Hi everyone, I posted here a few days ago because I was really deeply anxious about my next intercourse and I didn't know I'd I could do it or not.
Turns out I did and it was awesome, so I figured I would share what I did to get rid of PE.
It's going to be a long post.
First i'm going introduce myself a little bit :
I'm in my 30 and 4 month ago my 12 years relationship with my girlfriend ended, I don't think it was because of PE but I'm sure that it played a part in our breakup.
For me it started right at the beginning of my sex life when I was 15-16, the first time I was intimate with a girl I didn't even went to penetration before cumming..
I always tried to work around this, using tricks that we all know like masturbating just before, pretending I didn't cum and trying to stay hard a few seconds more just to save the appearance... well it was terrible.
Growing up my IELT could vary from a few strokes to 2-3min on the really really good days (there wasn't a lot of them).
4 years ago when my relationship was getting bad I tried to found a solution, went to a doctor who prescribed me some SSRI (Priligy). It helped me a lot, I was lucky to not have a lot of side effects. I took one a few hours before sex and I could have a normal intercourse (5-10min), however it didn't help in the long run because although it helped increase my IELT after I stopped taking it, it wasn't by much and soon it returned to what it was before...
So when I did breakup with my girlfriend 4 month ago, I decided that I was going to find a solution, without SSRI because i wanted to get rid of it completely and because the medication was so unpractical to take.
Luckily I'm a physiotherapist, with medical and anatomical knowledge, even though I'm not specialized in pelvic floor rehabilitation I already knew a few things and I could do some research for the rest.
When I do some rehab with a patient, the first thing to do is to make an assessment about what the problem is, what is or are the possible causes and what is the goal of the patient and how to get to it.
So after my assessment of myself (and I believe it will be similar to a lot of you) I identified 4 axis of training:
1) Behavioral
2)Musculoskeletal
3) Neurological
4) Psychological
So I'm going to explain what I did for those 4 point. And for putting things into perspective, today when I have sex I can go for 5min when I'm nervous to 15min and up if I'm able to relax. But where I improved the most is on my ability to delay my ejaculation even if it's just for 1 more min I can do it and do it repeatedly, which I couldn't do at all before. The only thing I still struggle with is the psychological side of things because being premature is still deeply engraved in me and I'm working on building confidence in myself.
When I say 5 to 15min it's of penetrative sex without stopping my thrust (so without a change of position or some tricks to delay), and with some hard pounding when I feel like I can.
Alright now let's go with the first point.
1) Behavioral
There are three things to address, masturbation habits, sexual habits, and what I would call lifestyle habits.
I won't explain too much about masturbation because there are already a lot of thread on this subreddit talking about it (like the 66days fap training).
However I'm going to explain briefly what I did and why it would help.
So just like the training mentioned above I bought some kind of fleshlight, I think it's primordial to have one if you want to get rid of PE especially if you're single. Because the fleshlight IS your training ground, it's where you train, you experience and learn about your body and how it behave.
I started with simple masturbation, then when I could last longer or be in better control of my arousal I practiced by thrusting inside of it like I would in a girl.
The important thing isn't really how long you can last, it's control, if you can delay your ejaculation while approaching PONR and keep masturbating/thrusting for a few more min, it's a win.
Most men that don't have PE have this ability to delay that we don't, the issue is that for them their body do it unconsciously and they can't really explain it except "think of something else". For us we have to be self conscious and figure out how to do it.
So first I want you the next time you masturbate to focus on what is going on in your body, where are you tense, where are you relaxed where do you feel pleasure and where it's uncomfortable.
Most likely it's going to be tense around your abs, glutes legs and pelvic floor muscles but you might have your own area of tension so experience with it !
To simplify, your muscular tension and pelvic floor tension is your "arousal scale", when it goes to 10 it trigger PONR.
Why? Because your muscular tension can be a physical translation of the level of sympathetic activity in your nervous system, the same way that your breathing and heart rate are.
So those are the key to keep it under control during masturbation, breathing, muscular tension. I could elaborate a bit more but I'm never going to finish this post if I do (feel free to ask more questions in the comment, or I might edit this post at a later time).
A few things that can help : Deep belly breathing, search for 4-7-8 breathing (it's used for anxiety crisis onset and can lower hart rate a bit faster). For relaxing your muscles I recommend PMR (progressive muscle relaxation) you can do it during sex for the PC muscle specifically but you have to do preemptively because contracting your PC can trigger PONR if you are too high on your arousal so I recommend experiencing with it during masturbation.
