How to manage psychogenic premature ejaculation?

Question

Hello doctor,

I am a 34-year-old unmarried male. I can control my ejaculation during foreplay with my girlfriend, but I struggle to maintain control for more than 30 seconds after entering the vagina. Is this an indication of lifelong premature ejaculation (PE), or could it be related to fear or performance anxiety? I once used a condom to alleviate my fear, but the problem persisted. I am soon going to get married, and I am concerned that this issue may affect my married life, which is causing me to hesitate about marriage.

In the past, I developed a habit of masturbation starting at age 14, initially two to three times daily, though the frequency has since decreased. I still masturbate, and my ejaculation occurs within a few seconds when watching porn. However, without porn, I can control it for four to five minutes using the start-stop method. I tried Dapoxetine 30 mg during masturbation once, and it was effective. But when I used it for the second time with a sex worker, I could not achieve an erection and was left disappointed. Additionally, I am reluctant to use medications due to their potential side effects, such as reduced sex drive.

I am struggling to understand my actual problem. Could you please help clarify it?

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and understand your concerns.

Based on the description you provided, it seems that your premature ejaculation may be psychogenic in nature. The fact that you can control ejaculation during oral sex but struggle during penetrative sex suggests a psychological component rather than a lifelong condition. Premature ejaculation is definitely treatable with either medication or psychotherapy. While you have concerns about medication, it is worth noting that there is no strong evidence suggesting that it decreases sex drive.

Regarding alternative treatments, Kegel exercises can be highly effective. Start by aiming to control ejaculation for 15 seconds, then gradually increase this by one or two seconds each day. Though results may take some time, consistent practice should lead to noticeable improvement.

I hope this helps you.

Thank you.