Premature Ejaculation

What is premature ejaculation?

Premature ejaculation (PE) is a type of sexual dysfunction that occurs when a person has an orgasm and ejaculates sooner than they or their 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 make your sex lives less enjoyable.

PE can be lifelong, meaning you’ve had it since your first sexual experience. It can also be acquired, which means you’ve had sex previously where PE wasn’t an issue.

What is the average intercourse time for premature ejaculation?

Many healthcare providers would define premature ejaculation as ejaculating within one minute of beginning intercourse. The exact timing for premature ejaculation varies and only your healthcare provider can make a diagnosis.

Most healthcare organizations consider ejaculation “premature” if it:

• Occurs sooner than you or your partner desires.
• Causes distress to one or both partners.
• Happens during all or almost all sexual activity.
• Happens within one minute of penetration.
• Has been occurring for longer than six months to one year.

How common is premature ejaculation?

Between 30% and 40% of people experience premature ejaculation at some point in their lives. It’s the most common type of sexual dysfunction in people with a penis, with about 1 in 5 people between the ages of 18 and 59 reporting premature ejaculation.

What causes premature ejaculation?

Anxiety/psychological factors are most often the cause of premature ejaculation. Extra sensitive penile skin is also a common cause.

Emotional or psychological causes include:

• Performance anxiety. It could come from the nervousness of being with a new partner, the anxiousness of having sex again after a long period of abstinence, being overly excited or other reasons.
• Stress. Stress could be coming from work, other relationships, life changes or other events in your life.
• Relationship problems. This could range from history of sexual abuse to hostile feelings about your partner.
• Depressive thoughts. These could include feeling guilty or overwhelmed.
• Poor self-esteem. This includes body image issues or lack of confidence.

Physical and chemical causes include:

• Erectile dysfunction
• A hormonal problem involving oxytocin levels, which has a role in sexual function — 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, which are chemicals in your brain that are involved in sexual desire and excitement
• A penis that’s extra sensitive to stimulation
• An inflamed prostate

It’s worth noting that premature ejaculation isn’t typically due to an underlying penile disorder, disease, infection or problem with your reproductive organs. Most of the time, everything is working as it should and the problem comes from stress, nervousness and anxiety.

Are there symptoms of premature ejaculation?

No. The only symptom of premature ejaculation is ejaculating too soon.

What are the complications of this condition?

Premature ejaculation can have a significant effect on your relationship with your partner, making the complications psychological rather than physically harmful. You may feel embarrassed or that you can’t satisfy your partner. This can lead to issues with intimacy and impact your relationship as a whole. It’s common for people with PE to experience depression and frustration.

For this reason, it’s important to seek help for PE. It’s a common condition that frustrates many people. Your healthcare provider can help determine the best treatment for you depending on the cause of your premature ejaculation.

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. They may ask:

• How long have you had this problem?
• Under what circumstances has it happened?
• How often does it happen?
• Does premature ejaculation happen at every sexual encounter?
• 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’s 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’re taking. They’ll also ask you about any alcohol and 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 condition is contributing to the problem.

How is premature ejaculation treated?

There are many different treatment 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 behavioral therapy and/or counseling to help with emotional concerns, performance anxiety or stressors that may be contributing. You can try more than one treatment approach at the same time, and in fact, combinational therapy may be more effective than any one treatment alone.

Behavioral modification therapy

Behavioral therapy involves trying different practical methods to delay your orgasm. The 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’ve gained control in delaying your orgasm.
• Distracted thinking. With this technique, the idea is to focus your attention on ordinary nonsexual things during sexual activity. 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 or naming all the players on your favorite sports team.

Counseling

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

Medications

Your provider may recommend certain medications to help with PE.

Antidepressants are one of the first-line therapies for PE as they can help delay ejaculation. This is an “off-label” use (not approved by the Food and Drug Administration). Be sure to discuss the side effects of this medication with your urologist to be sure it’s appropriate for you.

Antidepressants your provider might prescribe include the tricyclic antidepressant clomipramine (Anafranil®) or selective serotonin reuptake inhibitors (SSRIs), for example:

• Citalopram (Celexa^®)
• Escitalopram (Lexapro^®)
• Fluoxetine (Prozac^®)
• Paroxetine (Paxil^®)
• Sertraline (Zoloft^®)

Anesthetic (numbing) creams and sprays you apply to the head and shaft of your penis is another potential first-line medication option to delay ejaculation. Your penis absorbs the anesthetic cream or spray in about 10 to 30 minutes. It causes you to experience less sensitivity in your penis. It’s important to wash your penis before sex to prevent numbness to your partner’s genitals.

Erectile dysfunction medications, which include sildenafil (Viagra^®), tadalafil (Cialis^®), vardenafil (Levitra^®) and avanafil (Stendra^®), may help treat premature ejaculation, particularly in people with underlying erectile dysfunction.

In certain cases, your provider may prescribe tramadol, an opiate medication.

While alternative therapies also exist for PE treatment, there isn’t enough evidence to prove they’re effective.

Is there a cure for premature ejaculation?

Most people find relief using one or more of the treatments above. Behavioral therapy and using different methods to delay ejaculation tend to be the most helpful.

Does having sex less help with premature ejaculation?

No, it actually worsens the problem because it makes you more sensitive to sexual stimulation.

Can I prevent premature ejaculation?

Yes, you can prevent PE depending on what’s causing it. It’s best to discuss your feelings with your healthcare provider so they can help you determine a cause and recommend the appropriate treatment. There are many treatment methods you can use to avoid PE.

What can I expect if I have premature ejaculation?

By involving your partner and seeing the appropriate healthcare professionals, you may be able to control your ejaculations and enjoy your sex life again.

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

Premature ejaculation itself isn’t harmful but other health problems may contribute to the development of premature ejaculation. These health problems include:

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

When should I see my healthcare provider?

Talk to your healthcare provider if you believe you have premature ejaculation or if ejaculating too soon is affecting your sex life. It’s normal to feel embarrassed about discussing sex with your healthcare provider, but know that PE is a common condition and that your provider isn’t there to judge you.

Can wearing a condom help with premature ejaculation?

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

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

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

Erectile dysfunction can lead to premature ejaculation. This happens because you know you can’t maintain an erection, leading to quick ejaculation so you don’t lose your erection.

Because of this connection between these two conditions, your urologist 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 alcoholic beverages can delay orgasm, it’s not a recommended treatment for premature ejaculation.

How do I stop ejaculating early?

There can be many reasons for premature ejaculation. Getting to the root cause of PE is the first step in finding the best treatment. Sometimes, treating the underlying cause — like depression or hormonal disorders — can be all you need to stop ejaculating early. Be sure to discuss all your options with a healthcare provider.