Premature ejaculation occurs when a man ejaculates sooner during sexual intercourse than he or his partner would like. Premature ejaculation is a common sexual complaint. Estimates vary, but as many as 1 out of 3 men say they experience this problem at some time.
As long as it happens infrequently, it's not cause for concern. However, you might be diagnosed with premature ejaculation if you:
- Always or nearly always ejaculate within one minute of penetration
- Are unable to delay ejaculation during intercourse all or nearly all of the time
- Feel distressed and frustrated, and tend to avoid sexual intimacy as a result
Both psychological and biological factors can play a role in premature ejaculation. Although many men feel embarrassed talking about it, premature ejaculation is a common and treatable condition. Medications, counseling and sexual techniques that delay ejaculation — or a combination of these — can help improve sex for you and your partner.
How Does Ejaculation Work?
Ejaculation is controlled by the central nervous system. When men are sexually stimulated, signals are sent to your spinal cord and brain. When men reach a certain level of excitement, signals are then sent from your brain to your reproductive organs. This causes semen to be ejected through the penis (ejaculation).
Symptoms
The main symptom of premature ejaculation is the inability to delay ejaculation for more than one minute after penetration. However, the problem might occur in all sexual situations, even during masturbation.
Premature ejaculation can be classified as:
- Lifelong (primary). Lifelong premature ejaculation occurs all or nearly all of the time beginning with your first sexual encounters.
- Acquired (secondary). Acquired premature ejaculation develops after you've had previous sexual experiences without ejaculatory problems.
Many men feel that they have symptoms of premature ejaculation, but the symptoms don't meet the diagnostic criteria for premature ejaculation. Instead these men might have natural variable premature ejaculation, which includes periods of rapid ejaculation as well as periods of normal ejaculation.
When to see a doctor
Talk with your doctor if you ejaculate sooner than you wish during most sexual encounters. It's common for men to feel embarrassed about discussing sexual health concerns, but don't let that keep you from talking to your doctor. Premature ejaculation is a common and treatable problem.
For some men, a conversation with a doctor might help lessen concerns about premature ejaculation. For example, it might be reassuring to hear that occasional premature ejaculation is normal and that the average time from the beginning of intercourse to ejaculation is about five minutes.
Causes
The exact cause of premature ejaculation isn't known. While it was once thought to be only psychological, doctors now know premature ejaculation involves a complex interaction of psychological and biological factors.
Psychological causes
Psychological factors that might play a role include:
- Early sexual experiences
- Sexual abuse
- Poor body image
- Depression
- Worrying about premature ejaculation
- Guilty feelings that increase your tendency to rush through sexual encounters
Other factors that can play a role include:
- Erectile dysfunction. Men who are anxious about obtaining or maintaining an erection during sexual intercourse might form a pattern of rushing to ejaculate, which can be difficult to change.
- Anxiety. Many men with premature ejaculation also have problems with anxiety — either specifically about sexual performance or related to other issues.
- Relationship problems. If you have had satisfying sexual relationships with other partners in which premature ejaculation happened infrequently or not at all, it's possible that interpersonal issues between you and your current partner are contributing to the problem.
Biological causes
A number of biological factors might contribute to premature ejaculation, including:
- Abnormal hormone levels
- Abnormal levels of brain chemicals called neurotransmitters
- Inflammation and infection of the prostate or urethra
- Inherited traits
Risk factors
Various factors can increase your risk of premature ejaculation, including:
- Erectile dysfunction. You might be at increased risk of premature ejaculation if you occasionally or consistently have trouble getting or maintaining an erection. Fear of losing your erection might cause you to consciously or unconsciously hurry through sexual encounters.
- Stress. Emotional or mental strain in any area of your life can play a role in premature ejaculation, limiting your ability to relax and focus during sexual encounters.
Complications
Premature ejaculation can cause problems in your personal life, including:
- Stress and relationship problems. A common complication of premature ejaculation is relationship stress.
- Fertility problems. Premature ejaculation can occasionally make fertilization difficult for couples who are trying to have a baby if ejaculation doesn't occur intravaginally.
Psychological Therapy
Psychological therapy is a way to work through the feelings and emotions that may lead to problems with sexual relationships. The goal of this type of therapy is to learn the source of problems and find solutions that may help PE. It can also help couples learn to grow closer. Psychological therapy can help you become less nervous about sexual performance. It can also give you greater sexual confidence and understanding to help your partner's satisfaction. This type of therapy can be used as the only treatment, or it may be used along with medical or behavioral therapy.
Behavioral Therapy
Behavioral therapy uses exercises to help build tolerance to delay ejaculation. The goal is to help you train your body away from PE. Some choices are the squeeze method and the stop-start method. Exercises work well, but they may not be a lasting answer.
- The Squeeze Method
With this method, you or your partner stimulates your penis until you are close to ejaculation. When you are close, you or your partner firmly squeezes your penis so your erection partly goes away. The goal is for you to become aware of the sensations leading to climax. The squeeze method may help you better control and delay climax on your own. - The Stop-Start Method
In this method, you or your partner stimulates your penis until just before ejaculation. When you are about to climax, you or your partner stops until the urge to climax lets up. As you regain control, you and your partner start stimulating your penis again. This process is repeated 3 times. You ejaculate on the fourth time. You repeat this method 3 times a week until you have gained more control.
- The Squeeze Method
Medical Therapy
No drugs have been approved in the U.S. to treat PE. Still, there are a number of drugs, numbing creams and numbing sprays that may slow ejaculation in men with PE.
Drugs
Doctors noticed that men and women on antidepressants have delayed orgasms. Drugs such as fluoxetine, paroxetine, sertraline, clomipramine and tramadol affect serotonin levels. Some doctors use these drugs "off-label" (for a different reason than the drug's original use) to treat PE. If one drug does not work, your doctor may suggest you try a different drug.
For others, α1-Adrenoceptor antagonists are another option for drug therapy. These drugs may induce ejaculatory dysfunction such as retrograde ejaculation and/or failure of emission.
Drugs for PE can be taken each day or only before sex. Your health care provider will suggest when you should take a drug based on your activity level. The best time to take the drug is not clear. Most doctors suggest from 2 to 6 hours before sex. PE can return if you stop taking these drugs. Most men with PE need to take these drugs on an ongoing basis.
Numbing Creams or Sprays
Numbing creams and sprays may be put on the head of the penis about 20 to 30 minutes before sex. If you leave the numbing cream/spray on your penis for longer than suggested, your erection may go away. Also, the numbing cream/spray should not be left on the exposed penis during vaginal sex because it may cause vaginal numbness. Wash the cream off your penis 5 to 10 minutes before sex. Wearing a condom can also help dull sensation.
With the techniques listed here, about 95 out of 100 men will recover from PE. There is no way to promise recovery, but learning how to relax may help. If the problem stays, keep working with your health care provider to find solutions.