Because premature ejaculation is associated with infrequent sex, men with low frequencies of sexual activity often get extra excited and aroused, which can manifest as performance anxiety when sex presents itself.

What is the No. 1 sexual issue that men face today? OK, the guy who said finding a sexual partner wins

- By Dr. Hernando Chaves

I will give you that one. What’s the second then? Chances are most of you said premature ejaculation and most of you likely had a reaction to that term -- you felt some anxiety or thought about clicking back to your streaming porn that’s taking forever to download. It’s time to stop avoiding the issue and look at it. Why? For the simple reason that we only live once and having the best possible sex life should be an item on our bucket lists.

The Diagnostic Statistical Manual of Mental Disorders (DSM IV) defines premature ejaculation as a persistent or recurrent ejaculation with minimal sexual stimulation before, on or shortly after penetration and before a person wishes. Wow, that’s not a sexy definition. Personally, I define it as you come quicker than you or your partner wants.

How often does this occur in different age groups for men? According to the 1999 NHSLS survey by Laumann et al., 30% of men ages 18-29, 32% ages 30-39, 28% ages 40-49, and 31% ages 50-59 stated climaxing too early was an issue. I know some of you were hoping age would slow things down. If men were asked if they’ve ever had at least one experience of premature ejaculation, almost every guy would get in line for their membership card.

What causes premature ejaculation? There’s not one cause; it’s a combination of factors. Some believe anxiety is the culprit, repetitive learned behaviors, excessive or insufficient arousal, or muscular tension. They’re all associated, and addressing each of them is the key to curing premature ejaculation. Evolutionary psychology suggests men learned to ejaculate quickly to ensure they completed the sex act before a predator attacked, a female escaped, a male interrupted, or to increase the chance of procreation. Maybe we can blame the cavemen? For our purposes, let’s leave the scientists to figure out the causes and let’s focus on tips for curing premature ejaculation.

Premature Ejaculation: Anxiety Reduction

Let’s start with what we can do before our penis comes into play. First, you need to learn to calm yourself down and lower your performance anxiety levels. Because premature ejaculation is associated with infrequent sex, men with low frequencies of sexual activity often get extra excited and aroused, which can manifest as performance anxiety when sex presents itself. Even men with frequent sex can get extra aroused. Reducing anxiety is different for everyone. Meditation, hypnosis or imagery exercises may help for some. Just like an athlete works with the sports psychologist to envision their performance, you can do the same sexual imagery for the bedroom. How many of you imagine positive sexual scenarios, envision your interactions and what behaviors you would engage in? Imagery can be like a positive mental plan, something you can fall back on that can help you manage your anxiety beforehand -- and in the moment.

Communicating your anxiety is also helpful. We hear the expression, “a big relief to get that off my chest,” yet it’s rarely used for premature ejaculation. Talking with a partner, friend or therapist opens the door for anxiety relief and can help address and alleviate some of our fears. Men are notorious for keeping things inside and it’s no different for a delicate subject like this. Things like our penis size, body image, relationship difficulties, and stressors in life (work, financial, family, health) can all add to our anxiety levels in the bedroom. Lastly, pick up some sex education books/DVDs on sex technique and sexual expression. There are thousands out there and the more sex education you have, the more competent, confident and less anxious you’ll feel.

At first, masturbate alone using the start-stop method, then use it during partnered manual stimulation, hand job

Premature Ejaculation: Pelvic Muscles

Ever notice the tension you feel in your body? Men are less likely to find ways to release pelvic tension. Often, men are engaged in actions and behaviors throughout their lives and during sex that reinforce muscular tension. During sex, if you’re holding your breath, flexing your abs and muscles, or supporting your weight in certain sexual positions (missionary), you’re creating muscle tension that increases the potential for premature ejaculation.

The classic example is men who tighten their muscles as they push out their erection to feel and appear larger to their partner. Since orgasm is muscular contractions that release muscular tension, it’d be wise for us to work on our muscle tension levels. Activities like yoga, stretching, anxiety reduction skills, and working out are all ways to decrease the tension in your pelvic and abdominal regions outside of the bedroom.

I also recommend you allow your partner (or masseuse) to give you a full body massage. Be mindful of the performance anxiety you experience and the tension release you feel as they touch your stomach, your thighs, your buttocks, and other areas of your body. It’s not about genital stimulation; it’s about managing the discomfort we may feel with our bodies, being touched and feeling exposed. Men that are comfortable with their body image and with being touched often have lower ratings of sexual anxiety.

