Premature Ejaculation: Is It Fixable?

"I really believe the two of you have to get back into a better emotional place to create the sex life you both want," Dr. Schwartz says.

Q: My wife seems to want intercourse only but I have a problem with premature ejaculation (PE). In my previous marriage, I satisfied my ex-wife with oral sex and then we'd have short intercourse. My current wife won't let me perform oral sex, but I believe it's because she prefers intercourse. Part of my problem is that her ex was long-lasting and I can't get it out of my head. She won't go to counseling. We did, and it was working, but she stopped. I have the medications for ED (erectile dysfunction) injections, but I don't see how that will stop my PE. I am so depressed about this. I want sex all the time but until I can last longer, she just lies there, so I stop trying. Help!

Dr. Pepper Schwartz: There are so many issues in this letter, I hardly know where to start. First, why did counseling stop? Is she angry with you? You say it "was working" - but what was changing and why wouldn't that encourage her to continue therapy? Is it because she is just angry with you now and doesn't want to cooperate? I ask because it's important to know how much anger is going on. There seems to be a lot of anger directed at you and that isn't going to help PE, I can tell you that!

Any stress, heavy-duty expectations or disapproving vibes (like just "lying there") will make it more difficult to sustain an erection. Though the PE mechanism is different from Erectile Dysfunction or  ED, neither one of them is helped by negative emotions or feelings of rejection. The two of you need to be in therapy to get in emotional sync in order to make premature ejaculation less likely.

But on a purely mechanical level, you can do a couple of things to help slow you down. First, you can masturbate before you have sex. A previous ejaculation the same day makes it a little harder to ejaculate quickly. If you can't manage two good erections in the same day, masturbate the day before - that still might help.

Second, use  sex toys such as vibrators and dildos to penetrate and arouse her. Make it fun - experiment with sizes. If a woman can get into toys (and why not, they're great!) she can have a great orgasm before her partner enters her. In your case it may work to help her feel satisfied and once she has had an orgasm, it could take pressure off you and make it easier for you to go a little longer.

Third, try the squeeze technique: It works for many people. Begin intercourse, and when you feel close to ejaculation, withdraw and firmly grasp the head of your penis with two fingers, one of which is the thumb on the inside of the penile ridge (the corona.) The squeeze will help the blood decompress and relax the sense of ejaculatory urgency. You can find this well-described in almost any how-to book on male sexuality.

Fourth, the ED drug you have may help. The fuller feel of the penis does help some men get harder and go longer.

Fifth, anti-depression drugs will slow down ejaculation. I recommend finding a new doctor, who specializes in sexual medicine. See if a new doctor feels you are a candidate for using an anti-depression drug for this issue.

Final comment, though: You have to work on the emotional climate between you and your wife. That truly can be making your PE worse. I am not sure why you know her ex-husband could last a long time, but I am guessing she told you that in anger because she wanted you to know how "deprived" she was. Hurling out that kind of information is hardly a loving or constructive way to deal with this problem, and I really believe the two of you have to get back into a better emotional place to create the sex life you both want.

Photo by naive art.

Dr. Schwartz  answers questions  every Monday, Wednesday and Friday.  Submit your question hereRead more of Pepper's  columns here . And be sure to follow Pepper on Twitter  @pepperschwartz.

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