my case of PE

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,

Welcome to PC hppd. I realize your case isn't the typical kind of PE due the other disorders. I'll leave you a couple links and you can sift through what might be helpful to you. One thing you should practice a few times daily are Kegel Exercises and delaying ejaculation - there are methods you can try for that. Hope this gets better for you soon.

Premature ejaculation: Treatments and drugs - MayoClinic.com

4 Ways to Stop Premature Ejaculation - wikiHow

You mentioned "leaking semen" with your first girlfriend. It could be "pre-cum" a natural lubricant some guys, not all (and some women) produce. Is it possible that in and of itself psychologically made you feel you had PE problems, and it went from there due to performance anxiety?

Just a thought. Best of luck to you, I'm sure that would be a very frustrating problem. Maybe a sex therapist could help, too.

Thanks for your response guys.

Cheers for the links, I will look through. As mentioned I have practice delayed ejaculation for a while and have got good at it. I could do Kegels, I used to for a while, but I really believe this problem needs to be solved from the top down, it's a (psycho)neurological issue.. just building up muscles in the penis isn't solving the conditioned response of sexual hyper-arousal on being close to/thinking about a woman.. that's what I'd like to resolve.

Yes I am sure that's what it is (pre-cum). Thanks for your analysis, could be, but I don't think that is the case, because I had three years of sex where I was able to cum when I wanted, hours if I wanted to. All the while sometimes/most of the time this leak would be there.. I just accepted it. As mentioned, I don't really have performance anxiety.

I will stress why I do not believe my case is an (conscious) anxiety problem. The response can be so rapid that conscious anxiety doesn't have time to process before the arousal of the penis. I mean, for example, when I am happily day-dreaming about a girl I like, and then I realise my penis is aroused.. where is the anxiety? There's certainly not any conscious anxiety as with many PE cases i.e. I am trying to distinguish that I don't have performance anxiety in the sense that things start happening with a girl and my brain's thinking 'you're gonna cum, you're gonna cum' and then you self fulfill your anxiety, it's not like that.

I accept that the anxiety circuit might be involved involuntary/unconsciously. This would make sense because HPPD involves this circuitry.

You're welcome for the links and I'm assuming you're under a new username? yes I know just strengthening the muscles won't solve the problem but your case is unique so I didn't want to emphasize the traditional med route. Hopefully that new med will help with the hyper-arousal. Usually a man with PE is told not to think about sex to calm down the arousal but you said that's not the problem. Its good you're being honest with your doctor and try not to worry or anticipate failure because this makes it worse obviously. Hopefully this will get better soon. The exercises will help any man to have more control. Best of luck.

Oh weird, must be an old account or something.

Fair enough, what is usually the traditional med route, SSRI's?

Indeed, they will of course be beneficial!

Many thanks