Another important technique to lasting longer is doing Kegel exercises. If you haven’t tried them, what are you waiting for? There’s no better method to strengthen your pelvic region and to create strong pubococcygeus muscles. One of the reasons Peyton Manning and Tom Brady are two of the great quarterbacks in the NFL is because they spend thousands of hours watching game films to prepare for the game. What are you doing to prepare for sex? You can’t expect greatness if you don’t put in the time.

Premature Ejaculation: Start-Stop Method

The start-stop method is a tested method to learning ejaculatory control and lasting longer. A male will stimulate his penis until he is ready to have an orgasm and then cease stimulation. Why this self-administered torture? You’re training yourself to find when your ejaculatory inevitability occurs, or your point of no return. This is the moment before orgasm when you’re about to explode. Instead of ejaculating, you refrain from stimulation and allow the feeling of orgasm to subside. People will often squeeze their PC muscles (a Kegel contraction) to help hold back orgasm and ejaculation. Essentially, you’re teaching your mind and body to get comfortable with being in heightened states of arousal and learning when the onset of orgasm approaches. The goal is to stretch out the plateau phase of the sexual response cycle and put more distance between the excitement and orgasm phase. People will do the start-stop method repeatedly for months and most gradually notice changes in their control, duration of maintained stimulation, and their anxiety and confidence levels. At first, masturbate alone using the start-stop method, then use it during partnered manual stimulation (hand job), fellatio (blow job) and, finally, incorporate the start-stop method with intercourse.

Masturbation is the best practice for sex

Premature Ejaculation: Masturbation

Masturbatory patterns are a form of learned behavior that often need to be unlearned. Most guys have a fast-track orgasm approach to masturbation. Whether it’s because mom always knew the worst time to knock on your door, or your decision to rub one out fast when stressed, we often train ourselves to be quick on the orgasm trigger. You need to change this masturbation mentality of goal-oriented orgasm to one that focuses on taking your time and getting comfortable with heightened sensations. Masturbation is the best practice for sex. Instead of racing to orgasm, take at least 20 minutes of masturbation time before allowing yourself to ejaculate. During this time, you’ll focus on the start-stop method and penile stimulation of the shaft and glans (head). The glans are generally the most sensitive areas of the penis and is continuously stimulated inside the vagina. However, most men masturbate using an up-down stroking motion of the shaft and neglect glan stimulation.

Start off your 20-minute stroking without lube and just your imagination. In future masturbation sessions, work up to imagery and lube, and then incorporate an adult magazine without lube, an adult magazine with lube, porn without lube, porn with lube, and eventually porn with lube and a sex toy. What kind of toy? Anything that will mimic vaginal stimulation, such as a tenga egg, penis sleeve or artificial vagina will suffice it. Each of these likely have internal ribbed and studded portions that offer heightened states of stimulation, which you will learn to enjoy and control. Any of these toys can be ordered online and delivered if you’re uncomfortable buying them in person. This gradual increase in stimulation that you can manage, sustain and control will eventually be transferred to sex with a partner.

Premature Ejaculation: Sex Positions

Who would’ve thought the positions we have sex in can impact premature ejaculation? Oddly enough, the most popular position in the U.S. is male superior (missionary), which is also the position associated most with premature ejaculation. This is because muscular tension is increased as the male is supporting his body weight with his arms and core strength. For a male looking to cure premature ejaculation, utilize positions that limit muscular tension such as female superior (female on top), side-to-side (spooning) and rear entry (doggy style) when both partners are on their knees. Incorporate deep breathing with these sex positions to keep the blood and oxygen circulating.

Premature Ejaculation: other treatments

Personally, I think desensitizing creams are a short-term fix. Why would you want to reduce your sensation? Isn’t the whole point of sex to feel sensation and find ways to enhance this? Condoms have similar desensitizing aspects but at least protect you from STIs and pregnancy. Ejaculating before intercourse is another way to last longer. The more times we ejaculate in a sexual experience, the longer lasting we become and less semen we produce. Lastly, some MDs are prescribing psychotropic medications known for their sexual side effects of delaying ejaculation. Interesting -- you last longer and feel less depressed or anxious.

Manage Premature Ejaculation

Most of you can eradicate premature ejaculation in a few months if you stick to your program. There are a lot of self-help books, videos, therapists, and sex coaches that can help you through this process. One issue with training yourself to last longer is that once you start lasting longer it’s difficult to go back to quickies. But, I guess most of you can live with long sessions of intense sensation, arousal and partners screaming your name in ecstasy. It’s a decent trade-off.