Dealing with Premature Ejaculation & Causes of Premature Ejaculation (from The Ultimate Guide To Male Enhancement)

Dealing with Premature Ejaculation & Causes of Premature Ejaculation

The following are two chapters taken from the book: The Ultimate Guide To Male Enhancement.

Edited for content

Chapter 12: Dealing with Premature Ejaculation

What is Premature Ejaculation?

The definition of what constitutes premature ejaculation may vary depending on the source, but it’s commonly accepted as a scenario where the length of time for sexual performance on the part of the male is unsatisfactory, by either the man or his partner. That being said, what constitutes premature ejaculation can be arbitrary. There is no set time that if you orgasm before it then you have premature ejaculation.

Consider this – the average time between arousal and ejaculation is typically three minutes for a man. Considering the
average time for a woman to orgasm is typically 13 minutes after arousal it can be seen how many men may think they have premature ejaculation, but really they are simply normal. With this in mind, you can see why foreplay is so important to satisfying a woman.

Phases of Ejaculation

There are two phases of ejaculation.

● The Emission Phase and
● The Ejaculatory Phase

Emission Phase:

Here are the physical processes which occur during the emission phase of ejaculation:

● The vas deferens begins to contract to move sperm from the testes toward the urethra and prostate gland.
● The seminal vesicles secrete fluids into the urethra
● Chemical messages activate the sympathetic nervous system and begin what’s known as the ‘point of no return’
(PONR). Ejaculation is inevitable at this point.

Ejaculatory Phase:

During the ejaculatory phase, the posterior portion of the urethra senses the sperm and secretions and sends a signal
to the spinal cord. This then sends messages to the muscles at the base of your penis. This causes said muscles to contract, which results in ejaculation.

Chapter 13: Causes of Premature Ejaculation

Premature ejaculation can be caused by any number of factors. These can be separated into two categories:

● Physical (which can include chemical side effects) and
● Mental (or psychological) causes.

It’s not uncommon for both some mental component to be present in physical cases of premature ejaculation. Worry
about the experience of premature ejaculation often compounds any physical components.

Physical Premature Ejaculation

The most common form of premature ejaculation is due to physical causes. The most common among these is negative conditioning. This is usually because most men masturbate in a hurried and furtive manner. Doing this repeatedly trains the body into ejaculating quickly, so it shouldn’t be surprising to understand how this can lead to issues.

If added stimuli like porn is used, it can further skew what you can expect from real sexual encounters. This then adds to anxiety, which further increases the possibility of premature ejaculation. The easiest way to correct this is to train in a manner contrary to negative conditioning. This will be discussed in detail further in the section.

Hormonal Issues

If you have low testosterone or abnormal levels of catabolic hormones this can have a drastic effect on your ability to maintain an erection. This can turn into premature ejaculation if you have to strive to get erect. It can be further compounded if your hormone imbalances induce negative emotions like anxiety. Diet and exercise is often recommended as a treatment for issues related to hormone imbalances; however, if do-it-yourself treatments aren’t effective, then a full blood work up is necessary to determine the cause of these imbalances.

Chronic and/or acute stress can lower levels of dopamine in the system. This can create a scenario where you can find it difficult just to get aroused even in the absence of anxiety. Stress management is key to helping treat this issue. The amino acid L-Tyrosine has been shown to be effective at helping to restore natural dopamine levels.

Infections

It’s been shown infections of the prostate and urethra may contribute to premature ejaculation. Infections usually require medical attention and antibiotics for treatment.

Pelvic Floor Issues

Pelvic floor spasms may contribute to premature ejaculation. If these symptoms are minor, rest and targeted stretching of the area should help to alleviate the issue. If the problem is more severe, this might require the services of a physical therapist for relief.

A strain in the pelvic floor may cause pain upon Kegeling and symptoms such as “hard flaccid”. Certain muscles like the ischiocavernosus can become perpetually strained. This leads to a difficult to resolve issue, as these muscles are involved in many different bodily functions. Due to this, it’s not easy to allow them to recover as you would if you immobilized an arm or even a leg. A strain may require targeted massage and heat. Specific yoga poses which specifically target the pelvic floor may help to speed healing as well.

A common cause of pelvic floor issues is due to abusing the Kegel. This includes the Reverse Kegel (contractile) exercise. It’s vital you start Kegeling by using only as much contractile force as is needed during any of the Kegel type movements. A limited number of reps should be performed as well and then slowly increased each session.

Prescription Medications

Some prescription drugs may cause premature ejaculation as one of their side effects. If this is the case, contact your physician or pharmacist to see if there are alternative medications.

