Watch the latest videos and news on Premature Ejaculation…and what men can do to address this common and very much growing condition.
Premature Ejaculation: A Urologist’s Perspective
Video Transcript ▼
Hello, my name is Dr. Sriram Eleswarapu, and I’m a urologist at the Men’s Clinic at UCLA, which is a comprehensive center for men’s sexual health, infertility, low testosterone, and other issues. I’m also an Assistant Clinical Professor of Urology at the UCLA Department of Urology. Today I’ll be talking about premature ejaculation. At any time, feel free to ask questions on Twitter using the hashtag #UCLAMDChat, and to start, let’s talk about the motivation for today’s talk. So, premature ejaculation is a common condition. It’s difficult to talk openly about it, particularly with a doctor, but this is something that I hear about on a daily basis as a urologist, and so it came to my attention that we need to have some better information out there. There’s tons of information available on the internet. You can find tons of stuff on YouTube, Twitter, Reddit, and a number of other social media elements, but we don’t know whether that online information is reliable, what’s real and what’s not so real. If you ask 10 people, you’ll get 10 responses. As a urologist with a special focus in male reproductive and sexual health, my interest and my goal is to provide some clarity to the condition and maybe give you some advice on what you can try. Today we’ll talk about a few things. First, we’ll start with definitions–definitions are key. What is premature ejaculation? What’s normal ejaculation? How common is premature ejaculation? How do I, as a urologist, diagnose PE, and what’s my approach to treating men who have PE? And then we’ll talk about why you might want to see a urologist. So what is ejaculation? There are four stages of the sexual response: desire, arousal, orgasm, and then resolution. As you get increasing levels of sexual arousal, you reach a threshold at which you trigger an injector, a response which usually terminates the sexual experience. Ejaculation, I like to think of as three different distinct elements: emission, expulsion, and orgasm. Emission and expulsion are a spinal cord reflex, and I’ll go into what those two words mean in a moment, whereas orgasm is the pleasurable response that occurs in the brain in response to emission and ejaculation. They all happen nearly instantaneously. You don’t–as an individual experiencing orgasm, you don’t distinguish between the three, but I like to distinguish between the three because they are three individualized components of response. So let’s just go through a brief anatomy lesson of ejaculation. Here, you see a cross-section of a spinal cord, and you see some sort of input nerve, and some form of an output nerve or an efferent nerve. So with any kind of stimulus, any reflex stimulus, whether it’s tickling the eye and blinking, or tapping you on the knee and kicking, or ejaculation, there’s some stimulus that, in this case, occurs at the skin level, and that travels into the spinal cord, and then immediately there’s a reflex response that travels out to the structures that are innervated by that particular response, in this case the seminal vesicles and the organs that produce an ejaculate. Looking at that in terms of the anatomy of the pelvis, you see some important structures here, and I’d like you to draw your attention to this area right here. Here you have the bladder, of course. This is the penis. This is the testicle. But in terms of ejaculation and orgasm, emission occurs when the seminal vesicle, where the semen is stored and produced, begins to kick out some of that fluid into the ejaculatory ducts. So that is emission, and that is a spinal cord reflex. And then the other spinal cord reflex is ejection, or expulsion, and that occurs with the muscles in the pelvis, the muscles in the urethra, as well as some deep muscles behind the prostate and underneath the prostate to push out that ejaculate. So those two things, again, spinal cord reflexes, and those spinal cord reflexes are dependent upon a few different things, but in particular, serotonin. So you’ll hear me coming back to serotonin later in the talk, but serotonin is this kind of master neurotransmitter, this chemical throughout the body that regulates different things, but in particular, it’s important for ejaculation. How do we define premature ejaculation? There have been many different definitions over the last 40-50 years, and these definitions have been proposed, they’ve been used, and then they’ve been discarded. Different neurologists would use different terminologies, different definitions. More recently, about 6-7 years ago, the International Society for Sexual Medicine convened a panel to define this to provide some commonality, some structure, to the definition, and the definition consists of three parts. They characterize premature ejaculation as male sexual dysfunction characterized by 1) Ejaculation that always or nearly always occurs before or within approximately one minute of vaginal penetration, which we call lifelong PE, or a clinically significant or bothersome reduction in intravaginal ejaculatory latency time, often to approximately 3 minutes or less– that’s what we call acquired PE, or acquired premature ejaculation. So drawing attention to those particular distinct elements and the intravaginal ejaculatory latency time, we define things as an IELT, an intravaginal ejaculatory latency time, of either less than 1 minute or less than 3 minutes. Now, there are a few things to kind of break down in the verbiage of this discussion. Number one, you’ll notice that there’s a lot of hemming and hawing, there’s quite a bit of variability here. They say “always or nearly always,” they say “within approximately,” you know, they say “approximately three minutes or less,” so of course, there’s some room for error here. It’s not a defined, definitive thing. There’s always some room for a little bit of interpretation when you come to see the doctor. The other thing is that this definition presupposes vaginal penetration as the predominant way of sexual intercourse for a particular man. Now, we do know–and I see all the time–men who do not have vaginal penetrative intercourse. I see men who have sex with other men, men who have sex with women but don’t have vaginal