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She showed up at my clinic without an appointment and asked if she could see me for a few minute. D had been my patient for the past five years. She was 32 and a disciplined, thoughtful and caring person.

It was rather unusual for her to show up at my clinic unannounced. I thought she might have some serious problem. Instead, she was beaming with joy as she placed an invitation card on my table.

“Doc, I am getting married,” she said. “Can I invite you to solemnise our marriage?”

I met D’s husband, an engineer on the day of their marriage. He was 36 and seemed introverted, shy and soft spoken.

I expected good news from D when she came for a consultation six months later. Instead, she burst into tears when she saw me.

“Our honeymoon was a disaster” she sobbed. “We could not consummate our marriage.”

Apparently, her husband ejaculated before penetration every time.

“Was he tense? Did it happen every time?” I asked.

“Yes. He was very tense. I asked him to take it easy and encouraged him to try the next day.

“But again there was no success. We tried a few more times and failed. For the past few months, our sexual desires have waned. We hardly attempt sex now and quarrel over this occasionally. We have lost confidence completely and need help.”

D’s husband has a condition called premature ejaculation (PE). An occasional instance of PE might not be cause for concern, but if the problem occurs with more than 50 per cent of attempted sexual relations, a dysfunctional pattern usually exists for which treatment maybe appropriate.

PE is a very distressing and common sexual problem when the man is unable to control ejaculation voluntarily. It is estimated that about 10 to 40 per cent of men have this trouble. It is less common in older men when the threshold for orgasm is raised.

As in D’s case, PE is devastating for a man’s self-esteem and makes the couple unhappy and frustrated. It threatens or can even ruin a marriage, simply because it spoils their sex lives.

The exact cause of PE is not well understood although the majority of cases are attributable to psychological factors.

Animal studies have shown that a low level of the chemical serotonin in some areas in the brain could cause premature ejaculation. This theory is supported by the proven effectiveness of anti-anxiety medication or selective serotonin reuptake inhibitors (SSRIs), which increase serotonin levels in the brain in treating PE.

Anxiety plays an important part in many cases. If the husband is nervous, he is likely to climax quickly. Some men take a small amount of alcohol to ease their nerves hoping it will make them less likely to climax prematurely. However, this does not work in most cases.

I taught D’s husband some simple distraction techniques such as turning his attention to something else when he felt climax was near. These methods did not work for him.

He tried to apply a local anaesthetic cream to numb his penis shortly before intercourse. But that resulted in D developing an allergic reaction to the cream.

Although SSRIs have been used successfully to treat PE, D and her husband preferred not to take a drug as they were afraid of side-effects. They opted instead to try one of the

behaviour modification methods widely used to treat PE which I could advise them about.

D and her husband practiced diligently over a period of two months. With motivation and under careful instruction, her husband finally learnt how to delay ejaculation.

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