The Guide to Getting It On (116 page)

The squeeze technique for premature ejaculation has been around almost as long as the penis itself. It has had numerous incarnations. You would think there would have been a number of studies investigating its efficacy; not so. Part of the problem has to do with funding. Since the squeeze technique is free, drug companies aren’t exactly lining up to fund the research. And as you might have noticed, our government rarely chomps at the bit to fund studies on improving sexual pleasure.

Two studies that were done on the squeeze technique during the 1980s showed that a number of men had success with it initially, but most of the gains were lost. This is not unusual in the world of sex. Seasoned sex therapists often schedule follow-up appointments for any kind of problem every six months to a year after successful treatment. That’s because sexual problems have the tenacity of the cockroach. There can also be a placebo effect with any kind of sexual intervention, which means it works at the start because you believe it will. So don’t be surprised if you need to do squeeze-technique refreshers every couple of months. But this should be fun. Seriously, what’s not to like about a partner stroking your penis?

Warning #1: Get a Grip—Stop Apologizing

Some of the most annoying aspects of premature ejaculation that women report are the constant apologies and self-criticism that men express after coming too soon. This whining and bellyaching puts their partners off. If you decide to work on these exercises together, the man needs to promise that he will no longer apologize or berate himself for coming too soon.

Warning #2: Feel Your Sexual Excitement

Whatever the cause(s) for coming too soon, men with PE often try to slow it down by thinking about something unsexy, which is about as productive as a race-car driver thinking about golf to help with his anxiety when he’s entering a high-speed turn. All of us are occasionally distracted when having sex, but to intentionally think about something besides sex is not a good way to last longer. It could lead to erection problems, so you’ll then have ED and will still come too soon. Let yourself feel totally turned on.

Squeeze-Technique Particulars

You both get naked and kiss and fool around. Then you kiss and fool around some more. At some point, which is totally up to the two of you, the female partner wags her finger in the male’s face and says sternly, “On your back, dude!” Then she starts stroking his penis handjob style. While it’s usually done without lube, there’s nothing that says lube can’t be used. See what works best for the two of you and happily abuse the penis with it.

The man’s job is to tell his partner what he’s feeling in his penis. As soon as he feels like he is reaching the point of no return, he asks her to stop stroking and that’s her cue to start squeezing—right below the head for 10 to 20 seconds. Then, after a minute or so, the man’s urge to paint the ceiling should subside, and she can start stroking his penis again. Repeat three or four times or more if you like. When the two of you decide that Mr. Winky has had a good enough workout, she can stroke him until he blows.

After a few weeks of doing it this way, the woman might experiment with switching techniques. Rather than stopping and squeezing when he tells her he’s about to come, she might try rubbing the head of his penis instead. So she goes from choking his chicken to polishing his helmet.

As for erections, don’t worry about them. What you are interested in is trying to tolerate more sensation.

A variation on the squeeze technique is called
the stop-start technique.
Instead of squeezing when the man is close to coming, his partner removes her hand from his penis. It’s totally your call as to which technique you’d prefer to use.

From Squeezing to Intercourse:
When the two of you feel you are getting more control over the situation, the woman might try stimulating the penis with her lips instead of her fingers, or by sitting on top of the man and rubbing his penis with her vulva. This is called femoral intercourse. It is where the shaft of the penis glides through the lips of the vulva like a hot dog in a bun. The penis doesn’t go into the vagina, but glides through the vulva’s lips. The woman can lift her pelvis up when her partner is close to coming.

After another week or two, she might try putting the man’s penis inside of her vagina while she is on top. It’s good to keep it there for several minutes without thrusting too much. This helps the man get used to the warmth and other sensations, and there’s nothing that says she can’t be playing with her clitoris while his penis is inside her vagina. Keep experimenting.

The Point of No Return:
When doing the squeeze technique, it is helpful to recognize when a man is approaching the Point of No Return. This is when nothing short of stepping on a land mine will keep him from ejaculating. Signs that ejaculation is eminent include: the veins in his penis start to bulge, his love log gives a sudden throb, the color of the head darkens, his testicles suck up into his groin, his muscles start to tighten, his hips thrust, and he starts to groan like a dying bull or invokes the name of God or Allah. Appreciate how well you are doing if you can keep him close to the point of no return for several minutes without letting him go over the edge. With some men this will be possible, with others it might require a pharmaceutical assist (discussed in the pages that follow).

Also, it helps if the couple can cut themselves plenty of slack. There will be times when a guy reaches the point of no return before his partner can squeeze or pause. It’s no big deal. It’s not like this is the first time he’s ever ejaculated with a hand around his penis. Doing the squeeze technique should be fun, and occasionally funny. It’s not a reality-show competition.

Treatments —The Drugs

Most of the drugs that are now used for PE were not designed for PE, just like Viagra was not originally designed for ED. The erections caused by Viagra were an unplanned side-effect of a drug that had been designed for high blood pressure. The ejaculation-delaying properties of drugs like tramadol and SSRI antidepressants were first discovered as unwanted side effects. These drugs have not yet been approved for treating PE and may never be approved for it.

