Premature ejaculation is a common sexual disorder in which ejaculation happens sooner than desired. While many men experience this condition at some point in their lives, persistent premature ejaculation can cause anxiety, depression, relationship problems, and psychological pain.
Many factors may contribute to the inability to control ejaculation, including health conditions, substance use, and mental health conditions. Treatment is most successful when using a multimodal approach that incorporates different types of therapy.
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What Is Premature Ejaculation?
Premature ejaculation is when you ejaculate earlier than you or your partner would like, generally before or just after sexual penetration. Ejaculation earlier than planned commonly happens during sex but can become a chronic condition that needs treatment if it happens for more than six months and causes psychological distress.
Premature ejaculation happens when there is limited sexual stimulation, and it often results in unsatisfactory sex for both partners. This, in turn, can lead to anxiety or negatively affect your relationship.
How common is premature ejaculation?
Premature ejaculation is one of the most common types of sexual dysfunction. Most men have experienced it, and about 1 in 3 men will have problems with premature ejaculation at some point in their lives.
Even though premature ejaculation is common, many men are too embarrassed or ashamed to talk about the condition with their doctors.
What causes premature ejaculation?
Doctors haven't pinpointed the exact causes of premature ejaculation.
However, feelings of anxiety, depression, guilt, or stress can make it worse. This condition is most often thought to be psychological, although it may involve a mix of psychological and medical factors.
Some biological and medical factors that can contribute to premature ejaculation include:
- Age — Being younger and having less sexual experience can cause premature ejaculation or being older and experiencing physical changes to erections.
- Alcoholism.
- Diabetes.
- Erectile dysfunction.
- Hormonal imbalances.
- Inflammation in the prostate or urethra.
- Low serotonin or dopamine levels.
- Prostatitis.
- Recreational drug use.
- Side effects from medication.
Possible psychological causes include:
- Concern over sexual performance — Nervousness of performance or being with a new person.
- Interpersonal issues — Such as hostility against women, self-loathing, lack of confidence, or personal history of sexual abuse.
- Lack of confidence/poor body image — Low self-esteem and anxiety.
- Mental health issues — Anxiety, depression, guilt, and stress.
- Relationship problems — Interpersonal issues between you and your partner.
- Sexual repression — Negative feelings about sex, often linked with feelings of guilt or shame.
Premature ejaculation risk factors
Your risk of premature ejaculation may increase if you have:
- A medical condition that contributes to premature ejaculation.
- Mental health issues.
- Substance use issues.
Complications of premature ejaculation
Complications of premature ejaculation include:
- Erectile dysfunction.
- Performance anxiety.
- Relationship issues or failed relationships.
- Worsening psychological or mental health issues.
How can I prevent premature ejaculation?
Since premature ejaculation is primarily a psychological condition, therapy can help prevent it. The therapy programs that have the most success preventing and treating premature ejaculation are:
- Behavioral therapy — Can help educate and train someone to delay ejaculation.
- Muscle rehabilitation therapy — Retrains the muscles to delay premature ejaculation and help extend sexual pleasure.
- Pharmacological therapy — Topical anesthetics, SSRIs, and other medications to help delay ejaculation.
- Physical therapy — Helps minimize and prevent premature ejaculation.
Combining different therapy methods has proven successful in addressing the condition from different perspectives.
What Are the Signs and Symptoms of Premature Ejaculation?
Premature ejaculation is primarily indicated by uncontrolled ejaculation that happens within one to three minutes of penetration or after little sexual stimulation.
Other signs that premature ejaculation is a chronic condition include:
- Avoiding sexual intimacy for fear of ejaculating early.
- Inability to delay or control ejaculation during sex most of the time.
- Feelings of anger, depression, frustration, guilt, or shame.
When should I see a doctor about my premature ejaculation symptoms?
If you've been experiencing the inability to control ejaculation during sex for more than six months, you should talk to your primary care physician about premature ejaculation.
How Do You Diagnose Premature Ejaculation?
You can expect your doctor to ask you many detailed questions about your medical and sexual history to help diagnose premature ejaculation.
Be expected to answer questions about your:
- Ability to delay ejaculation.
- Feelings of anger or frustration caused by the premature ejaculation.
- History of sexual abuse or trauma.
- Relationship health because of your symptoms.
- Sexual health outside of symptoms.
- Timing between penetration beginning and ejaculation.
- Timeline of symptoms.
Your answers may tell the doctor whether a medication change or lifestyle habit could be contributing to your condition. If your doctor suspects that your condition has a medical cause, they may order lab tests to uncover the cause.
Depending on your conversation with your doctor, they should be able to diagnose the condition and discuss personalized treatment options.
Premature ejaculation prognosis
While there is no cure for premature ejaculation, there are many treatment options available today that can make the condition manageable. Success rates for treatment are high, but it is common to relapse at some point.
How Do You Treat Premature Ejaculation?
Typically, this condition gets better over time with age and experience. Treatment isn't always necessary. Lifestyle changes, counseling, different therapy methods, and medication may be useful depending on the causes of your issue.
Lifestyle changes
Several lifestyle changes may help with premature ejaculation, including:
- Avoiding illegal drugs.
- Abstaining from alcohol.
- Distraction methods during sex.
- Relaxation techniques.
- Quitting smoking.
Your doctor or a therapist can recommend several behavioral therapy techniques, such as:
- Start-and-stop technique — This method involves engaging in sexual activity until the feeling of ejaculating begins, then stopping all sexual activity and using a distraction method. When the feeling to ejaculate dissipates, resume sexual activity. This method helps train the body to delay ejaculation naturally and is most successful when done consistently.
- The squeeze method — This method involves engaging in sexual activity, then grasping the head of the penis and lightly squeezing it when the feeling of ejaculation begins. This motion usually ends an erection fast. Once the feeling of ejaculating dissipates, you may resume sexual activity. This method also helps train the body to delay ejaculation and has a high success rate at first. After a few years if not resolved, the success rate of this method drops significantly.
Counseling
Individual or couples counseling can help you and your partner learn to use different techniques to delay ejaculation. A sex counselor or doctor may recommend trying different positions and communicating with your partner leading up to an orgasm to slow or stop stimulation. Counseling can also aid you in reducing symptoms of stress, anxiety, or depression, along with stress directly caused by premature ejaculation.
These therapy methods may offer different approaches to combat the issue, including:
- Creating a safe environment to discuss relationship and personal issues.
- Empowering the person to confidently make changes for their sexual health.
- Increasing communication and self-awareness.
- Providing helpful information, education, and guidance.
Medication
While there is no medication specifically designed to treat premature ejaculation, some antidepressants and other medicines can prevent or slow an orgasm, which helps combat premature ejaculation.
Your doctor may prescribe one of these medications and provide guidance on how to use it:
- Topical anesthetics — These come in spray, cream gel, and wipe form and are applied to the tip and shaft of the penis before sexual activity. These topical solutions can reduce sexual pleasure for both partners — a condom can be used to help reduce impact on a partner’s experience.
- SSRIs: These antidepressant medications are taken daily and delay ejaculation by affecting the serotonin transporter. Because symptoms may return if you cease medication, many men use SSRIs indefinitely.
- Other antidepressants and pain medications — Doctors may prescribe other medications such as tramadol, dapoxetine, clomipramine, nonselective beta-adrenergic blockers, or alpha-adrenergic blockers to help delay ejaculation.
Wearing a condom can also help dull the sensation and may improve sexual function.