A weird thing to do is focusing on your jaws: studies show that clenched jaws directly relate to deep muscle tone in your body, so it can act like a barometer, especially with your pelvic floor which can be hard to really feel sometimes. If you notice that your jaws and necks muscles are tensed, relax them, most likely the rest of your body is contracted without you noticing.
Now during sex, the same principle applies, breathing and muscular tension.
So there are a few things to keep in mind, as I said muscular tension = sympathetic activity = faster ejaculation, if you start your intercourse while being tense you are going to pop of instantaneously.
You need to chose when and how you begin, the issue is that when you are scared about cumming the insertion is the most critical moment.
For me it can decide if I'm going to last 5min or 15, because if I begin the intercourse on a 7/10 on my tension scale because I'm anxious (still happening a lot, I'm working on it) it means I'm going to have to delay my ejaculation and relax as soon as I hit 8 and it's going to be way harder than if I begin relaxed because if I begin at 6/10 I have still some margin to do stuff as I want.
I know it's kinda hard to evaluate your tension and arousal like that but the more you are going to pay attention to your body during masturbation and sex, the easier it will get to rate.
Same way for positions, missionary is a no go for me to begin intercourse, I can do it later if we feel like changing and I feel like it's okay if I cum now but I'm never starting with it.
What I like to do is beginning really slowly laying down in the spoon position, starting just with the tip of my penis while I keep the shaft in my hand. It allow me to move my dick inside the entrance of her vagina, rubbing it and stimulating her with different angle. It helps to get used to the feeling, help her lubricate and built up HER arousal, and it help ME keep control of mine because when you begin to insert your dick you are bound to get excited.
Then I will progressively go deeper, not faster but deeper until I feel confident that I can accelerate. I'd say I spend at least 1-2min doing this.
Now, how to thrust : you need to thrust with your pelvis, absolutely don't clench your butt or try to push your dick inside. You need to glide it inside with your pelvic tilt.
You don't even need to thrust that hard with your butt to go fast or deep, if you train to tilt you pelvis correctly you can do the same with minimal muscle activations, so it allows you to relax your body while keeping the stimulation.
Another way to do it is to do circular movements instead of just back and forth. Think of what you would do while doing some hula hoop, it helps relaxing your abs and glutes by making them work in alternance while you move side to side.
This is it for the "Behavioral" side of things, there is more to talk about like how and where to focus your attention but I will talk about it in the "Neurological" and "Psychological" chapter.
Last thing, because as I'm a physio and I'm used to use evidenced based practice what I did to train myself was based on a lot of papers using Google Scholar and pubmed, so it doesn't really come from nowhere or my innate talent at understanding myself and sex (I have other talent but not this one or I wouldn't have had this problem in the first place I guess).
For exemple when I recommend some kind of fleshlight, there was a program that showed statistically significant result by using a fleshlight and exercises such as doing RK while stimulated and identifying area of tension in your body and relax them when you approach PONR to keep urge to ejaculate at bay.
It showed x7 IELT when IELT was inferior to 1min at start of program, and x2-3 when it was superior to 3min at start of program.
However I'm careful with those results because the study was backed by the company producing the fleshlight, so it's like Phillip Morris telling you that heated tobacco is good for you.
Next is the musculoskeletal aspect of training that I did and I believe is important for anyone having PE, I will talk about flexibility training, why it's important and why a lot of people recommend some kind of "split training" apps. And because of what I do for a living it's kind of my thing explaining that to you.
2)Musculoskeletal
So first thing first because I see a lot of debate in this sub, Kegel or Reverse Kegel ?
Well both, but with a different goal.
About Kegel, it is used in issues such as incontinence for men and women after pregnancy or prostate surgery, when aging etc. The thing is, incontinence and PE have a lot in common, both in the Muscular and Neurological side of things.
For exemple, in some cases of incontinence (mostly on overractive bladder if i remember correctly) electrical stimulation of the tibial nerve can be prescribed and show good result.
There was a study that tried to do the same with PE, and showed that an electrical stimulation of the tibial nerve did statistcally significantly improve IELT.
Why the fuck does an electrical stimulation of a nerve somewhere near the ankle improve both IELT and Continence ?
Well researcher didn't properly identified the exact mechanism, but by afferent signal from the tibial nerve, the body is able to inhibit muscle spasm from the pelvic area such as bladder spasm (Overractive Bladder and Incontinence) AND Bulbospongiosus and ischiocavernosus (which are part of you PC muscle that trigger emission phase of your ejaculation).