penetration, and so in those men there is, again, some room for interpretation in molding this definition to an individualized treatment. The 2nd component of the definition is that there’s an inability to delay ejaculation on all or nearly all vaginal penetration. So it’s not enough to just have the first component. You also have to be trying to delay things, and you’re not able to, and then the 3rd part is that you have a negative clinical personal consequence, such as distress or bother or frustration, annoyance, and you may even be avoiding sexual intimacy with a partner because of this condition. So again, the types of premature ejaculation–there are two–there’s life-long and there’s acquired, as we discussed, but there’s also two others, variable and subjective. So, variable–going back, variable premature ejaculation are men who have normal ejaculations, they don’t have any issue with premature ejaculation normally, but then on occasion they have these episodes of premature ejaculation, and that’s within the normal variation. Subjective premature ejaculation is men who perceive they have premature ejaculation, but in fact they don’t, so these are men who have IELTs of 15-20 minutes, but for them they feel that it’s not long enough. So variable and subjective PE are largely situational, and they can be affected by stressors, performance anxiety, relationship factors, hormones, erectile dysfunction, and those are important things to assess, but those don’t meet the criteria of lifelong or acquired PE. How common is this condition, and what is normal? So there have been numerous stopwatch studies ver the last 50-60 years, and these are literally studies with a stopwatch, where a man and a woman will be having sex, and immediately on penetration, they hit the button, and then immediately when they orgasm, they hit the button, and they calculate an IELT. On these numerous different studies, there’s anywhere from 4% to 40% of men who have premature ejaculation. So there’s a large variability in these studies. There’s also a variation between what we do with a stopwatch and what we see with a man who comes in and reports a particular problem in general. As a urologist, I’m more interested in what the man experiences than, you know, the stopwatch event. If I can make your sexual life better, that’s my goal. So, you know, take that with a grain of salt in terms of the actual timings and what’s normal. The median across these studies is about 5 1/2 minutes. The range is anywhere from 30 seconds to 45 minutes, and we do know that IELT decreases with age. So if you have a 20 minute IELT, and then, you know, you hit age 50 or 60, and you start to see that number decline, you start to last only 5 minutes, that is expected with aging. So that’s not pathology, necessarily; that’s just you getting older, and this is just a pictorial representation of that distribution. So most men fall in this 200-300 second range, so about 5 minutes, but there are men who perform out to longer periods of time. So, again, variability. There are a number of different causes of premature ejaculation. In terms of the lifelong PE, we tend to explain this by variations in the sensitivity of the serotonin receptor and the interaction between serotonin, that neurotransmitter, and one’s receptors in the nerves that are the spinal cord reflex, and that’s a biological cause. There are, of course, other components to it, there are behavioral components, but we do tend to lean towards the biological cause for acquired PE. Again, there’s a biological cause, of course, but there are some other things that can impact one man’s experience with his premature ejaculation, including anxiety in sexual performance, psychological or relationship concerns, ED, prostatitis, which is inflammation of the area around the prostate, thyroid conditions, any kind of withdrawal for medications or even recreational drugs, as well as metabolic syndrome. So we do see with men who have elevated cholesterol or diabetes or obesity and other factors, these things are comorbid conditions that can precipitate as premature ejaculation or even erectile dysfunction. In terms of the evaluation, like I said before, a lot of it is patient self-report. I want to see you come to my office and tell me that you’ve got a problem. I asked for it in men who don’t come specifically for this problem, but if you’re coming to me, we’ll talk about, you know, what your experience is, how long you last, and then what is your level of bother? Is this something that bothers you every day, or is it something that bothers you, you know, once in a while? There are some important questions that we will discuss in the office visit and that you should discuss with whomever you’re seeing, if you’re seeing a doctor for this condition. What is the time between penetration and ejaculation? Can you delay your ejaculation? Do you feel bothered or annoyed or frustrated? Has this problem been present since your very first sexual experience, or is it something that’s more recent? Is your erection hard enough to penetrate? Do you have difficulty maintaining that erection to the end of sex? Do you have to rush intercourse to make sure that you ejaculate before you lose your erection? And how upset is your partner with your premature ejaculation? Because that’s the relationship component of things. Have you received any kind of previous treatment for PE? We also focus on a discussion of these other comorbid conditions, like I talked about, obesity, diabetes, cholesterol issues, etc. And sometimes we’ll do blood tests to evaluate possible medical causes and maybe treat those to see if we can get a response. In terms of treatment, I start with the simple stuff, and then we’ll talk about some medications and things that I prescribed, and then I’ll close out by discussing some of the experimental therapies and maybe natural remedies that you hear about online. In terms of physical fitness, we have multiple studies that have shown that weight loss and improved cardiovascular fitness, particularly in men with metabolic syndrome, can impact and improve premature ejaculation as well as erectile dysfunction. In terms of cardiovascular exercise, getting the blood flowing, you want to do this at least 3 times per week for at least 30 minutes at a time. You want to be sweating, you want to be panting, you want