do you want to know how to last longer
in bed well i'm dr rena malek urologist
and pelvic vision and today i'm going to
answer exactly that question
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i want to thank promes at your one-stop
shop for sexual wellness for sponsoring
this video so before i get started i
want to explain how long do people
normally last in bed what's average so
if you've watched my last video on the
average duration of sex you know that
the average time that someone takes from
the beginning of vaginal penetration to
the end is about 5.7
minutes so that's average so if you're
doing that and you're comfortable with
it that's totally fine however when you
look at surveys where they ask people
how long they want sex to last it's
anywhere between 7 to 13 minutes today
we're going to talk about how to deal
with something called premature
ejaculation which will essentially help
you last longer in bed however before
you go down the rabbit hole or even
watch the rest of this video make sure
that's something that you and your
partner both want if you are both
completely satisfied with how long sex
lasts for you you do not need to do
anything or change anything you're doing
and also talk to your partner about what
kind of stimulation they want maybe it's
not just penetrative sex maybe they want
oral or manual or to bring some sex
tools into bed with you so make sure you
talk to them and find out other ways
that may be equally pleasurable or more
pleasurable than having longer
penetrative intercourse so when should
you consider using the tools in this
video to help you well in medicine when
ejaculation happens sooner than you or
your partner want we call that premature
ejaculation when you look at studies you
see that about 30 percent of men
struggle from premature ejaculation
however only nine percent actually go
see their doctor about it so how do we
define premature ejaculation well
there's three major components to it one
is having ejaculation within one to two
minutes of penetrative intercourse
number two the inability to delay
ejaculation in nearly all sexual
encounters and number three that this
should cause some negative personal
consequences like bother stress anxiety
things like that that are actually
causing you distress that's considered
primary premature ejaculation meaning
you've had that problem your entire life
sometimes people can get what's called
secondary or acquired premature
ejaculation and that's when you've
previously had normal ejaculatory
function meaning you've had a normal
duration of sex and all of a sudden you
start developing a shortened time to
ejaculation usually less than three
minutes after vaginal penetration and
this is something that may be
consistently seen after a certain time
period that's causing you bother and is
very different from the way you used to
ejaculate previously well there's
evidence to suggest that it's due to
abnormal transmission of a chemical
messenger in the brain called serotonin
when people have premature ejaculation
they have receptors that respond to
serotonin that happen to inhibit
ejaculation or stop ejaculation from
happening and these receptors don't work
as well also it's important to
understand how ejaculation happens
ejaculation is a reflex meaning that
your body automatically ejaculates in
response to certain things and in this
case it's usually friction as well as
how your brain is perceiving that
friction to feel i.e pleasurable this
reflex is organized by an area called
the spinal ejaculation center which is
located in the spinal cord so when you
have these stimulations it sends signals
to the spinal ejaculatory center which
takes that plus other information from
the brain as to what you're thinking
about the situation and it triggers the
ejaculatory reflex also if you want to
learn how semen is made and how it
actually gets forced out of the body
make sure you check out my video on how
semen is made ultimately premature
ejaculation is a super stressful problem
and when you look at data on this you
see that men have tried at least five or
more things before seeing their doctor
about premature ejaculation but when you
see your doctor are there certain tests
that they're going to do there's
actually no diagnostic testing that's
necessary in order to diagnose premature
ejaculation it's what we call a clinical
diagnosis meaning we'll talk to you
exactly about what's changed in your
ejaculation or how it's always been and
kind of understand a little bit about
what's going on and if it does fit in
the definition of occurring earlier than
usual and causing you bother or distress
then that's a reason to go ahead with
treatment so what treatment options are
available well number one is either
psychotherapy or sex therapy the reason
for this is things like depression
stress anxiety guilt can really impact
the time to ejaculation so it's
important to take into consideration how
your mind is perceiving
sexual activity with your partner fixing
these issues with the help of a
psychotherapist or sex therapist can be
extremely helpful as always i'll link
down a website which can help you find a
sex therapist near you people who do end
up seeing a psychotherapist or sex
therapist in addition to the next
treatment option have a eight times
increase in their time to ejaculation a
next treatment option is called the stop
start method and what this is is when
you're getting close to ejaculation your
partner squeezes your penis until the
erection partially goes away you do this
about three times until you finally
allow yourself to ejaculate do this
continuously three times a week until
you see that you've increased the time
to ejaculation sometimes seeing a pelvic
floor physical therapist in addition to
doing these treatments at home with your
partner can be even more helpful because
they can help you identify the muscles
that can potentially control ejaculation
as far as medical therapies the first
line therapy is topical anesthetics and
what these do they're numbing agents
that you put on the penis and what they
do is they actually diminish the
sensitivity of the gland's penis so
you're getting less sensory information
from the penis to the spinal ejaculatory
center hence inhibiting that reflex from
going the first option for topical
anesthetics is delay sprays these are
great because you can get them over the
counter without a prescription and my
favorite product is promescent it's the
only delay spray in the united states
available over the counter that's been
clinically studied and you can buy it
without a prescription their study was
led by dr kristin mark and the study
protocol was approved by the
institutional review board at the
university of kentucky in their study
they recruited 195 men through their
extensive network of people seeking to
have longer lasting intimacy 91 of those
men were sent a sample of the product
and asked to use it every other time
they had sex they also asked them to
fill out a daily electronic survey
before they started the study they had
to answer a bunch of questions about how
long it usually took them to ejaculate
as well as several validated
questionnaires or questionnaires that we
use in research to assess if someone has
premature ejaculation the question they
ask is how much time passes between the
start of penetration with your partner
to ejaculation at the beginning of the