Mental Premature Ejaculation

Premature ejaculation may be placed on the spectrum of erectile dysfunction, especially if the case is so severe that penetration becomes difficult or impossible. This is often the case if performance anxiety is involve. A common scenario will involve difficulty in obtaining an erection, with almost immediate ejaculation upon or even before penetration. This stage most commonly precedes impotence.

Anxiety, depression and stress are three of the leading mental causes of premature ejaculation. Sometimes, it’s a matter
of which came first though – the chicken or the egg – the premature ejaculation or the anxiety/depression/stress. It’s
not uncommon for men to suffer from these three common challenges without even realizing. It’s even more common for these challenges to surface, when there’s a concern about premature ejaculation.

The Ultimate Guide to Male Enhancement

A Doctor with Hard Flaccid – Updates and Advice

A Doctor with Hard Flaccid – Updates and Advice

by Romero MD

Original post: A Doctor with Hard Flaccid – Updates and Advice

Hi everyone I am 26 years old and I recently developed this mythical problem called Hard Flaccid.
I am a medical doctor. I finished medical school a few months ago, and I am currently applying for Obstetrics-Gynecology.

First, my story. I have been practicing PE, intermittently, for the past 4-5 years. Basically, only manual stretches (I am satisfied with my girth), but, like many others, I think my injury was caused by Edging and excessive Kegeling, which I have been practicing for over 10 years, for stamina training and erection quality.

And without knowing the extreme importance of Reverse Kegeling. Every time I have sex, I also do intense kegels, in order to last 60-90 minutes of penetration. I know, I know… maybe it’s a little too much… But my girlfriend and I have always liked long love sessions Almost 2 months ago, while I was having sex with my girlfriend, I started to lose my erection suddenly, after performing an intense Kegel, during a sex position that placed my penis at a downward angle (so, I did a “very weighted Kegel”).

I thought I might have torn a muscle or ligament, and we stopped at that moment. The next day, I woke up with a hyper contracted and cold penis. As it didn’t seem to be a penile fracture, nor did I have any skin lesions, hemorrhages or bruises, I decided to simply rest. Because I thought that any fellow urologist would tell me to simply do the same – to rest.

After two weeks of online research, I discovered my diagnosis – Hard Flaccid/CPPS. However, I only have/had symptoms related to the anterior/superficial pelvic floor (Ischiocavernosus and Bulbocavernosus Muscles). I don’t have pelvic pain, difficulty passing stools or other posterior/deep pelvic floor symptoms. But I have/had:

– Sudden erectile dysfunction (9-10/10 to 4/10)
– Sudden premature ejaculation (90min to 3-5min)
– Hyper contracted penis (Hard Flaccid). Which improves sitting, lying down, with Reverse Kegels and with heat; and worsens standing, with physical activity, with Kegels and with Involuntary Kegels
– Cold and soft glans (sometimes scrotum and penis too)
– Mild urinary retention
– Loss of morning and spontaneous erections
– Slight bend of the penis to the left, from the base of the shaft. (IC injury?)
– Slight downward curvature of the penis, from the middle of the penis (BC injury?)
– And a slight twist of the entire shaft, clockwise (IC injury?)

The next day, I visited the Urology Department at my hospital. I was observed by 4 urologists. As expected, none of them had ever heard of Hard Flaccid… After explaining the whole story, situation and symptoms, I was medicated with:

– Ibuprofen (anti-inflammatory), for 7 days
– Cyclobenzaprine (muscle relaxant), for 30 days
– Tamsulosin (alpha blocker, to decrease all sympathetic nervous activity, stressful or non-stressful, to the pelvic floor), for 30 days
– Total sexual abstinence (masturbation and sex), for 30 days, which I was already doing for 2 weeks.
After these 30 days, I will have an appointment with one of the best Andrologist in my country, which will be on August 27

So, after 3 weeks, I have been doing a lot of research (books, websites, forums) … And, according to my symptoms, I am almost sure that I had/have a strain of the Left IC Muscle (and maybe the Left and/or Right BC), which is, consequently, contracting the anterior/superficial pelvic floor and the penile smooth muscle (giving rise to the Hard Flaccid and the shortening of the penis, while it is erect) and, consequently, compressing the pudendal nerve, dorsal nerve and pudendal arteries, giving rise to all the other symptoms.

And that’s why REVERSE KEGELS are so important for the progressive relief of all the symptoms.