your heart rate to go up. That means that you’re having a good experience of exercise that’s going to have an impact on your overall health. If you’re just taking a leisurely stroll once or two times a week, that’s not sufficient to see an improvement in your sexual function. Sex therapy is a huge component of any kind of individualized treatment paradigm for premature ejaculations. So, this can take the form of individual counseling or couples counseling, it can help to expand the sexual repertoire, open things up for discussion, bring things out into the open so that you’re not hiding with a condition that really bothers you. This also helps to develop strategies to address avoidance of sexual activities. So, if you have premature ejaculation, we know that you’re more likely to avoid sexual encounters, be afraid of them, and so you could develop different strategies, talk therapy and other things to address that avoidance. It’s particularly useful in men with acquired premature ejaculation, and it can be a component of a larger paradigm of treatment, including medications or topical therapies, etc. So it’s not the only thing that we might do. There are other things, and we’ll go over those other things, but it is a nice backbone if you are interested in giving it a try. In terms of behavioral therapy–this is different from psychotherapy–behavioral therapy is what you can do to improve things. So there are a couple of different methods that were described in literature 50-60 years ago, including the start-stop technique, or what we call edging nowadays on the internet. This is where you stimulate the penis until you feel the urge to ejaculate, and then you let that feeling subside–you pause, you let it subside, and then you repeat the process, and the idea behind this in masturbating or in partner stimulation is that you’re retraining that spinal cord reflex, and you can. It is successful. There was also the squeeze method, which was described by Masters and Johnson, this is where you take yourself up to the point of almost reaching that threshold, and then you squeeze the head of the penis, the glans, to dissipate that effect. It’s almost–it’s not quite painful or anything, but you are kind of rerouting, or abruptly stopping, your sexual encounter in that fashion. Very similar techniques in terms of their effectiveness, and we do see a short-term response. Anywhere from 90% to 95% of guys will see some response. Whether it’s enough to make them happy, that’s a different question. The thing about this is that it is generally a short-term response. So if you have acquired PE, or even lifelong PE, you kind of retrain yourself. You might end up having to do it again later on down the line. So, just know that. There are topical anesthetics, topical agents. We’ve seen multiple studies that show that men who have premature ejaculation have a lower baseline sensory nerve threshold in the penis, and the idea here is that we can maybe mask that sensory input with local anesthetics to increase your IELT. Everybody’s a little bit different, so it may not work for you, but these are pretty cheap and available over-the-counter. There’s creams, there’s sprays. I like to suggest a spray to some of my patients. The thing you have to caution yourself with these sprays is that they can rub off on your partner and cause some degree of diminished sensation in your partner if you don’t give it enough time to absorb and dry up. So, be mindful of that. The other thing is that if you have erectile dysfunction as well, then you likely won’t see a response with the sprays. So you have to have a good, rigid erection to be able to see an effect with the sprays. There’s also antidepressant medications, which take 2 flavors in the treatment of men with PE. So, there’s SSRIs and tricyclic antidepressants. So, antidepressant medication is off-label use, it’s not approved by the FDA for premature ejaculation, but we use it all the time as urologists, pretty safely, at low doses. These are based on the role of the serotonin receptor, as I talked about before, in mediating that ejaculatory response. It can be used daily, or it can be used on demand. We see better effects with daily dosing at a low daily dose. It usually takes about 2-3 weeks to take an effect and see a response, so you have to be patient. And then after about 6-8 weeks, we can start to wean off the medication, if that’s something that we both, as a doctor and as the patient, you’re interested in. And these are some of the names: paroxetine, sertraline, fluoxetine are the SSRIs. Clomipramine is the tricyclic that we tend to rely on. Generally speaking, I’m prescribing mostly paroxetine, a few of the others, and of course, these do have side effects, so it’s important that you know that. In terms of erectile dysfunction medications, we know that men who have concomitant ED and premature ejaculation should have the ED treated first, and the way I like to think about this is, if you have erectile dysfunction, it’s your sort of evolutionary or biological imperative to reproduce, and so if you are not having as rigid an erection, your body, your mind thinks that you need to ejaculate as soon as possible before you lose your erection. So if we correct that, if we restore your erectile function with Viagra or Cialis or one of the other medications like Stendra or Levitra, then we can eliminate the PE by getting you rigid enough. But also, in men who have normal erectile function and premature ejaculation, now, you can use these medications in an off-label fashion to see if we can improve the IELT, and, in fact, that’s what the studies show, that we do see some impact on premature ejaculation just with–even in men who have normal erectile function. These can be taken again daily or on-demand, depending on the individual, and we often combine these with SSRIs. So, there have been clinical studies, controlled trials, that have shown that a combination of an SSRI with an ED medication can improve an IELT. Again, these also have side effects, and when I talk about side effects, this is very individualized, and so this is dependent upon a patient’s overall health, their tolerance of other medications, and we work with you on an individual basis to optimize things. Tramadol is another medication that we occasionally use. This is an opioid medication, so I don’t like to