The most common men’s sexual health complaint I treat at my clinic is erectile dysfunction, followed closely by low sex drive. A less common, though perhaps equally frustrating and disruptive concern is premature ejaculation. In this article I will share what I’ve learned in my ten years of clinical herbal medicine practice about the factors that contribute to premature ejaculation, and what you can do about it —and I am not just going to tell you to do kegels and breathing exercises, like every other self-help article on the internet.
I’m going to share some things that you probably haven’t heard before, and that will help out a lot more than breathing and squeezing.
I highly recommend reading through to the end of this article; gaining an understanding of why your body is doing what it’s doing can greatly help inform the path forward to better sexual health.
That being said, if you are ready to jump right in and start working with me to improve your sexual function you can get started with treatment through my online herbal clinic. Our process is easy, fast, and discreet. Just take a few minutes to complete our online intake, and get customized herbal medicine delivered to your door. Interested? Check it out here.
First off, what is premature ejaculation? This is one of those medical diagnoses that I wish we had a better term for, but it’s also a tricky one to define. The medical definition of premature ejaculation is “ejaculating sooner than desired.” If you’re seeking the porn ideal of an invincible cock that thrusts non-stop for an hour, well then most men would fall into the category of premature ejaculation. Even if it only takes 10 seconds of stimulus to cause ejaculation, there isn’t technically anything “unhealthy” about this in Western medical thought because the biological goal of dispersing genes has been accomplished. However, ejaculation after a brief period of stimulus is generally less satisfying, the orgasm intensity is often less pleasurable, and it can lead to frustration and lack of satisfaction in your sexual partnership.
Premature ejaculation is a somewhat stigmatized term, and you may relate to it or you may not. You may just feel like a regular guy who just wants to last longer in bed. Sexual compatibility is complex chemistry, and you might find that lasting 5 minutes works great sometimes, and other times you need to last 20 minutes for everyone to be satisfied. Whether you feel like you're experiencing significant sexual dysfunction or you just want to improve function and ejaculation control, understanding the physiology of ejaculation and the tools we use to treat premature ejactulation will benefit you.
Getting the ideal sexual experience out of your penis can be a real Goldilocks-type scenario; you don’t want the porridge too hot or too cold —it’s gotta be just right.
Hot Tub Time Machine (2010) might not exactly be a classic film, but there’s a scene in it I think illustrates this aspect of the male sexual experience well. Rob Courdry as “Lou” and Clark Duke as “Jacob” find themselves in a situation in which a woman wants to have sex with both of them. She leaves the room for a moment and the older Lou coaches young Jacob: “You don’t want to seem overzealous with a full-on rager, but you don’t want to insult her either. You’re gonna wanna get at least a half-a-chub going.”
The demands on your Johnson can seem like a high bar at times. You want rock-hard boners, on-demand, and you want to finish at exactly the right time, also on demand.
When this issue is approached too simplistically, it can appear that these requirements are at odds with each other. A lot of the simplistic approaches out there will either turn up arousal - good for ED (erectile dysfunction) but bad for PE (premature ejaculation), or they will turn down arousal - good for PE, but bad for enjoyment and for ED.
Fortunately, when you understand all the factors contributing to premature ejaculation and take the right approach, you can actually improve both erection hardness and ejaculation control simultaneously.
Nervous Tension
Are you a guy that people might describe as “tense”, “anxious”, “inflexible”, “stressed”, "wound up”, “wired”, or “wound tighter than a two-dollar watch”? Do you have chronically tight muscles and tendons? Are you ticklish? If so, you may have a high degree of nervous system tension. This tension can contribute to premature ejaculation in two ways.
Physical tension in the muscles of the pelvic floor can put pressure on the prostate gland and can stimulate early contraction. Contraction of the prostate is what pushes semen into the urethra to result in ejaculation.
Nervous system tension also reflects the balance of neurotransmitters in our brain and body. Neurotransmitters like dopamine and serotonin have roles in controlling arousal and ejaculation, as well as our overall mood and relationship with stress and anxiety. People who tend towards nervous tension may experience more ups and downs, which is related to more dependence on dopamine level fluctuations. Serotonin exhibits a more stabilizing effect on mood and nervous tension, as well as having an inhibitory effect on ejaculation, whereas dopamine has a stimulating effect on ejaculation.
In other words, people with a high degree of nervous tension are more sensitive to sensory stimuli. This is not necessarily a negative thing overall. For example, these are qualities you want in a person on guard duty who is keeping watch for danger. But in terms of ejaculation it means that the body has a lower threshold for a sensory stimulus like pleasurable sensations before it is overwhelmed by dopamine release and leads to earlier ejaculation.
So how do we create more nervous system relaxation and neurotransmitter balance? Well, to be fair breathing techniques and traditional yoga practices are great techniques for helping deal with physical tension and regulating nervous system balance. But most of the time people need more support than those tools alone can offer.
To help men dealing with premature ejaculation I provide individualized treatment through my online herbal clinic. I assess each person’s specific needs, and provide intensive Chinese herbal medicine treatment. Each formula is composed of roughly 12-18 herbs that are specifically chosen to fit the needs of each individual.
