Premature Ejaculation

What is premature ejaculation?

Premature ejaculation is a type of sexual dysfunction that occurs when a man has an orgasm and releases (ejaculates) semen sooner than he or his partner would like. It often happens before or shortly after penetration during intercourse. Premature ejaculation can be a frustrating experience for both you and your sexual partner and makes your sex lives less enjoyable. However, the good news is that it’s usually fixable!

How common is premature ejaculation?

Between 30% and 40% of men experience premature ejaculation at some point in their life. According to the American Urological Association, premature ejaculation is the most common type of sexual dysfunction in men. About one in five men between the ages of 18 and 59 report incidences of premature ejaculation.

What time frame medically defines a man’s ejaculation as premature?

Although the definition of premature ejaculation varies, the American Urological Association defines ejaculation as “premature” if it occurs sooner than desired, either before or shortly after penetration, causing distress to either one or both partners. The American Psychiatric Association defines three levels of severity (mild, moderate, severe), based on time to ejaculation, with mild being under one minute. If pressed for a time frame, many doctors would define prematurity as ejaculation within a minute of beginning intercourse. Despite professional opinions, your feelings as to what is premature are also considered.

What causes premature ejaculation?

Physical, chemical and emotional/psychological factors cause premature ejaculation.

Physical and chemical problems include:

• An underlying erectile dysfunction diagnosis.
• A hormonal problem with oxytocin levels, which has a role in sexual function in men. Other hormone levels that play a role in sexual function include luteinizing hormone (LH), prolactin and thyroid stimulating hormone (TSH)
• Low serotonin or dopamine levels, chemicals in the brain that are involved in sexual desire and excitement.
• A penis that is extra sensitive to stimulation.

Emotional or psychological causes include:

• Performance anxiety. Could be due to the nervousness of being with a new partner, anxiousness of having sex again after a long period of abstinence, lack of confidence, guilt, being overly excited or stimulated or other reasons.
• Stress.
• Relationship problems.
• Depression.

Are there other symptoms of premature ejaculation?

No. The only symptom of premature ejaculation is the condition itself.

How are the causes of premature ejaculation diagnosed?

If you have frequent premature ejaculations, or if premature ejaculation is causing you anxiety or depression and affecting your relationship, make an appointment to see a urologist.

Your urologist will begin an exam by asking about your sexual experiences. You will likely be asked:

• How long have you had this problem?
• Under what circumstances does it happened?
• How often does it happen?
• Does premature ejaculation happen at every sexual attempt?
• Does it happen with all partners?
• Does premature ejaculation occur when you masturbate?
• Do you have trouble maintaining an erection?

While the questions are personal, it is important that you answer your urologist honestly so they can best diagnose the source of your problem.

Your urologist will also ask about any other medical conditions you may have and any medications including over-the-counter medications, supplements and herbal products you are taking. You will also be asked about any alcohol and illegal drug use.

Are lab tests needed to make the diagnosis of premature ejaculation?

Lab tests are usually not needed unless your healthcare provider suspects that an underlying health problem is contributing to the problem.

How is premature ejaculation treated?

There are many different treatments options for premature ejaculation depending on the cause. These include behavioral therapy, counseling and medications. Most causes of premature ejaculation are usually treated first with behavior therapy and/or counseling to help with emotional concerns, performance anxiety or stressors that may be contributing. Often more than one treatment approach may be tried at the same time.

Behavioral therapy

Behavioral therapy involves trying different methods to delay your orgasm. Its goal is to teach you how to control your body and your feelings. Methods include:

• Start and stop: With this technique, you or your partner stimulates your penis close to the point of orgasm then stops the stimulation for about 30 seconds until you regain control of your response. Repeat this “start and stop” approach three or four times before allowing yourself to orgasm. Continue practicing this method until you have gained good control.
• Squeeze therapy: With this technique, you or your partner stimulates your penis close to the point of orgasm then gently squeezes the head of your penis for about 30 seconds so that you begin to lose your erection. Repeat this technique a few times before allowing yourself to orgasm. Continue practicing this technique until you have gained control in delaying your orgasm.
• Distracted thinking: With this technique, the idea is to focus your attention on ordinary nonsexual things while you’re being sexually stimulated. Naming sequences are a good way to focus your attention. For example, visualize naming all the businesses you pass on your drive to the gym, naming all the players on your favorite sports team or naming all the products on the aisles of your favorite store.