use it for everybody, but in certain individuals, it can be effective. It has a reactivity with the serotonin receptor, again, kind of getting back to that same theme. This is not FDA-approved for premature ejaculation, and in some municipalities and states, you can get into a lot of trouble trying to get this medication if you don’t have actual pain that’s documented. So, opioid medication–but it can be effective as an on-demand medication. It does, of course, have side effects, and then there’s alpha blockers. Alpha blockers are used in men, generally speaking, for urinary symptoms. Guys who have bigger prostates have difficulty peeing at night, for example. But we do know that these medications work by reducing sort of that emission threshold, or raising the emission threshold and reducing the amount of actual fluid that gets kicked out into the ejaculate, and so by doing that, there’s some theory that it can affect you, can affect or help with premature ejaculation. I don’t often use this for premature ejaculation. I use it mainly for men with urinary symptoms or prostatitis who may also have premature ejaculation, and sometimes it will have an effect on the sexual aspect of things as well. In terms of alternative options and experimental therapies, a lot of patients will ask me about physical therapy, pelvic floor physical therapy, and I love pelvic floor physical therapy. I really like to prescribe it to patients who have history of pelvic floor dysfunction, trauma, urinary symptoms, prostatitis, pelvic pain. All those things respond really well to PFPT, or pelvic floor physical therapy. Premature ejaculation–the data is still out on that. But if you have one of those other conditions and premature ejaculation, this is a great option for you to start out with. In terms of acupuncture, there’s emerging data on its effectiveness for different conditions, including premature ejaculation. I’m very interested in seeing what that data will show eventually. It can’t hurt. It certainly might help. So if that’s something you want to try, absolutely. Yoga–yoga is excellent for physical fitness. Good for stretching of the pelvic floor. We do know that men who perform yoga on a regular basis have very strong, relaxed pelvic floors, and that might help with the ejaculatory response, although I don’t have the data on that. In terms of surgical or procedural options like circumcision or Botox or penile nerve surgery, for circumcision, there’s no conclusion that circumcision helps with premature ejaculation. So if you’re interested in circumcision, that’s mainly for medical reasons or cosmetic reasons, not so much for premature ejaculation. Botox–it’s only been studied in animals for this purpose–for premature ejaculation. There’s some good evidence that it might help, but it hasn’t been used in humans yet. So stay tuned, we’ll see. In terms of penile nerve surgery, again, not a whole lot of conclusive evidence one way or the other. It’s not something I offer to patients unless there’s some sort of trauma or something in the history that requires a surgical intervention. In summary, premature ejaculation has a very specific definition. It’s common. It’s under-recognized. The diagnosis involves a thorough discussion of both a medical history and a sexual history, and there are a wide variety of treatments, as I described, and a urologist can really help to come up with an individualized plan for you. So, thank you for listening. And at this point, I’ll take any questions on Twitter at the #UCLAMDChat hashtag. So, we already have a couple of questions here. First question is “What is the contribution of low T–low testosterone?” So we do know that there is, in addition to the serotonin or nervous system component or reflex component of ejaculation, there is also a hormonal component. So, low testosterone can impact the ejaculatory response. In some men, low testosterone will delay orgasm, and in other men, low testosterone will contribute to premature ejaculation. If a man comes to me with ejaculatory symptoms of any sort or erectile symptoms, I will check a testosterone level along with a few other things, including the estrogen level, maybe even the pituitary gland hormones in the brain, to see whether there might be a hormonal contribution, and then treat those things if we need to. I have another question, a very good question. “What is the contribution of stress to premature ejaculation?” So, we do know that stress absolutely causes an effect on sexual function. It does that through a number of different systems in the body. So, people like to talk about mind-body, that it’s all in your head or whatever. It really isn’t just in your head. So, stress– stress actually has a physiologic mechanism that drives up the adrenal glands to produce adrenaline or epinephrine and other mediators like cortisol, and those things can affect the brain, affect the spinal cord, so stress reduction, mindfulness–these are things that are very important. “Do Kegel exercises help PE conditions?” So, the data are mixed on this, and that’s going back to the pelvic floor physical therapy. It’s something that you can actually try yourself since it’s easy and cheap, and if free, you could try Kegel exercises. Generally, Kegel exercises, in my practice, I prescribe to men with urinary symptoms who happen to have had surgery on the pelvis, whether it’s a prostatectomy or a colorectal surgery, and then they have eretile dysfunction or ejaculatory dysfunction. So, Kegel exercises–what those are, are basically contractions of the pelvic floor muscles. The way that I kind of teach a guy to do Kegel exercises is, I tell them, you know, the next time you go to the bathroom and you try to pee, you’re standing there and you’re trying to pee, try to interrupt your stream and it’s that muscle where you stop your stream. That’s the muscle you’re trying to hone in on. You can try it. I don’t know that it’s going to help a whole lot with ejaculatory dysfunction or premature ejaculation, but if you have concomitant prostate related symptoms or urinary tract symptoms, it might help with those and thereby maybe have an effect on your ejaculation. Looks like we’re we’re done with questions, so I think– as always, I’m available and and other urologists are available. Thank you for listening, and I hope to see you soon if you need me. Take care.
