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Premature Ejaculation - Glickman Urological & Kidney Institute Overview

Premature ejaculation is a condition that causes men to orgasm before he or his partner would like. Learn about treatment options at Cleveland Clinic.

What is Premature Ejaculation?

Learn more about Cleveland Clinic's top-ranked urology program in the nation.

Premature ejaculation (PE) is believed by many sexual specialists to be the most common sexual disorder among men. Between one in five men between the ages of 18 and 59 may have suffered PE for a portion of their lives. Despite its prevalence few men seek treatment, which is unfortunate because there are a variety of effective treatments available.

How many men have Premature Ejaculation?

It is not well known how many men experience PE frequently or continually. The National Health and Social Life Survey indicates that one of every five U.S. men between the ages of 18 and 59 may have the problem. Other estimates put it even higher with some saying more than a third of men may have PE. Data is sparse but what exists suggests that risk factors for PE can be smoking, drug use, cardiovascular diseases and diabetes. Some studies even suggest that there may be racial and ethnic differences but these have yet to be confirmed.

The difficulty epidemiologists have in determining how many men experience PE lays in the absence of a universally recognized definition of the problem. Different surveys asked different questions and therefore produced different results. An international consortium of experts defines PE as “persistent or recurrent ejaculation with minimal stimulation before, on, or shortly after penetration, and before the person wishes it, over which the sufferer has little or no voluntary control which causes the sufferer and/or his partner bother or distress.” The American Urological Association treatment guidelines for PE shortened this definition to a more manageable “premature ejaculation is ejaculation that occurs sooner than desired, either before or shortly after penetration, causing distress to either one or both partners.”

The key word in these two definitions is “stress.” Intercourse can be an essential aspect of a relationship and PE can build disappointment and anxiety which put severe stress on a relationship. It can lead to one or the other of the partners in the relationship seeking to minimize or avoid sex. In instances, one partner may regard the other as being selfish. The full consequences of PE on relationships have yet to be adequately studied. One thing is certain. It need not happen.

How does normal ejaculation occur?

The male reproductive system is far more complex than many might imagine. Only those organs, structures, and tissues involved in ejaculation are described here. When a man becomes sexually stimulated, blood fills spongy tissue in the penis and it becomes erect. Sperm is produced in the testes, and the rest in the epididymis, a small organ that rests atop the testes within the scrotum or sac. A tube known as the vas deferens connects the epididymis to the seminal vesicles that lie behind the bladder. The vesicles produce a fluid, semen, that lubricates the urethra, the channel that runs the length of the penis and serves to empty the bladder. This fluid also provides nutrients for the sperm.

Physical and mental sexual stimuli induce neural stimuli that cause a rapid contraction of reproductive ducts and accessory glands which squeezes the sperm and fluid into the urethra. The bulbospongiosus muscles in the penis contract and expel semen from the penis in a reflex known as orgasm.

What Causes Premature Ejaculation?

It is not well known how many men experience PE frequently or continually. The National Health and Social Life Survey indicates that one of every five U.S. men between the ages of 18 and 59 may have the problem. Other estimates put it even higher with some saying more than a third of men may have PE.

Data is sparse but what exists suggests that risk factors for PE can be smoking, drug use, cardiovascular diseases and diabetes. Some studies even suggest that there may be racial and ethnic differences but these have yet to be confirmed.

The exact cause of premature ejaculation isn't known. While it was once thought to be only psychological, doctors now know premature ejaculation is more complicated and involves a complex interaction of psychological and biological factors.

Psychological Causes of Premature Ejaculation

Some researchers have suggested that psychological state of mind may sometimes be to blame for premature ejaculation. If a man suffers from erectile dysfunction, they may be anxious about sexual encounters which may lead to rushing to ejaculate, creating a mental pattern which is difficult to change. Normal anxieties concerning sexual performance or relationship problems may also contribute to psychologically induced premature ejaculation.

Psychological conditions and patterns that were established long before a current sexual encounter that a man experiences premature ejaculation matter as well. Early sexual encounters in men's lives which may be difficult to modify later in life. For example, sexual encounters that may have been rushed to avoid being discovered or feelings of guilt associated with sexual activity.

Biological Causes of Premature Ejaculation

While many men can attribute premature ejaculation to performance anxiety, some have underlying physical or biological conditions which make it difficult to ejaculate regularly. These causes, either genetic or otherwise, can be tested for and diagnosed by a Cleveland Clinic physician to help understand the cause of premature ejaculation.

  • Abnormal hormone or neurotransmitter levels
  • Abnormal reflex activity of the ejaculatory system
  • Thyroid problems
  • Inflammation and infection of the prostate or urethra
  • Nerve damage from surgery or trauma (rare)

What are the Symptoms of Premature Ejaculation?

Although the origins of the problem may be complex, the simplest description of this single symptom disorder is that offered by the American Urological Association – premature ejaculation is ejaculation that occurs sooner than desired, either before or shortly after penetration, causing distress to either one or both partners.

How is Premature Ejaculation Diagnosed?

There are no true diagnostic tests for premature ejaculation. The physician or specialist will determine the origins of the problem by thoroughly discussing your medical and sexual history. He or she will ask questions about the frequency and duration of PE, the nature of the stimulus which leads to PE, the nature and frequency of intercourse, the type and quality of relationships, aggravating or alleviating factors, and drug use.

In some instances the PE may be related to erectile dysfunction (ED), the inability to maintain an erection sufficient to engage in and complete intercourse. In such instances, the ED is treated first. Successful treatment of ED may resolve the ejaculation problem.

How is Premature Ejaculation Treated?

PE therapies fall into three categories: behavioral, medical and combinations of the two. Behavioral therapy involves instruction, often with a partner, in mental and physical methods that help control and delay ejaculation. There are a number of medications which reduce or prevent PE. Selective serotonin re-uptake inhibitors have been shown in clinical trials to have such effects. The generic names of these drugs are fluoxetine, paroxetine and sertraline but they are probably better known by their trade names: Prozac or Sarafem, Paxil and Zoloft.

The non-selective serotonin re-uptake inhibitor clomipramine (Anafranil), an anti-depressant, has also been shown to have an effect on PE. The advantage these agents have is that they have been in use for a number of years and their side effects are well known. Primary side-effects observed in some patients receiving the drugs for other disorders are mild headache, nausea, sweating and dizziness. It should be noted that these drugs are usually used at lower dosages when treating PE. This minimizes side effects.

Another approach is to desensitize the nerves in the glans or head of the penis. The simplest way to do this is to use a condom. Topical creams such as lidocaine-prilocaine cream applied 20 to 30 minutes before intercourse also desensitizes nerves in the glans. Drugs used to treat erectile dysfunction – Viagra (sildenifil), Cialis (tadalifil), Levitra (vardenafil) – have also been shown to ease PE but have not been studied for this purpose in large clinical trials. Nevertheless, they have a proven safety record and like the SSRIs, their side effects are well known. Glickman Urological and Kidney Institute physicians take a total approach to both diagnosis and treatment and it is not unusual for combinations of the preceding therapies to be applied.

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