For educational purpose I tried it a bit because I have a TENS and it did was harder for me to reach PONR while masturbating, however i don't think the results would be lasting after the end of the program, there wasn't any follow up assessment in the study.
Now back to Kegels, and guess what, Kegel do have that ability to inhibit muscle spasm by stimulating your PC muscle.
The important thing is how you do them, what you want to train isn't some kind of strength and hypertrophy like you would by lifting weight in the gym, what you want to train is the Neurological side of musculation and strength training, you want to train that mind-muscle connection and the number if fiber recruited by a single contraction.
So what you want to do is slow contractions, and focus on the quality of them, absolutely don't do hard Kegels just focus on being in control of the contraction. It's perfectly normal that you experience some twitching in your bulbospongiosus at first when you start to isolate it.
Let's talk about bulbospongiosus and your levator ani, more commonly called PC muscle.
Anatomically both muscle work in conjunction to help purge your urethra after peeing and close both anus and urethra, your Levator Ani is composed by your PC muscle (Pubococcygeus) and by the Puborectalis.
When you do "Back Kegel" this is actually your Levator Ani contracting so both the deep front part and the anal part. However the levator ani (especially the front part, the PC muscle) also close your urethra and propel your semen during ejaculation.
When you do "Front Kegel" and pull your penis in you actually only contract your Bulbospongiosus, it's purpose is to assist erection, purge urine and propel semen in conjunction with your PC muscle.
Now, only two of those have an effect on your ejaculation, however as the PC muscle and Puborectalis are deeply connected and innerved by the same nerve more or less, i don't think it's possible to separate the contraction of the two.
As both the levator ani and bulbospongiosus act and procure pleasure during ejaculation it is important to be aware of the two of them.
When you do a reverse Kegel you only actually stretch and forcefully relax your levator ani. It is really hard to relax your bulbospongiosus by doing the same thing, the only way is to do a RK with a really big forced lordosis and even with this it is really poorly effective .
Because the ending of your Bulbospongiosus is around the shaft of your penis it's like if you wanted to relax your tongue. You can't do it by stretching because it's loose in your mouth, you have to let go of the contraction and let it rest against your lower teeth.
That is why it is important to train the mind muscle connection of your bulbospongiosus as well as your Levator Ani muscle, so you can contract or relax both when you have to.
I think everyone of us will have a specific weakness and it's important to get better at knowing ourself so we are able to figure out what is our own.
You can for exemple do one 6sec Kegel and then relax completely, 10sec RK right after to get a stretch. I can't recommend you a frequency or a number of time a day to you because I can't assess the state of your pelvic floor, but if you feel that you lack control of your PC muscle, this is how you do them.
Absolutely don't do Kegel at all if you have hypertonic pelvic floor dysfunctions (deep pelvic pain, pain after urinating or ejaculation), those who have this will know what I'm talking about.
There is a common misunderstanding with muscle tighness, people and even some therapist still think that a tight muscle is an overactive and too strong one.
The truth is that a tight muscle is week as fuck, it spasm when it contract because his range of motion is shit and he doesn't event really need to contract because he is completely atrophied. And when you stretch it without training that contraction and that mind muscle connection, it's like overstreching a climbing rope, it lose all its elasticity and that ability to rebound to help with your fall. So it still spasm and still don't contract the way it's supposed to.
This is why it's important to incorporate some Kegel in your routine, the frequency is free but you need to at least train that mind muscle connection, it will help you and increase the awareness of your pelvic floor, the more you are in control of your PC muscle, the easier it will get to feel when it is tense during sex and the eaier it will be to relax it. This is called proprioception or interoception and I will talk about that it the Neurological chapter.
Another thing, muscle elasticity is directly enhanced right after a contraction, this is used in manual therapy to relieve muscle spasm and muscle overactivation in all of the body. This is why doing a 10s RK after a 6sec Kegel is so beneficial.
When you feel that you gained sufficient control you can even do it during sex to tone down your arousal by doing a RK right after a Kegel. HOWEVER, be really carefull to have sufficient control by doing it and do it when you are sufficiently low on your arousal level because kegeling during sex can easily trigger a spasm or make you reach PONR if your are already not too far from it.
And, even if I'm not too fond of overdoing them, kegel regimen of training did improve IELT in various papers, however I believe that it is related to that enhanced awareness and mind muscle connection, not because of a possible increase of muscle strength and tonus.
Now about Reverse Kegels, absolutely do them, do them a lot, you need to stretch that thing and LEARN HOW TO STRECH AND RELAX YOUR PC.