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Checkout This Device That Cures Premature Ejaculation??
okay oh my gosh okay probably no glasses all right we’ll give people a couple minutes to join us but before we get started I want to introduce you to my beautiful friends Daisy right there who is a well why don’t you just introduce yourself tell us about you okay hi I’m Stacy Ysidro and I’m a sex coach I have specialized in anything from Tantra and sacred sexuality to BDSM and kink and I work primarily with men over 30 yes and making her youtube debut at present and what’s your website where can people find you a holistic progression com is my website and I also have a facebook page and a channel on YouTube holistic progression holy all you saw her here first I want you to go find her as soon as we’re done with this livestream I’m sorry I’m shaking a little bit I’m holding the camera and I drink a lot of coffee today okay so I invited Stacy here because I want to prove premiere a device that I recently got sent you all know that I do premature ejaculation that’s like my primary purpose in this world also as you’re sitting in will you please tell us your names sign-in tell us who’s here I never like middle in the afternoon on what day is it today by Thursday Thursday bill the afternoon on a Thursday so thank you all so much for coming through and signing in hi Wow give me more names give me some names and thumbs up if you don’t take your name and give me a thumbs up so at least I know you’re out there that you’re listening that you see it us hi Louie hey what’s going on our guest star today our beautiful co-host hi Michael what’s up Michael I know you’re all really excited to see what the heck this device you’re about to learn about is I actually invited Cynthia Mike handed her this device right before we went live so there’s so much I shot that yeah not yet not yet wait people get on their hi shot hi welcome to the live stream madam thanks miss Taba hi Brad Dave David Sophie on sufyan oh you love music I’ll be G Chad c’mere one Norman Dennis hello hello hello I add up thank you thank you thank you so much Bob yes we’re both that we’re coming to you live from Austin Texas uh where are you all located somebody sent Denver hey y’all were coming sometimes not over here and we are learning about how to be speakers because I want to talk on to the stage better speakers that are speakers we’re practicing right now Tommy you’re in Dallas we’re practically only like ten hours away Oh Georgia also Dallas hey Georgia Alabama Connecticut Texas LA Georgia who’s the new lady this is Stacy since the is also a sex coach is also a flirt certified erotic blueprint coach as am i we met each other through our coaching program we had a Paris France on yeah we’d answer yes yeah so many skills show for you yeah actually you can see why I’m medially I don’t we can sharp into her I was like we’ve got to befriend think we got Las Vegas in the house used to all my uncle’s from Pakistan all right very cool from Louisiana all right perfect all right excellent so give me a thumbs up already give us a thumbs up holler at us let us know that you’re here that you are enjoying if you’ve never seen a special guest on my channel ever before well thank you for a loan okay so all right what’s this device that we are talking about well for many of you if you’re already familiar there’s not a lot of stuff out there that can like fix P permanent premature ejaculation I develop my course come when you want that is my system for caring premature ejaculation it’s 98% effective I’m super proud of that and there’s this really really cool tool that came out recently it’s a medical device cleared by the FDA comes out of a company that’s based in the United Kingdom and I handed it to Stacey right before we have done the livestream so that we could figure this thing out together sis do you see why don’t you share the people this is the probe won’t you a little bit closer it’s from a brain awesome texture that looks like that probably goes up against your car yeah you’ve got it the buttons yeah some buttons here animoves yeah there’s kind of this one moves over here and what happens is it vibrates so that would be vibrating on your deck that’s called the prolong device you can find it at prolong device calm and they sent me this like silicon guy it is so cool you wouldn’t think there was a sex toy what do you if you just like found this somewhere online or like if you just like open up your boyfriend’s cabinet and found that next to his bed you wouldn’t be like that’s a sex toy it’s not a sex toy it is a premature ejaculation device that works by desensitizing your penis so essentially what you do you were so right I love that I handed that [Music] you just figured it out and the way that you use it is that you’d use it as part of a training program so this is called the desensitization device does it go up under your cock by your phone no you had it exactly where she goes right on top yeah like fur there so imagine you do like this you be the cock okay I’m gonna turn it on just like owners but reality yes project cock knesset through your pairs alright so now it’s vibrator to make it wide and we and this is this will be the bottom this would be the ball let me put it okay look here’s the balls Oh perfect as you know this is good for nelem right this is the most sensitive part of the people this is the part that feels so good to be strong yes so all I would do is push this with my own hand up against the fernell um it’s gonna feel like oh my gosh there’s so much pleasure because it feels so awesome time and then you would stroke it up and down until you thought you were going to ejaculate and then you take the device off you cool off you move back down from your edge yes perfect Susie excellent demonstration breathe deeply breathe all the way down to the puppet floor relax and then as soon as you were ready just start again you would continue stroking up and down again you’re using Lube but there’s a lot of friction there what does it feel like against your fingers it feels a little textured with Lube it would definitely feel obviously we’re slippery but the vibrations are strong but subtle it’s very quiet you can notice you can’t even can hear it at all yeah some