Consider that tramadol prescriptions are given out by the thousands each day for everything from back pain to toothaches. A lot of people take it daily in doses that are 5 to 8 times higher than is required to help delay ejaculation. If a man goes to his healthcare provider for chronic back pain, he’ll likely walk away with a prescription for tramadol. If he goes to his doctor for premature ejaculation, no such luck. Not that tramadol is without other side effects. It is also unfortunately becoming a favorite recreational drug for abuse, but not because of it’s orgasm-delaying properties. (See the warning in the section on tramadol.)

The Current State of Affairs

More and more research is being done on premature ejaculation, especially since the drug companies realize they would have a pharmaceutical gold mine on their hands if they could come up with a pill that helps men last longer without putting them to sleep or making their penises feel like lead pipes. Unfortunately, the drug companies will then try to convince men that their sexual self-esteem will rise exponentially if they take the new
intimacy-enhancing
pills. Then, guys who last “only” six minutes—which is close to what half of men last—will assume they have a disease and will want to take the new drug. So while there will be a definite upside to a medication that really works for PE without other side effects, there may also be an ugly underbelly.

Until recently, one of the problems in evaluating drugs for PE was the lack of a universally accepted definition of “premature ejaculation.” As a result, it has been difficult to compare studies face to face. For instance, out of 14 studies on PE, only 2 of the 14 bothered to ask the men about their feelings—the others were all about stopwatches and delaying ejaculation. None of the studies included input from the men’s partners, which should be of paramount concern. Only 1 of the 14 studies had decent enough methodology and validation to be taken seriously. None were designed to be helpful to healthcare providers. Also, the statistical methods that are used often make the drugs appear to be more effective than they are in real life.

Treatments—Pills

As of press time, no pills have been approved in the US as treatments for premature ejaculation. Using them would be off-label and the wisdom of doing so is between you and your healthcare provider. These summaries are for information only and might not reflect the latest research by the time you read this.

Also, all of the medications mentioned have side effects which could be negligible for some men, but genuinely bothersome for others. The possible side effects include dry mouth, nausea, headaches, weight gain, insomnia, erectile dysfunction, low sex drive, the occasional unexpected suicide attempt, drug addiction, and fertility problems. (According to some researchers, more than 50% of men wo start taking drugs for PE discontinue them because they either don’t work as well as promised or because of the side effects.)

If the pills alone don’t extend your range very far, some physicians suggest combining them with the squeeze technique or layering them, such as using an SSRI with a boner drug or delaying cream. Unfortunately, there are currently only a few studies to guide us on combining medications for PE.

SSRI Antidepressants (brand names include Paxil, Prozac, and Zoloft):
A common side effect for SSRI antidepressants is delayed ejaculation. The delay in ejaculation can be so significant that for a guy who doesn’t have PE, taking SSRI antidepressants can make him feel like he’s wearing a dozen condoms. This is why SSRIs have been just what the doctor ordered for men with premature ejaculation.

There are some SSRIs that delay ejaculation more than others, but the additional side effects can be problematic. The front line SSRI that one sexual medicine expert prescribes is Zoloft (generic name is sertraline). He says there are other SSRIs that might be better for PE, but he finds that Zoloft is better tolerated. He also likes the fact that Zoloft has a generic version that doesn’t cost his patients as much.

Keep in mind that SSRIs can have wicked sexual side effects including ED and killing your libido. They can cause headaches, nausea, drowsiness, weight gain, and other physical and mental nastiness. There is concern that young men who are taking them are at an increased risk of suicide. Also, some men with PE who find early success with SSRIs report their PE returns after several months.
Please, do not even think of taking SSRI antidepressants for premature ejaculation if you are bipolar.
If you have erection problems in addition to PE and taking the erection drugs alone isn’t enough, there have been limited studies on taking an SSRI with a PDE5 (erection drug). None of the research subjects died. Some sexual medicine specialists report prescribing an SSRI and PDE5 combination in refractory cases.

Dapoxetine (Priligy):
Some researchers assumed that a fast-acting SSRI with a short half-life would be a good on-demand solution for premature ejaculation. While one SSRI by the name of dapoxetine (Priligy) has been approved in other countries for on-demand treatment for PE, our own FDA was not particularly impressed.

Erection Drugs (brand names are Viagra, Levitra, Cialis, and Stendra):
Clinicians have noticed that a number of men with PE have also have erection-related problems. One of the unanswered questions is whether the erection problems are also causing the premature ejaculation, or if the PE causes the men so much distress that they end up having ED. Research funded by the Viagra people has not found that Viagra helps men with PE to last significantly longer. However, the men with PE who used Viagra reported increased confidence, a greater perception of ejaculatory control, and more overall sexual satisfaction. Perhaps the reason for this is while Viagra didn’t improve their overall time in the saddle, it may have resulted in a more reliable erection, which was a big relief. Viagra also allowed the men with PE to get it up more quickly after coming the first time. This can be a significant benefit for guys who come quickly the first time. They can enjoy a longer time in the saddle if they can rally soon enough for a second go-round. (Research by the Levitra people found Levitra to be helpful for PE, but you can’t always trust the claims of the boner drug companies. And unfortunately, you can’t trust the claims of the physicians who the drug companies will often pay obscene amounts of money for pimping their drugs to the unsuspecting public.)