what helps, what doesn’t and how he keeps working on overcoming PE.

Luke writes:

Hi Jason and bangontime,

I really like the site you folks have put together. Seems like good sound and supportive advice and guidance.

I’m 29 and I’ve had a very difficult life long case of PE that I’d like to outline in the chance that you can offer some advice/support but in the chance that sharing these experiences may potentially help others going through similar things.

From my earliest pre-teen masturbation (11-12) to my first time having sex as a teenager (16) I have always had an issue with PE.

Over the years this has morphed into a kind of mental and physical health issue, which is part of why I wanted to reach out to you in the first place and share my story. Also, I seem to be a lot like ‘Jeff’, in the sense that I have a long-term loving and supportive partner, who really just wants me to relax and enjoy having sex and being intimate. Still, I’ll admit that I feel great shame around not being able to give her pleasure/fulfilment through sex. I should also point out that aside from the health issues mentioned in this email, I’m overall fit and healthy and enjoy regular exercising and hiking.

So yes, PE has always been a problem and it’s always been distressing to me mentally. However, around 4 years ago, I had a bit of a spiral, where after some minor progress, my PE seemed to get worse and worse. Eventually, I was cumming immediately upon or before penetration and the ejaculation-response was becoming completely unlinked to orgasm or any kind of pleasure.

It was like I was so unsatisfied with my lack of bodily control, and my general inability to do anything about it over the years, that I subconsciously caused myself to ejaculate immediately in a kind of fear/distress response. This continued until, one time, as I was trying to hold back ejaculation during sex, I felt a rupture up my left side and in my balls.

Immediately my left testicle swelled up and I knew something was wrong. I went to the doctor the next morning and was diagnosed with acute epididymitis, and given a treatment of antibiotics. While the treatment made the swelling in my testicles go away, I was left with lasting chronic pain (in my prostrate, left testicle, as well as along my left side reaching back to my kidneys/bladder) for approximately 11-12 months. The pain lasted all day long, and got worst when I was exhausted, tired or horny.

During this time I pursued all kinds of treatment: including going to a urologists (relatively unhelpful, although I was able to gain some insight into the pain and scarring that can come from from epididymitis); a sexologist (minimally helpful, though I found there was a limit to what I could accomplish simply talking about the issue and trying to masturbate slowly); an acupuncturist (surprisingly helpful in encouraging circulation and healing); and even a hypnotherapist (unhelpful).

I also worked on my kegels and read books and scientific literature about premature ejaculation; things I had both done before but that I now continued with new intensity after my injury/disorder. I also sometimes tried to share these experiences with other men but I was often met with jokes or mocking.

Some of these treatments helped for a time with the pain I was experiencing, and for a brief time they even seemed to help with the PE itself. However, after a year of undergoing this variety of treatment and training I had still made little or no longterm progress with my PE.

Relatively desperate for a solution, I asked my doctor to prescribe me SSRI antidepressants (in my case, paxel) which I had researched working in extreme life-long cases of PE. While the drugs completely diminished my sex-drive, they generally still did not help my PE, and caused extreme side-effects like intense insomnia and multi-day ‘chemical-fogs’. Needless to say, I eventually stopped taking the drugs.

Since then, I have continued to practice meditation more seriously and what I guess you could call meditative/relaxing masturbation. Still, I seem to be unable to deal with my PE when it comes to vaginal intercourse. Recently in the last year or so, it’s become, again, quite distressing for me, to the extent that I found myself avoiding intimacy and sex with my partner.

It seems that the more horny and tense I become down there, and the more unable I am to release this tension through sex in a slow and relaxed manner (again, and not with the quick and automatic anxious ejaculatory response I had developed that was generally uncoupled from any kind of orgasm), the more my old pain associated with PE and epididymitis acts up.

In an effort to work on my mental health around this, I have, over the last two to three months started a yoga, tai-chi and breath-work routine, which includes the basic, 3-round, Wim Hof breathing, daily. This has helped me with the stress and anxiety I have around PE, however, as of yet I have not seen any progress in terms of my ability to enjoy sex without PE.

Truly, sometimes I just feel at the end of my rope with all this — as it has been going on so long and has only resulted in increased distress and physical conditions as I’ve gotten older.

I want to relax and be able to enjoy sex with my partner and I have rarely been able to do this in any kind of meaningful way.

Perhaps you can offer some advice/guidance?

Thanks for your time and support.

Thank you Luke for sharing. Your story is full of thoughtful insights for other guys who struggle with PE. It’s a story of motivation and resilience too.

Let’s pick up on some of the things you’ve mentioned, and see where you might go from here.

Premature ejaculation shame is rife

Feelings of shame around premature ejaculation are extremely common. Guys feel guilty about their perceived inability to satisfy their partners, and this can spiral into feeling flawed and worthless. This feeds back into the problem, creating a loop of anxiety and avoidance around sex.

I try to remind men that yes – some of us naturally ejaculate sooner than others. It’s how our bodies want to work. In primitive times out on the savannah, this was advantageous. Maybe there’s an evolutionary reason why guys who take an hour to reach ejaculation are fewer in numbers: they got disturbed and eaten before they finished.

Guys who experience lifelong PE aren’t broken, but they do need to put in some foundation work if they want to last longer with their partners. Just as you have experienced, Luke, it can take time and effort to find an approach that works – and a fair amount of optimism too.

Shame is demotivating. It blocks our effort and openness and progress, and keeps us stuck in the loop.

So I think it’s essential for us to make peace with our own bodies. We have partners who want lots of intimacy with us, so we’re getting the essentials right. Overcoming premature ejaculation is best viewed as personal development rather than fighting with our own bodies and resenting what nature did or didn’t give us.