vibrators that are like a weed whacker so everyone knows my neighbors like with this device nobody would know no one would know this is called the prolong device we are naughty we’re doing this in a restaurant right now oh that kind of do you feel a little nah I’m actually yeah few minutes yeah it gets all of your nerve endings to get used to having so much stimulation so now if you were to go and have sex you will feel less intensity in the pleasure less intensity of the stimulation plus since you’ve been doing it as part of an edging routine you’re gonna know your point of no-return better and you’ll be better at noticing that’s starting to come up so that you can stop get a glass of water change positions you know do some deep breathing deep breath Emily demonstrated earlier so if you have some so type in some questions in the bar and I do have oh my gosh I have a discount code how didn’t I say that the beginning this is I say it’s not a cheap device it is fda-cleared it’s a medical device and with my code which is Caitlyn V you can get oh my gosh I was so excited to ride in I did get the 20% off it’s honestly a huge chunk of change you can give yeah you can get a decent amount of money off of this device it is not cheap but it is worth it and you can always put it in the comments or something yeah I will absolutely put it on the comments I’ll put it in the video description right away but if you want it right now go to prolong device comm try the code Caitlyn V and there’s like an orange button in the upper right hand corner to purchase that try code Caitlyn V if that doesn’t get you discount red code Caitlyn I’m pretty sure it’s Caitlyn VI so so sorry y’all I will fix this I will put it in the comments I just get so excited Stacy’s beauty distracted me you know just a goddess we can talk about the lady Jack ulation just about right now yeah absolutely I think if I have delayed ejaculation and you wanted to masturbate with something there vibrates it could feel good like this could also feel good Stephen say hi Stacy thumbs up please everyone pause right now and hit thumbs up if you enjoyed seeing Stacey on this channel and her gorgeous tips just say thanks guys how many guys are sleeping with Caitlyn at one time usually just I can only have one at a time cuz it can be too much you know I think the you know the maxis is obviously higher than one actually talking about I talked about my favorite threesome on YouTube one time so you can find that because the devil’s threesome okay billion thirty-eight thumbs up for CC only 38 come on you guys I dragged her out of a conference of it I can’t put anything on her fingers and Jackson we’re getting my energetic cock was on display yes cock all over YouTube do you have let’s see do we have any other thoughts on how someone might use this or what makes this device cool and interesting well I mean I can definitely attest to the fact that when I use something that vibrates for a prolonged period on my own clip like it I can desensitize myself for a while and it looks like I need to take a break so I comes back yeah it does come back but I can attest to the fact that vibrating on something can actually dull the sensation for a little while so that I can attest to even just for my own personal experience so I can understand why this would be working yes ya know yeah there’s that and and I like that it’s just it’s discreet it’s discreet it looks professional yeah you better part advice wash it it’s super simple and it’s designed to less the battery is not changeable but it’s designed to last for six weeks okay and this type of is this a silicone yeah yeah it’s gonna be a medical grade silicone so for all you environment will help people out there you’re not gonna get plastic in your cock yeah no we don’t and if you were using delay to check I would say you put on the perineum the space between cockin yeah I think so you like the prostate there yep if that would be strong enough yeah but also I’ve been working with someone on delayed ejaculation and recently and we made a lot of breakthroughs sometimes there’s a lot of inner game stuff so much so yeah and it’s about allowing yourself to receive my shirt yes 100% delayed ejaculation I found also sometimes has to do with shame yeah like if there’s just a lot of men experience shame around ejaculation like ejaculation themselves and your clothes into PE – I mean it’s like it’s either too soon or not soon enough so it’s basically all the same thing within that same spectrum of controlling the orgasmic energy flowing through you yep so this device could be of service yes they can find you again and see if they see more thumbs up we’re not done yet holistic progressions calm holistic progressions on YouTube and sex coach underscores Stacey Stas CIE should she IE on Instagram thanks coach underscore Stacey ie an Instagram also should Stacey start her own third keep doing more YouTube videos should she do there’s Apple videos up there there’s a few videos you’re beautiful on camera thank you so much thank you prolong device code Caitlyn when dissing sir
Nothing groundbreaking but every little helps to overcome this problem.. tips and ideas how to prevent.
Can I Prevent Premature Ejaculation?
Premature ejaculation is a common problem among many many men and we get asked a lot, can you prevent it? Well you can certainly help if you have premature ejaculation, there are various treatments that you can try that will assist with this problem and sometimes when you’ve used these treatments for a short while the problem of premature ejaculation goes away. Not necessarily something that you will suffer for a lifetime, so there are things like delay sprays that you can buy and at Moorgate we also offer Hyaluronic Acid injections into the glands which also desensitize the the head the glans of the penis a little bit which will help me keep you going for a bit longer. So there are initiatives that you can take that will help with premature ejaculation. If you feel this is a problem for you and you need some professional advice then give us a call, we’ll make an appointment for you to come and see one of our Urology doctors and seek some professional advice. That’s all from me today, I’ll see you next time back here at Moorgate. Until then, bye for now.