Counseling

If the cause of your premature ejaculation is psychological, emotional, or due to relationship issues – due to performance anxiety, depression, stress, guilt, or a troubled relationship – seek the help of a psychologist, psychiatrist, couples therapist or sex therapist. Your urologist can help direct you to these health professionals.

Medications

Several types of medications may be tried.

Antidepressants, especially selective serotonin reuptake inhibitors like citalopram (Celexa®), escitalopram (Lexapro®), fluoxetine (Prozac®), paroxetine (Paxil®) and sertraline (Zoloft®) or the tricyclic antidepressant clomipramine (Anafranil®), can help delay premature ejaculation. This is an “off-label” use (not approved by the Food and Drug Administration for this use). Be sure to discuss the side effects of this medication with your urologist to be sure it’s appropriate for you.

Anesthetic (numbing) creams and sprays applied to the head and shaft of the penis is another medication option to delay ejaculation. The anesthetic cream or spray is applied to the penis, absorbed for 10 to 30 minutes or until you feel less sensitivity in your penis. It’s important to wash your penis before sex to prevent numbness to your partner’s vagina or loss of your erection.

Erectile dysfunction medications, which include sildenafil (Viagra®), tadalafil (Cialis®), vardenafil (Levitra®) and Avanafil (Stendra®), have also been used to treat premature ejaculation, particularly in men with underlying erectile dysfunction.

Are lab tests needed to make the diagnosis of premature ejaculation?

Lab tests are usually not needed unless your healthcare provider suspects that an underlying health problem is contributing to the problem.

Can I prevent premature ejaculation?

Yes, you likely can! By following the techniques described in this article to delay ejaculation, taking any prescribed medications, and seeking counseling if needed, premature ejaculation can become a problem of your past.

What outcome can I expect if I have premature ejaculation?

There are several treatment methods that can help prevent premature ejaculation. By involving your partner and seeing the appropriate healthcare professionals – a urologist for initial assessment plus other health care professionals (psychologists, psychiatrists, counselors) as needed for underlying contributing problems, you will likely be able to control your ejaculation and enjoy your sex life once again.

Can wearing a condom help with premature ejaculation?

Yes. Wearing a condom can decrease sensitivity to your penis and help delay ejaculation.

Is premature ejaculation harmful or a sign of a medical problem?

Premature ejaculation itself is not harmful but other health problems may contribute to the development of premature ejaculation. These health problems include:

• Erectile dysfunction (man can’t maintain a firm erection for intercourse).
• Chronic pelvic pain syndrome (long-term pain and cramping in the pelvic area plus long-term urinary tract symptoms and sexual dysfunction).
• Thyroid disorders.
• Recreational drug use.

What’s the difference between erectile dysfunction and premature ejaculation?

If you have erectile dysfunction, you can’t attain or maintain your erection. If you have premature ejaculation, you have an erection but you reach orgasm and ejaculate earlier than you or your partner would have liked.

However, erectile dysfunction can actually lead to the development of premature ejaculation. This happens when a man knows his ability to sustain an erection is poor, so he develops the habit of ejaculating soon after erection before he loses his erection.

Because of this connection between these two conditions, your urology will want to figure out if you have erectile dysfunction and, if so, treat that first.

Can drinking alcohol help delay ejaculation?

While it’s true that drinking alcohol can delay orgasm, it’s not a treatment for premature ejaculation.

A note from Cleveland Clinic

Your urologist and team of healthcare providers will come up with a plan to treat your premature ejaculation. Premature ejaculation is often easily treated with a few simple steps, so it is important to see your urologist or other doctors if you are experiencing premature ejaculation. Although it may be uncomfortable to talk with your doctors about sexual problems, know that they are professionals and want you and your partner to have a satisfying sex life. Remember, this is a common problem and you are not alone!