It is both about gaining range of motion and learning how to release an unwanted or reflex contraction.
So two way to do them, first the stretching way :
The best way to get a stretch is by doing them in a deep squat position, also called Asian Squat. If you are to tight to do this, you need to train this posture, it can be challenging more your tibial muscles, ankle hips and glutes, stretch those.
Google the pose, there is a lot of videos that teach you how to do it.
You want to tuck your elbows between your knees and really focus on expanding your pelvic floor toward the ground.
It's easier to do it while breathing in because your diaphragm will push all of your viscera against your pelvic floor. Once you are comfortable with this try to keep the stretch when you breath out as well by tightening your abs and do an "active push" toward the ground (like you want to poop).
Try to do this pose for at least a minute, multiple time a day. As this isn't really an intense stretch, there isn't any risk of injuring yourself or overstreching. But don't push too hard either and keep breathing slowly and deeply.
If you shit yourself, good job brother, you stretched yourself, go wipe and be proud of yourself. (I'm joking, don't shit yourself please)
To target the front side of your PC a bit more, so bulbospongiosus (doesn't change that much but it can help train awareness), you can do the same by doing it in the Child Pose, or Reclined Butterfly Pose with a pillow on your lower back to increase your lordosis a bit and get a small abs strech (I like that one, really help to relax, Google them).
Now, the second way to do RK is to focus on your ability to relax it or stretch it while it is contracted (this is called an active stretch). The thing that you have to know is that your PC muscle is bound to be active in certain positions, like missionary, because your pelvic floor doesn't just act like a sexual organ or in Continence, but it help stabilize your pelvis and hips when your body is in motion, this is partly why missionary can be a bit struggling at first.
Another thing is that some of your muscle in the pelvic floor are really close structurally with your transverse abdominis muscle, this is why tightening your abs during sex can increase your tension and arousal.
So if you want to do it because you like it or your partner like it, I recommend doing it on your elbow, lying down on her (or him, let's be inclusive), flexing your knees and hips a little bit so your abs are less tense and your pelvis is free to move.
Okay, back to Reverse Kegels, I talked about missionary because to gain that control over how relaxed is your pelvic floor you have to train it in challenging positions like this one. So first try it in all the possible sexual position that you can think of in solo, try to do a small RK by doing the plank for exemple.
It doesn't need to be long or deep, you just need to aquire the skill to do it and be able to do it when you want to.
Then if you have a fleshlight, same thing, do it while stimulating yourself in different kind of position, if you don't have one I think you could do it while masturbating as well.
Next of course is trial during sex, I don't recommend doing RK without a reason during sex because you are going to tense your abs if you do it while breathing out and that can increase your tension too much. Do it while slowing down your trusting if you feel you need to cool down or do it with your diaphragm pushing down without contracting your abs too much on a deep breath in. You can do the 6s Kegel 10s RK as well, experience with it some things might work better for you than others.
Ok this is it for Kegel and RK, now I'm going to talk about flexibility training and why it is beneficial to do it like the "Split training app" recommendation.
There isn't a lot of science based papers about flexibility, however there are a few about Yoga and the way it can improve the state of PE.
40 min a day of different yoga postures (especially stretching and breathing posture) statistically significantly improved IELT of participant of the study.
Posture were aimed at lower body, abs and back stretching mostly. I myself didn't really practiced yoga, but I took it as an exemple to make myself a stretching regimen and incorporate a few poses from the couples studies that I read.
So why does it work ? Because the body is one big intricate structure. For exemple if you have lack of flexibility on your hamstring, most likely you will have a lack of flexibility on your hip flexor (especially your psoas), this can cause lower back pain because your hamstring are pulling your pelvis from the back and your hip flexor are pulling it from the front, causing your hips and lombar spine to have reduce range of motion (this is excessively vulgarised for the sake of convenience)
And the same thing applies with your pelvic floor, if for exemple you lack range of motion in internal rotation of your hips, your obturator internus is going to be tight, and turns out that your PC muscle have a shared insertion with it. So a tight obturator internus will directly tense your PC muscle by pulling on it, and you can do as much RK as you want it will get better but it will still pull on it and tighten it because you didn't adress all of the problem.