Sexpert weighs in on premature ejaculation
our sexpert Dorothy Black is joining me in studio and today we’re going to be chatting about premature ejaculation Dorothy’s nice to see you with you hi Jennifer hating good how I’m good so today we’re talking about premature ejaculation yes I love that I love the hand gestures that come with it yes research accusation right how does it happen how does it happen well I know how it happens quickly so basically the new research has kind of come out where they’ve systemized how we look at premature ejaculation I’ll talk about that just now a bit but how it happens this will say it’s not a medical condition so there’s not something physically wrong with you it is 99.9 percent of time something psychological other people will say that depending on which scripts you’re speaking to that premature ejaculation has a lot to do with how men train their bodies to ejaculate when they masturbate from a very young age but you know I think it’s maybe a little bit of a lot of things but definitely psychological so definitely psychological so if your partner is prematurely ejaculating or you are prematurely ejaculating should you go to the doctor no one on this is actually other other situations that are coming into play like erectile dysfunction or like really low sexual extra sex drive that’s just a sudden Semyon sit unless our other extenuating factors then then I wouldn’t bother going to go see a medical doctor however if you are concerned and obviously go see someone but I think the thing you should be doing is maybe going to go see maybe going to go see a therapist so what we actually need to look at is what is premature ejaculation so what they’re saying now is is that you’ve got acquired erectile dysfunction which means that you’ve been having great sex all your life and then suddenly you start ejaculation typically and then there’s lifelong premature ejaculation or PE and so what they say is like if you come under a mineral list or your man comes under a minute list that’s a problem three minutes or less it’s less of a problem but the point is is that if you are left unsatisfied if you’re coming too quickly if you’re coming quicker than you want to come if you’re a man isn’t lasting then it’s a problem you know it’s a problem for you it doesn’t matter whether it’s at the five-minute mark or the 1-minute mark or the you know a 10-minute mark if you’re coming quicker than you want to come then there’s something to look at and there ways of going around dealing with that now should couples be going to therapy together or should it be just the man you know what I think if if the guy’s really suffering from PE and that’s got self-esteem issues and confidence issues and issues around his body and issues with regards to women and relating sexually I think that’s maybe and something that they need to do by himself ok now I know you have some techniques that men can try it right or prematurely ejaculating well if you’re with your what let’s put this but if you’re with your guy and he’s coming too quickly and he’s coming too quickly for you or you’re coming too quickly with your woman the first thing to do is to stop and talk about it ok so if you feel like the the experience is lasting too short or it’s not long enough you need to open your mouth and start talking because the first thing you need to do is bring it to the table yeah and without making it an issue you know the minute you make something an issue the bigger issue it is now should you speak about it right away or should it be something like right off to it’s like oh my god what is this yeah no no no no no I think you know take it I always I always feel that like the big sort of the big bedroom discussions which make us feel a little bit vulnerable she sounds let’s be taken outside of the bedroom so don’t do it like on pillow talk like well honey you know that was great just a pity that you come and see quickly all the time that’s really the satisfying for me no don’t be whirling your eyes that’s not going to help either so take the discussion maybe like over dinner or at a time when you’re relaxed and bring it into the conversation as a conversation a set of judgments you’re not fighting you’re not arguing you’re curious you’re getting information you’re giving information so you know they’re stopping and they’re talking about it and what you want and what satisfies you but the techniques involved it said some people will say this is quite contentious some people said works it doesn’t work you know science researchers everybody’s gonna have their own story but this is what Masters and Johnson came up with was the stop stock method which means that if you’re with your partner or are you by yourself masturbating is that you stop just before you ejaculate so you bring yourself up to your peak just before ejaculation stop and you keep doing that until your times get longer and longer some people use a flashlight for this okay you know what that is yes okay but maybe people don’t know what it is okay so hmm a flashlight is a guy is a six or so guys and which is like a sheath like a penis sheath basically which can often look like a really nasty plastic vagina but they’re sons that don’t look like vaginas oh and then you can use that to mean sometimes use that to help them practice practice getting out of out of the habit of it if it’s out so there’s that Ananas also the the squeeze technique where if your guy’s about to you take the head of his penis in between your thumb and your forefingers and you give it a good squeeze for about 10 seconds so that’ll stop him from from ejaculating and then do you continue continue you know I think people get very caught up in the idea of having to orgasm or they think that they they need to you know rush through the process from foreplay and then we’re having sex and then we come and then it’s over yeah I think people can really use this as as a way of exploring each other and taking their time with each other because it also means that you have to get to touch each other a lot longer and you know kiss heavy pit there were a whole bunch of other stuff before penetration so practice taking your time take a lot of time if it gets to a peak stop go back to to foreplay or to touching or to heavy petting or to are all and then go back to penetration and you can stop and if you’re the woman who is with the guy you suffers a PE get on top and you control the rhythm so you you can tell when a guy’s about to come or if he says he’s about to come then stop pull back and then start again but those are you know those are techniques that’ll help maybe deal with the physical aspects of it but I think the why of why someone’s going through a