Premature ejaculation shame is alienating too. Society is more open to discussing intimate health problems than ever before, but just as you’ve found Luke, this topic remains off limits. There are sex advice columns and information products and blogs like this in corners of the internet. But guys tell me that they feel uncomfortable even typing ‘premature ejaculation’ into Google, never mind mentioning it out loud.

So there’s a gap in the market for positive, pragmatic discussion of premature ejaculation and you’re helping to fill it right here. Mocking is a natural reaction when we’re reminded of our own insecurities and struggles. I’ve talked previously about the scare-mongering and pathologising that goes on in order to spam us with help products and magical cures. That just ramps up the feelings of shame and brokenness. Let’s be the antidote to all that.

For anyone feeling alone and anxious about PE, remember that at least 30% of men have the same struggle. There’s an irony to all this, where nature has us chasing our own tails in silent exasperation. Try to maintain your sense of humour, but not to push the issue away or mock others. Stay positive about this with your partner, and show your strength of personality winning through.

Seeking professional advice

Epididymitis is a new one to me, Luke, and thanks for explaining what you’ve been through. I’ve heard anecdotal stories of guys trying hard to stop themselves from coming and sustaining injuries, but not a rupture such as this. You’ve been through some serious pain, and every guy reading this will empathetically shift in their seats. Good on you for overcoming this setback and moving on, picking up insights and understanding along the way.

I’m an advocate for reaching out to professionals for help. Doctors and urologists should be able to rule out any potential medical issues, such as prostatitis or thyroid problems. A sex therapist or sexologist can help identify gaps in sexual understanding or factors in the relationship dynamic. I’m a bit sceptical about the usefulness of hypnotherapy in treating premature ejaculation, and I’m qualified in clinical hypnotherapy.

But therapists work within the limits of medical understanding. Maybe for the same reasons that guys don’t talk about PE, there isn’t enough ongoing research and education. Research studies of treatment tend to focus on a specific behavioural or pharmaceutical approach and findings are usually vague.

There’s a general consensus that for couples who specifically want to enjoy intercourse for longer, a combined biopsychosocial treatment is best. But this is difficult to study and outcomes are notoriously hard to measure, usually relying on stopwatches (awkward) or questionnaires (too subjective).

Most therapists, including me, will advise on relaxation, slower masturbation, taking pauses, the PC muscle and kegels and all the workaround ways to enjoy sex without intercourse. Increasingly, doctors will suggest trying an SSRI antidepressant too. But few therapists have the experience or resources to put together a holistic, combined approach.

A biopsychosocial treatment for PE

I don’t have all the answers to premature ejaculation. My approach is primarily psychological, but I use sexological, relationship and biological elements that are within the limits of my understanding. As a therapist who primarily works with guys, I’ve had the privilege of trying out different methods and seeing how best to combine them.

Here are a few pointers from the info you provide:

Understand how control works (and how it doesn’t)

You’re doing many of the right things, including breathwork and relaxed masturbation with focus on sensations in your body. I’m sure yoga has loads of beneficial potential too. You are doing foundation work. Too many guys get too hung up on intercourse, trying to remember to breathe or relax during sex. They are too aroused, this doesn’t work and the frustrating battle with their bodies continues.

Be mindful of how we control our ejaculations obliquely. We learn how to create the physiological space for relaxed, confident intercourse. We learn to stop searching for a brake pedal that doesn’t exist. You know this; you learned it the painful way.

Keep having sex

Take the pressure off yourself by any means so you and your partner can continue having sex. Fun, unpredictable, spontaneous, goal-free sex. That’s the best way to try things out – curious, positive but free from ‘am I lasting longer this time?’ self-narration. A fine and delicate balance, I know. We find it by being (a connected partner, a giver, a lover) as much as doing.

Recruit your imagination

Enjoy meditative, relaxed masturbation as an experience in itself. Recruit your imagination as vividly as possible. Play through the stages of the intimate scenarios you want, synchronising with slower, faster, lighter, more intense self-stimulation. Feel that natural ebb and flow of arousal over time.

Get acclimatised

Understand how acclimatisation works. In a nutshell: embrace foreplay and don’t fret about getting aroused, then take penetration as slowly as you need at first. After riding those initial waves of intense stimulation, we can hit our stride and be in a more confident place.

Sex is an activity, not an event

There’s a well-known neurological truism: what wires together, fires together. Habits are formed by repeated triggers and events, in the brain and the body. This is completely applicable to premature ejaculation, where the fusion of arousal, anxiety, expectation and fear triggers the ejaculation response, over and over again.

Ultimately, we’re looking for ways to lower anxiety and mix things up. We want to create space between penetration and ejaculation, to make it an event occurring over a period of time.

This can feel like a remote concept for guys who have experienced lifelong PE. As I work with them, I ask how it feels to envisage intercourse as an activity, a passing of five, ten or twenty minutes. An ebb and flow, an oscillation of arousal rather than a sharp incline. Sometimes, they reply that sex feels more day-to-day somehow, appealing but not so breathlessly exhilarating. I take this as a sign that we’re getting somewhere.

At times, it’s understandable and somewhat inevitable that you’ll feel at the end of your rope. It’s tempting to sink into gloomy resentment. That’s the nature of this journey, this search for meaningful and satisfying connection. Keep your heart open, your partner on-side and remember that there’s a lot of sex in your stars, so relish every moment.

I hope you find this helpful and thanks again for sharing.


If you’d like to ask Jason a question or share your experience, feel free to get in touch.

Disclaimer: this site is run and moderated by Jason Dean, a qualified psychotherapist. But he is not your psychotherapist. All content and comment is an expression of opinion, not a medical diagnosis or consultation.

All content is for information purposes only, and is absolutely no substitute for medical advice from your own GP or NHS Choices. Please see the full terms of use.

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