study participants reported their
average time was about 6.5 minutes after
the study their time went up to about
11.5 minutes so clearly a longer time
after using the product interestingly
they also asked about the rate of orgasm
when using this product and what they
found was that the rate of orgasm of
both partners went from 44 to 66 after
using the product it's super easy to use
it uses a specialized metered dough
spray and what that means is that you
get the same dose with each and every
spray you start off with three sprays
for the glass of the penis at least five
minutes before sex and you can titrate
that dose from anywhere from one to ten
sprays per session until you get the
right duration of sex they use a
proprietary target zone formula now what
does that mean exactly well they have a
eutectic spray and what that is
essentially is two different substances
that are mixed together to make an oily
substance on their own they don't need
any other solution or what we call
solvent to dissolve the substance in
which means that you get a higher
concentration per spray and it works
faster that's why you can use it as
quickly as five minutes before sex and
you don't need to wash it off because it
starts getting absorbed so rapidly of
course if you are gonna use it for oral
sex make sure you wash it off before
your partner begins oral and the best
part is it has very little risk of
transferring to your partner so your
partner won't get any numbness after
you've used it promescent patented this
technology making them one if not the
best available options on the market
today if you're interested in trying it
out check out promescent at
www.promescent.com
rena for 15 off your entire purchase you
can get a whole host of sexual wellness
products here not only for you but your
partner as well condoms lubricants and
so much more you get free shipping over
ten dollars in the united states and it
arrives in discreet packaging so no one
needs to know what you're getting
especially if you've got those snoopy
neighbors your purchase is covered with
a 60-day money-back guarantee if you use
it and don't love it they'll give you
your money back there are also other
topical anesthetics available
particularly by prescription in the
united states you can get emla cream in
europe you can get fortacin emla is an
off-label cream so it's not approved
technically for premature ejaculation
also has two anesthetic or numbing
medications in it you apply it about 20
minutes before sex and you do need to
wash it off before use side effects for
this medication include some penile
numbness and sometimes a little bit of
irritation for our european viewers
fortassen is actually approved by the
european medical association for
premature ejaculation it also includes
two numbing agents that is made into a
again eutectic spray for use for
premature ejaculation because of that
it's also fast acting and can be used
within five minutes of sex but again
this does require a prescription from a
doctor to obtain moving on to our next
treatment option is antidepressant
medications
and you may be wondering why exactly
antidepressant medications but it's
because they all work on serotonin or
preventing the uptake of serotonin so
more of it's around to then work on
those receptors that are maybe not
responding as well so you can get more
of a delay before ejaculation certain
antidepressants called selective
serotonin reuptake inhibitors or ssris
are prescribed daily these are often
fluoxetine peroxide or sertraline these
are prescribed by your doctor off label
because they're not actually meant for
premature ejaculation but they have the
side effect of delaying ejaculation
typically if you take it daily you will
need about five to ten days after
starting the treatment before you notice
the difference and that may continue to
improve for up to two to three weeks
after you start the treatment you
usually start on a low dose and then try
trade your way up side effects include
fatigue or being tired having some
increased yawning nausea and some
diarrhea potentially or some increased
sweating but the most important and
bothersome side effect is sometimes
people notice a decrease in libido which
is clearly not desired if you're trying
to improve your ejaculatory latency time
or the time before you ejaculate usually
you'll notice these side effects early
on and they tend to disappear after
about two to three weeks but it is
something to look out for you can also
take certain medications on demand
meaning before sex the first on-demand
medication is called clomipramine and
what this is is it inhibits the uptake
of serotonin as well as another chemical
messenger called norepinephrine this is
taken about two to six hours before sex
and it also has shown significant
increase in ejaculatory latency time
similar side effects to ssris so you
need to be on the lookout for those
another medication is called depositing
which is not available in the united
states it is available in europe and
other countries around the world so
check if you do have it available to you
this one is shorter acting so you can
take it a little sooner before sex so
you don't have to take it six hours
before and it works quickly however many
people get frustrated when taking these
medications they may find that it's not
as efficacious as you thought it was
going to be meaning it doesn't work as
well or that they're spending a lot of
money or they're just frustrated that
they have to take a medication at all i
will say that if you are struggling with
erectile dysfunction or a difficulty
getting an erection that's firm enough
to penetrate your partner then you want
to treat that first with medications
like sildenafil or tadalafil and you can
check out my video to learn more about
those medications but typically treating
the erectile dysfunction also helps with
the premature ejaculation there's also
two other off-label therapies that are
used for premature ejaculation the first
one is called tramadol which which is
typically used for pain control and part
of the mechanism of the action is it
weakly inhibits the uptake of serotonin
it's used on demand meaning you take it
one to two hours before sex anywhere
between 20 and 100 milligrams
while studies have shown an improvement
in ejaculatory latency time the studies
were not really high quality and you do
need to know there are certain side
effects as because it is a pain
medication there is a small risk of
getting addicted to the pain medication
as well as fatigue nausea vomiting
dizziness or a headache the second off
label medication is an alpha blocker and
this medication is taken daily it's you
typically use for people who have an
enlarged prostate you may see
medications like this like tamsilosin
cylidosin and these medications
typically work by relaxing the prostate
tissue
to allow urination to flow better in the
study cylidosin was the most effective
of all the alpha blockers available but
again there are very few studies and a
common side effect with this medication
is having what we call retrograde
ejaculation so you may notice a decrease
in ejaculatory volume so the amount that
comes out when you ejaculate could
decrease on this medication hopefully
you guys found this video helpful as
always remember to take care of yourself
because you're worth it
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you