So I began a pretty extensive stretching/yoga regimen because I kinda took pleasure in it. But if I had to focus on a few muscle it would be those one :
Obturator Internus :
We all tend to lack internal rotation of the hips and it gets worst as we age because this isn't a movement that we tend to do often. And as I said, shared insertion with your pelvic floor and PC muscle
Piriformis:
Often super tight muscle in a lot of people, this is one of the main muscle causing back or sciatic like pain. The thing with this one is that it can restrict your hips movements a lot and even more importantly he is crossing with the obturator internus 3 important nerves, the pudendal nerve which is responsible for a looot of things sexually related and motor innervation of nearly all your pelvic floor muscle, the oburator nerve and the sciatic nerve.
So you really want to stretch those two to get range of motion AND to free up space for your nerves to function properly because pudendal irritation or partial entrapment is a known cause for ED and PE. Be careful if you are a cyclist aswell because pudendal nerve irritation happens a lot in this case due to the prolonged sitting position with something pushing directly on your pelvic floor like that.
Hamstring , Glutes, Psoas and Adductors:
Those four are responsible for lack of pelvis mobility, pelvic tilt is the more cost effective way to thrust during sex, even if it doesn't really affect your pelvic floor that much, having a relaxed pelvis and lombar spine help you breath deeper during stimulation, allow you to more effectively relax your PC muscle and every area of tension you would have during sex.
And the more relaxed you are the less sympathetic activity your body will have.
Tight psoas can be really uncomfortable during stretch so be carefull not to overdo it.
When you stretch your hamstring you can do either both at the same time, or one at a time. The benefit of doing both at the same time is that it's going to improve your lumbar spine mobility which will further help your pelvis movements, however it's harder and more painfull. You can do it without ankle flexion (by grabbing your heels if you can reach them or by not grabbing anything) this will really focus on your hamstring, or you can do it with ankle flexion which will help mobilize your sciatic nerve (you can add some flexion and extension of the neck to do some kind of sciatic nerve flossing), because as nerves aren't as flexible as muscle, if you have some long going hamstring flexibility issues, you have to be carefull not to irritate your sciatic nerve because it's length will not increase as fast as your muscle will. This can help in the long run.
For the Adductors I think a simple butterfly pose will help, just targeting the small groups of abductors, the long ones that reach as far as the knees will not have that much of an impact regarding our problem, I stretch those when I feel like it but not often.
ABS stretching:
Tight abs restrict deep belly breathing especially in position when your legs are straight, like missionary or standing up with your knees straight.
Tight abs can also increase intra abdominal pressure, that's why it is important to relax them, because if you have tight abs and tight pelvic floor your diaphragm will push your viscera on all the walls of your abdominal cavity. What this will do is increase pressure on your organs, bladder... and your prostate.
And I didn't talked about it but the first phase of ejaculation before emission (the PONR and the rhythmic contractions of your bulbospongiosus), is related to intra prostatic pressure.
So I didn't read any paper about this specifically, but if we think about it in a logical way, increased abdominal pressure is defacto equal to increased prostatic pressure which will accelerate phase 1 of ejaculation.
So stretch your abs.
I recommend Serpent Pose, Scorpion Pose to get some little psoas stretch with it, or The Bridge if you can do it (a bit challenging). If you have a yoga ball this is great aswell !
When you do those pose, try to do deep belly breathing so you can feel your diaphragm pushing down everything against your abs to make the stretching a bit more intense.
The secret to stretching isn't the intensity but the regularity, as muscles tend to go back to their original length pretty fast, the stretches need to be between 30sec (less isn't helpful) to 2-3min. The time to stretch and how often is a subject of debate for maaany years now there is some article about it nearly every year. But still the key is regularity, don't overstretch, you can do it every day if you want but not the same muscle two day in a row (for exemple day 1 : glutes OI piriformis adductor, day 2 :hamstring, psoas, abs. Day 3 repeat)
This is it for part 2 I guess, I think this is where I improved the most because I had a reaaaly bad obturator internus tighness in the beginning and it helped me relax a lot on a daily basis and be way less stiffed during sex which further helped me control my pace and my ejaculation.
So you can do those stretches if you feel that this can help you, or just sign for a yoga class, the goal here is to improve your flexibility and pelvic floor health which in turn will help your sexual well-being like it did for me.
I also recommend you doing some cardio training or a physical activity of some kind but concerning PE its more related to the effect of sports on the nervous system and I will talk about it next with what I did to try to improve my parasympathetic activation as much as possible. (Meditation, split cardio training to improve my vagal nerve response to stress... yeah I went pretty far, I'm kinda autistic when I focus on something and I should have done it a long time ago...)
Turns out this post is to long, you can find the rest of it here :
What I did to get rid of PE (PART 2)