In my herbal clinic we use more than 400 individual herbs, selecting the most effective herbs for each individual case to create a custom formula. Some of my favorite herbs for supporting nervous system relaxation and neurotransmitter balance in premature ejaculation are Peony root, Bupleurum root, and Cyperus rhizome.
Prostate Health
Now you might be thinking, what does prostate health have to do with ejaculation? Aren’t most men who are dealing with premature ejaculation fairly young, and they won’t have prostate issues until they’re older? Well, not exactly. While it’s true that BPH (Benign Prostatic Hypertrophy), or prostate enlargement, won’t typically affect men until their 50s, the prostate plays an essential role in ejaculation.
Contraction of the prostate gland is what forces the ejaculate out the urethra, and so the condition of the prostate plays a key role in timing ejaculation. In young men, chronic irritation or inflammation of the prostate gland is a significant contributing factor to premature ejaculation. One research study found chronic prostate inflammation in 47.8% of men with premature ejaculation. When the prostate is inflamed or irritated, it may swell to a larger size, or simply be more sensitive to pressure. When there is sexual stimulus, or an increase in tension in the pelvic floor muscles, this can cause the prostate to contract with the slightest sensation and result in early ejaculation.
Chronic prostatitis can be caused by chronic bacterial or fungal conditions, such as chronic UTIs or Candida overgrowth. It can also be caused by impaired blood circulation in the pelvic floor, which can be a positive feedback loop with nervous system and pelvic floor muscle tension.
To address chronic prostate inflammation in premature ejaculation, Vaccaria seed, Sparganium root, Curcuma zedoaria root, Red Sage root, and Atractylodes lancea root are some examples of herbs that I incorporate into custom herbal formulas.
Harder Erections Last Longer
This may seem counterintuitive, as a higher degree of arousal and erection hardness is generally associated with faster ejaculation. However, there is a point where the penis can be so hard and full of blood that it actually reduces sensitivity of the glans. So, an important element to addressing premature ejaculation can actually be to increase blood flow to the penis to increase erection strength and hardness to the point that it prolongs ejaculation by reducing sensitivity.
Using herbal medicines with this function has the secondary benefit of reducing the refractory period (the period of time after orgasm where the penis is not responsive to stimulus). By reducing the refractory period, even if the first round was shorter than desired you can get back to it sooner.
To help improve erection quality and reduce the refractory period in premature ejaculation treatment, Epimedium leaf, Curculigo rhizome, and Tribulus seed are some examples of herbs that I incorporate into custom herbal formulas.
What approach is right for you?
Most men will benefit from an approach that addresses all of the factors I’ve described in this article - nervous system tension, prostate health, and erection hardness. But those factors will not weigh equally for each individual, and the best results come from getting help from an experienced and qualified herbalist to have a custom formula made for you. With individualized treatment, the herbal formula will be focused on what factors are most relevant in your health, as well as considering other constitutional aspects of your health.
You can get my help with a custom herbal formula to address premature ejaculation (and a wide variety of other concerns) through my online herbal clinic. Visit the Chinese Medicine page to learn more about the treatment process, and get started by filling out our New Patient Herbal Intake.
St. John's Wort
In my experience, individualized Chinese herbal medicine treatment provides the best safe, effective, and comprehensive treatment for premature ejaculation. However, you may also want to explore tools like St. John's Wort to help manage nervous system balance.
St Johns Wort is an herbal ally that can help support nervous system balance to reduce premature ejaculation. St. John’s Wort is understood to increase serotonin levels, though the exact mechanism is not clear. St. John’s Wort is not an SSRI, though its action may be similar (but milder). Increasing serotonin levels can reduce premature ejaculation due to serotonin’s inhibitory action on ejaculation and by reducing contractility of the pelvic floor muscles. St. John's Wort is also used in western herbal medicine for supporting nerve health, which may be another reason it can be helpful in treating PE.
St. John’s Wort can be a helpful tool in managing premature ejaculation, but I don’t recommend it as a singular approach. Because St. John’s wort affects serotonin levels, it should not be taken concurrently with SSRI medications. Some people experience photosensitivity with St. John’s Wort and it is known to have interactions with many medications, so it is not appropriate for everyone. St. John's Wort acts on the CYP450 metabolic pathway, and can speed up the body's clearance of medications that use this pathway, which reduces the drug's effectiveness.
In Chinese Medicine, St. John’s Wort’s action is understood in part through observation of the plant itself. The latin name, Hypericum perforatum, refers to the tiny holes, or perforations, on the plant’s leaves. If you hold the leaves up to the sun, you can see the light shine through these small holes. In Chinese Medicine, St. John’s Wort is said to “let the light in”. Like many things in Chinese Medicine, poetic sounding phrases are both metaphorical and literal. It lets the light in, in the sense of letting the light into our spirit to help lift the clouds of depression ( especially useful in seasonal affective disorder) but also it literally lets more light into your skin and eyes and can thereby cause photosensitivity.
St. John's Wort can be helpful, but works best when combined with individualized herbal medicine treatment.
Cheers to having more fun, for longer,
Sean Dugan L.Ac.
Prevalence of chronic prostatitis in men with premature ejaculation. https://pubmed.ncbi.nlm.nih.gov/11489699/
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