PE situation also needs to be addressed and that means maybe doing some introspection and speaking to someone that can help you with that okay well that was all very great information I think for people who are affected by PE but what are some things you should not do don’t be running eyes making a mission out of it and blaming so no blaming no do you find women often blame or get annoyed I think yeah because I think men unfortunately you know we say you know women are incredibly affected by how society thinks we should and shouldn’t be but men are affected by exactly the same things so we have this idea that men are supposed to just like always be turned on always ready for six you know get a hard-on in the 10 seconds flat and then follow through and be able to be hired the whole time through you know men are people too it’s just bring that you know right back that their feelings and emotions and and so if someone is already in a vulnerable position where they feel like that they’re not performing right and then their partner in that space rolls their eyes hürrem’s blames goes you know what’s wrong with you there’s definitely something wrong here all of which I am guilty of doing in the past it’s crap it’s a really shitty thing to do don’t do it have a little bit of a compassion and then if your partner is willing to embrace it talk about it move through practice their techniques but don’t ya know blaming not eye rolling no arguing this isn’t anybody’s fault it’s not your fault it’s not his fault it’s just just happening it’s just half a day and it’s something else to talk with talk about and to deal with yeah well I know you just said that you have been guilty of doing it in the past yes what should people what would it as a woman you find yourself maybe it just comes out of your and you’re doing it how do you fix that and how do you move on from there in the middle of it so you roll your eyes yeah it happens you roll your eyes you get annoyed and then you catch yourself doing it is there any coming back from that I yes I mean you just apologized like I’m sorry I’m sorry I’m sorry like that was I was you know a bad behavior I’m sorry like I won’t do that again work for me and then don’t do it again yeah I just fixed right now maybe don’t do that not right then anyway thank you for coming in thanks Dan
Now here’s a challenge… Cure Premature Ejaculation in JUST 2 WEEKS!
Hi, I’m sex and relationship coach Caitlin V and today I’m gonna teach you how to last longer in bed using one super simple technique. Now, this is so crucial because lasting longer in bed isn’t just for you, it’s for your female partner. If you want to be able to give her an orgasm through penetrative sex, which I know you do, then you need to be able to last longer and not just that, once you are able to last longer, it boost your confidence, which makes you a better lover overall. You’re no longer in your head thinking about, ooh my God, is it gonna happen, I need to make this last No, once you know that you can do it, you can do it and you can do it every single time. When it comes to sex, how you practice is how you play. That means that when you are having solo sex, a.k.a masturbation, you are practicing for partner sex. The goal here is to make your solo sex the way that you want to have partner sex. In other words, if you masturbate for a very short amount of time, When you go to have sex with a woman, it’s also gonna last for a short amount of time. The good news is here that you can totally change the way that you masturbate, and it’s gonna change the way that you have sex with a partner. Simple enough, right. This works because your brain doesn’t really know the difference between when you are having sex with yourself and when you are having sex with a partner. I know that’s crazy just… I can explain the science to you later. Right now all you need to know is that your brain doesn’t know the difference. So, you can practice this way and then when you get in bed with a woman, that is how you’ll actually play, okay. So, the technique here is just to to extend the amount of time between getting an erection and ejaculating, while you are masturbating. First step is to time how long you currently masturbate for. So literally get out a timer and go from when you start to when you finish. Figure out what your baseline is and then set a goal. For all my clients their goal is 20 minutes, but depending on how long you are lasting, you are gonna do this in increments. So, let’s say you are lasting between 2 and 3 minutes right now when you masturbate. Your goal is each time that you masturbate, you are gonna last for one minute longer. So, that means 4 minutes, then 5 minutes, then 6 minutes. So, this might actually take you a couple of weeks, but trust me, stick with this program and you will see results. The biggest temptation that you are going to have is you gonna wanna take that short cut. You gonna be close orgasming and you’re just gonna wanna get there, coz it feels good. Totally understand. When you have that moment, I want you to just think, visualize, imagine that you are having sex with the woman of your dreams and you wanna make it last just a little bit longer. One way that you can control your level of arousal in order to make your self last longer, is by stopping touching yourself all together and just giving yourself a second to cool off. If that doesn’t work quickly enough for you, you can gently pinch the tip of your penis, which actually encourages blood to leave thus, decreasing your erection and decreasing your arousal. Some of you might find that it’s difficult to maintain an erection while you are doing this. That’s okay, if that happens, just put your pants back on and come back to it later. You’ll always have another shot at this. It’s more important that you wait, than that you give in to temptation and orgasm too soon. Ooh, you might find… You might say to me like, listen, I can masturbate for 20 minutes, but it’s different when I’m actually in bed with a woman. Okay, I totally get that, and this is why you need to follow my channel and subscribe. Because I give you all kinds of other advice and information that will help in those circumstances, okay. It’s still is vital that you take your time when you are having solo sex, so that you can take your time with partner sex. Do that I swear to you this will pay off. You will reap the benefits of this, alright. So, don’t forget to like this video and subscribe to my channel. Click the little red button underneath this video so that you do not miss any of my tips on lasting longer in bed, being an incredible lover, and making fantastic, satisfying, and incredible sexual experiences for you and your partner.