Hi,I would like some advice on my case of premature ejaculation.

For one, it should be noted that I have a condition called HPPD (I can't post links, please look at the wiki for 'hallucinogen persisting perception disorder') which has caused the last few years of my life to be extremely debilitating. This is likely to be with me for a few more years. Basically due to that, my neuro-chemistry is all over the place and I suspect that the chemical imbalances have caused if not exaggerated my PE. I did not have PE before I got this disorder, but also around the time I got HPPD I also broke up from my first relationship of three years which was difficult and I sank into deep depression + substance abuse for about a year (I contracted HPPD at some point around here or after, my memory is quite bad so I'm not sure). It should be noted that there is cerebral disinhibition in HPPD patients (again, can't post link, google 'Stable quantitative EEG difference in post-LSD visual disorder by split-half analysis: evidence for disinhibition'). There is also a hyper-arousal of the sympathetic nervous system.

When I was sleeping with my first partner I did not have PE, I have always had a tendency to leak small amounts of seamen when engaging in sexual activity though. But I was able to sustain periods of intercourse for as long as I wanted with my first partner, and also with another 1-2 girls I slept with since my first girlfriend. Since then, and since my HPPD, I have had really bad PE (usually ejaculating on entry into the vagina or sometimes before). I never feel anxious or nervous when engaging in sex, I am very good at relaxing. So I do not think this is an anxiety problem (although many people with HPPD do have large anxiety issues, it's really not a concern of mine). It very much feels like my head is disconnected from my penis in these situations.. my head is focused and not even thinking about the penis/ejaculating, but down there it rages away..

I want to work out the mechanism that causes my case. At first I wondered if it was olfactory in root, but I realised that sometimes when thinking about a girl that I liked, my penis would feel aroused slightly. So simply [girl attracted to] -> [sex] is the quick and short-circuited mechanism.. but in more detail, what's going on here?

I have practiced masturbating more or less every day for the last few months and actually find it difficult to ejaculate before 10 minutes now. Before I had hardly any control.

Yet still, when I come close to a girl I like, I get an erection really easily and no amount of relaxation and breathing properly can stop it. I suspected histadelia, but a 50mg niacin flush only caused mild flushing.. so I am not so sure about that.

I used to watch porn when I was younger but no longer do.

I have had success with numbing lotions applied to the penis and intercourse after a few drinks, but I want a proper solution. It might be the case that I can only treat it medicinally. I am single and can't exactly practice conditioning myself to not having an aroused penis whenever I get near a girl I like.

Obviously treating things medicinally should be a last resort but that's the only way I can see it being treated, unless anyone has some ideas

I am trialing Guanfacine (prescribed for ADHD patients) for the hyper-arousal + cognitive deficits that come with HPPD. I am only a few days into treatment, this might help as it should contain the hyperarousal of my sympathetic nervous system. I will not consider SSRI treatment as this is not well tolerated by HPPD patients.

Look forward to any responses.

Cheers,