Premature Ejaculation: An Interview with Expert Dr. Zvi Zuckerman

Diagnosis and the Four Different Types of Premature Ejaculation

When sexual relations have ended before they even started, there’s a problem.  Many men suffer from premature ejaculation, which significantly hurts their relationships. Luckily, there’s a way to deal with it.

The results are amazing. About 30% of men suffer from premature ejaculation, according to an extensive review published in the International Journal of Impotence Research: the Journal of Sexual Medicine. The problem is especially common among young men, up to age 40, and it causes them feelings of failure, shame, and guilt.

The partners of these men experience, on their side, great frustration and anger. Research shows that good sexual relations represent about 20% of the importance of the relationship, and if there’s a problem with the sexual relations this tends to rise to 80%, a high enough percentage to sabotage any relationship.

This is the second part of the interview with Dr. Zvi Zuckerman, former Director of the Andrology and Sex Counseling Unit at the Rabin Medical center. Dr. Zuckerman is the professional consultant to and one of the creators of the PE Program – a home exercise program to learn to control ejaculation that simulates the therapy process with a sexologist using a smart online system.

What is, in fact, premature ejaculation?

“According to the International Society of Sexual Medicine, premature ejaculation is:

  • Ejaculation that always or nearly always occurs before or within about 1 minute of vaginal penetration
  • The inability to delay ejaculation on all or nearly all vaginal penetrations
  • Negative personal consequences, such as distress, worry, frustration, and/or the avoidance of sexual intimacy

If you ask couples with premature ejaculation issues how long it takes for the ejaculation, usually they will overestimate and report 5 minutes, when usually it occurs within 1 minute. According to Helen Kaplan, a well-known expert in the field, if such an ejaculation is not controlled, if there is no control over the ejaculation reflex and it occurs within 1 minute – it is considered as premature ejaculation.

Dutch researcher Marcel Waldinger used to observe with a stopwatch in hand in order to take the time from the moment of penetration until ejaculation. He discovered that 90% of the men who suffer from premature ejaculation ejaculate within a minute and that the problem has a prominent genetic component – in about 91% of the cases the patients have first-degree relatives who also have the same issues.”

Is there a typical case of a man with premature ejaculation?

“No, there’s no one particular case, but there are common scenarios. For example, there are couples in which the husband and wife are lacking any sexual experience,” says Dr. Zuckerman. “Within no time they have two children, and only a few years later, after the wife has had the chance to talk with her friends and read magazines does she start to comprehend that sex can be different. She starts feeling frustration and anger, and the stress rises due to a sexual problem. Sometimes, the wife sends her partner to treatment without showing any wish to cooperate with it.

Men develop ‘patents’ in order to not ejaculate too quickly, such as drinking alcohol before the sexual activity or thinking about soccer or the overdraft in the bank during intercourse. Some tighten the muscles of the lower pelvis, or do one movement and then rest. Some ejaculate the second time. The first time is very quick, and then they wait for a second erection within a reasonable period of time – up to 30 minutes – and hope that this time they will last longer. But as the man ages, it takes more time to have a second erection. Therefore, some go for treatment only at an older age, when there’s no second erection or when there’s also a problem of impotency.”

In that case, what types of premature ejaculation are there?

“There are four main types of premature ejaculation.

Lifelong Premature Ejaculation

Lifelong Premature Ejaculation is a man who has suffered from premature ejaculation throughout his life. The premature ejaculation already appeared in the first sexual act and has continued ever since.

Acquired Premature Ejaculation

Acquired Premature Ejaculation is premature ejaculation that suddenly appears in a man who enjoyed regular sex up to a certain moment. Acquired Premature Ejaculation can be caused by stress or anxiety in a new relationship, or by seemingly unrelated issues such as work, finances, children, etc. In certain cases, Acquired Premature Ejaculation can appear due to a decrease in serotonin.

Subjective Premature Ejaculation

Subjective Premature Ejaculation is a state in which a man thinks he has premature ejaculation although his ejaculation is normal. Despite the fact that a doctor or sex therapist determines that the man has no problem, he still believes he does and wants to last longer during sex. Subjective Premature Ejaculation is characterized by a man having intrusive thoughts regarding a premature ejaculation that doesn’t really exist.

Variable Premature Ejaculation

Variable Premature Ejaculation is a condition in which a man ejaculates prematurely only in certain situations or cases. In other words, it is a case in which a man enjoys standard performance during sexual intercourse and only on certain cases has premature ejaculation. This can occur with a certain partner, or due to specific conditions unrelated to the partner.”

What do you do then?

“Regarding treatment, there are few options. Behavioral treatment has existed for dozens of years and helps obtain more control of the ejaculation reflex in up to 90% of the patients. It is recommended to do this treatment with a partner: wife, girlfriend or temporary partner, but you can also reach good results by yourself. The treatment is based on gradual exercises which you are to do according to the instructions. The treatment can be carried out in 10 sessions with a sex therapist or, alternatively, from your home with the online program we have developed, the PE Program. It is based on a smart online system that creates a personally tailored plan for the patient for the treatment of PE, which adjusts according to the patient’s feedback – just as a sex therapist would do in a “regular” clinic.

Another treatment is using a spray or ointment to decrease sensation in certain areas in the penis, which enable a few minutes of control. And yet, finding the right dosage is a delicate process. Not applying enough will be ineffective, while applying too much will cause numbness of the penis (occasionally resulting erectile dysfunction). Additionally, incorrect usage could end up desensitizing your partner’s vagina as well, and thus decreasing her enjoyment.

You and your partner may also suffer from a loss of spontaneity in your sex lives, as the spray must be applied 20 minutes prior to intercourse to a flaccid penis.

Another option is SSRIs, in which delayed ejaculation is one of the side effects. This is medicine you take every day or 6 hours before having sex. And yet, these might have undesired side effects, such as headache, nausea, dry mouth, drowsiness, and reduced libido.

In addition, the timing of the ejaculation is dictated by the medicine. And sometimes the man would like to ejaculate slowly, but other times – for example after the partner is satisfied – he would like to hasten the ejaculation, but wouldn’t be able to due to the effect of the drug.”

Unfortunately there is as yet no medicine which is indicated to premature ejaculation with no side effects”.

You can find out more about Dr. Zuckerman’s work at Between Us Clinic.