Treatments. What I have done to recover:
– Ibuprofen, Cyclobenzaprine, Tamsulosin
– Extraordinary healthy eating (Proteins, vegetables and fruits. Very important in the recovery of any injury) and supplementation (Ginkgo Biloba, Ginseng, L-Arginine, Fish Oils, Vitamins E, D, C, B complex and Zinc)
– No masturbation, no sex, NO PORN. And no pictures, no Instagram girls, nothing. Just hugs and kisses from the girlfriend. (Alright… We make love, but only with my hands and mouth. I don’t let her touch my penis… I was in this hardmode for 4 weeks. In the last week, I have been trying very light Edging (5 minutes of very light massage, very soft touches, always with REVERSE KEGEL), every other day, to give a little physiotherapeutic stimulation to the tissues. But without ejaculation (to avoid the Involuntary Kegels associated with orgasm, to keep my libido high and to increase the likelihood of spontaneous erections)

– Lots of REVERSE KEGELS/Front Reverse Kegels, throughout the day.
– Very light and Soft Squeezes (“massages”) of the flaccid penis, while Reverse Kegeling, to help relax tissues, throughout the day.
– Belly Breath Combos, Hindi Squats and Happy Baby, along with Reverse Kegeling.
– Light external massages, on the anterior/superficial pelvic floor
– 1 hour of STRETCHING (flexibility training) every other day – Pelvic Floor, Hamstrings, Psoas, Piriformis, Quadriceps, Adductors and Abs. (All along with Reverse Kegeling and Belly Breaths). Again, hardmode – Static, Dynamic and Weighted Stretches. I’m literally training to do the front and side splits.

– HEAT. Heat relaxes muscles and dilates arteries, increasing blood flow and, consequently, relieving symptoms. I wear shorts, under my pants, during the day. When I get home, I wrap my lower body in a blanket and I use a hot rice sock sometimes. And I place a big and soft pillow under my buttocks, when I am sitting in my chair.

– Sleep. A lot. (Very important in the recovery of any injury)
– I am a very active person (running and weighted calisthenics), but I stopped this type of physical activity since the day of the injury (to avoid Involuntary Kegels). However, I am doing some bodyweight Squats and Hip Thrusts (along with Reverse Kegels) before stretching. I read somewhere that gluteal and posterior chain strength is also important.

– ABSOLUTELY NO STRESS (!!!). I have always been a very calm and peaceful person, in all situations of my life. But, after reading that Hard Flaccid was highly influenced by stress and anxiety, I am now completely in a “ZEN state with the Universe” Buddhist monk style.

Not only to avoid any nerve discharge from the Sympathetic Nervous System to the pelvic floor (and, consequently, Involuntary Kegeling, which prolongs the contraction of the pelvic floor muscles, which worsens the compression of nerves and arteries), but also to prevent the rise of Cortisol and Adrenaline and, consequently, the drop in testosterone levels. And (as many of you claim) this is absolutely essential.

I was a little stressed during the first week (before I knew the real diagnosis) and my penis was terrible… Hard Flaccid like a rock, with a loss of 1.5inches in BPFL. After knowing that I really have to relax completely, I immediately felt the first improvements in 3-4 days.

However, on the other hand, I am very convinced that I did a muscle strain, at least, of the Left IC. Those left curvature and left twist… Hmmm… On August 27, I will ask for an MRI. If the radiologist tells me it is normal, I will try to take the images to more doctors.

So… after almost 2 months, I have improved a lot – Now, I only have hard flaccid if I’m standing. A few times, I don’t even have it standing. It happens when I get up after doing Reverse Kegels for a few minutes (or sitting for a while in a more comfortable position) and continue to do Reverse Kegeling while I’m standing. This was impossible 1 month ago.
– The morning erections are progressively coming back
– 3 days ago, I’ve managed to have a 8-9/10 erection during the mini Edging sessions.
– However, I still have a slight bend to the left and the clockwise twist, during erection (I no longer have the downward curve), and I lost about 0.5 inches in BPEL…

1- Now, I would like to ask Pegym’s brightest minds and everyone in this group who is still recovering from Hard Flaccid, what are the most recent updates on this disease/symptom? Regarding physical treatment, exercises, medications and supplements. What am I missing? Where can I improve to speed up recovery?

2- I have been thinking about starting to do a small daily session of Kegels/Front Kegels/IC kegels… In order to give a physiotherapeutic stimulus, just like any other muscle injury. But I’m afraid it could get worse… What’s your opinion? (See post 26)

3- What do you think about adding very light and soft manual penile stretches? (along with Reverse Kegeling) I feel a lot of relief with the soft squeezes. But, in these, the applied force is perpendicular to the penis. I’m not sure if extra parallel force will be beneficial for the tissues. (See post 26)

4- Okay, the last question might be a little funny, but I think it might be relevant. I think I have an injury mostly on the left side. So, is it more advisable to rest the penis in the left groin or in the right groin? It tends to get softer on the right, but naturally falls to the left. (See post 26)

Thanks a lot for reading my story Best regards to the entire PEGym community
And thank you so much, for saving me during the past 2 months UPDATES: post 21, post 23 (stress management), post 26, post 29, post 63, post 66 (HF & Stretching)