Premature (Early) Ejaculation (PE) is characterized by an inability to control the orgasmic urge during partnered sexual activity, resulting in ejaculation within one minute of penetration. In international studies, more than 20-30% of men ages 18-70 report concern about how rapidly they ejaculate.1 While PE can be distressing, oral medications, topical applications, and behavioral practices are highly effective forms of treatment.
What Is Premature Ejaculation?
Premature Ejaculation (PE) is a commonly occurring sexual complaint wherein male ejaculation occurs prior to or shortly after penetration during sexual activity. While penetrative sex is used as the diagnostic criteria for this disorder, the issue may also occur during other sexual activities, including masturbation.
Causes & Triggers of Premature Ejaculation
There is no current research to substantiate any theories regarding a consistent root cause for Premature Ejaculation.
From a biological perspective, when sudden onset PE occurs, unhealthy thyroid or prostate function may be to blame. Your general practitioner or urologist will help you to rule out physiological issues. It’s important to be honest with your doctor about any recreational drug use, as that may also be a component in sudden onset PE.
If you have experienced lifelong PE, the cause is more likely a higher sensitivity to sexual stimulation and/or psychological triggers. Although psychological causes for PE may vary, anxiety is a common component in PE. Performance anxiety in particular can cause or worsen PE symptoms. Once PE symptoms arise, anxiety can become cyclical; anxiety-triggered PE may worsen without treatment. Generalized anxiety, depression, stress, and relational difficulties have also been correlated with PE.
Impacts of Premature Ejaculation on Individuals & Relationships
Premature Ejaculation can have a negative emotional impact on both an individual and on a relationship, including frustration and lack of sexual satisfaction. PE in and of itself is not a biological dysfunction, as it typically does not indicate or lead to any health risks or an inability to conceive. PE can, however, cause psychological or relational distress.
Men experiencing PE may identify with the following repercussions of this disorder:
- Loss of self-esteem/feelings of inadequacy
- Inability to achieve an erection due to performance anxiety
- Loss of libido/desire for sex due to performance anxiety
Men in relationships may find that:
- Frequency of sex decreases due to performance anxiety.
- Loss of connection/emotional closeness occurs due to lack of sex.
- Their partner experiences a loss of sexual satisfaction (although this fear may be unfounded, as men typically care more than their female heterosexual partners about PE).2
Symptoms of Premature Ejaculation (PE)
The main symptom of Premature Ejaculation (PE) is a persistent and recurrent inability to control orgasm during penetrative sex, resulting in ejaculation prior to or within one minute of penetration. Although estimates vary, 1 in 3 men may experience this problem in their lifetime.3,4
Keep in mind that occasional rapid ejaculation is normal and should not be cause for concern. Also, common assumptions about long-lasting male stamina may lead to misconceptions about normative sexual function. The average time from penetration to ejaculation is approximately 5 minutes.5
In order to meet the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for Premature Ejaculation (PE) the inability to control orgasm must:
- Have been present for at least 6 months
- Be experienced during 75-100% of penetrative sexual activity during that time
- Cause clinically significant distress
- Not be better explained by a non-sexual mental disorder
- Not be better explained by severe relationship distress or other significant stressors
- Not be attributable to the effects of a substance/medication or other medical condition
Premature Ejaculation may be specified as:
- Lifelong: present since becoming sexually active
- Acquired: beginning after a period of relatively normal sexual function
PE may also be classified as:
- Generalized: Occurring during all sexual situations, types of stimulation, and with all partners
- Situational: Only occurring during certain sexual situations, types of stimulation, or with specific partners
There are levels of severity when dealing with PE:
- Mild: Occurring within approximately 30 seconds to 1 minute after penetration
- Moderate: Occurring within approximately 15-30 seconds after penetration
- Severe: Occurring prior to or within approximately 15 seconds after penetration
Treatment of Premature Ejaculation
Premature Ejaculation can often be treated with non-medical behavioral interventions. The following techniques are the most common approaches that doctors and sex therapists recommend when treating PE.
The use of condoms in penetrative sex can reduce sensation, which often allows men more control over when they ejaculate. Although using condoms is unlikely to solve the issue of PE entirely, if condoms provide some success in prolonging ejaculation, then other interventions directed at reducing sensation are likely to be effective as well.
Masturbation Prior to Sex
Pre-coital masturbation has been shown to be effective, particularly among younger men.6 Men (and women) have a “refractory period” after they orgasm during which it will be difficult or impossible to orgasm again. This period varies significantly from anywhere to minutes or days and may fluctuate over time.
For older men, the refractory period tends to be between 12-24 hours.7 Masturbating prior to sex, for some men even on the same day, can prolong the time between penetration and orgasm. For some men, however, it may be difficult to attain an erection shortly after masturbating.
The “Stop-Start” Technique
Recognized as the most effective behavioral treatment for ejaculatory control,8 the Stop-Start technique involves stopping stimulation as soon as the urge for orgasm arises, waiting 30-60 seconds, then resuming stimulation until the urge arises again and repeating multiple times. This can be practiced with a partner or during self-stimulation.
Masturbation may provide a better forum for practice than partnered activity; during masturbation a partner does not have to be signaled to stop stimulation and daily/consistent practice in orgasmic control may be easier to achieve. Short term benefits have been shown for this technique in 45-65% of men; long term benefits are less clear.9
The “Squeeze” Technique
Similar to the Stop-Start technique, the Squeeze technique involves squeezing the area between the shaft and the glans of the penis when the urge to climax arises for approximately 30 seconds then resuming sexual activity and repeating multiple times.
The Squeeze technique can feel awkward or mechanical, particularly during partnered sex. It can occasionally affect the erection of the penis as well, which is why the Stop-Start technique is generally superior. However, trying both techniques is worthwhile to establish which technique is more effective for an individual.
Pelvic Floor Exercises
Weak pelvic floor muscles can impact the ability to control orgasms.10 Although Kegel exercises are typically recommended for women, men can do them as well, and a strong pelvic floor is important for urological health. To identify where your pelvic floor muscles are, experiment with stopping urination in midstream. Once you identify the action of tightening your pelvic floor muscles, you can practice this in any position and in just about any situation.
You might choose to “pair” this exercise with another daily activity such as brushing your teeth or driving, so that you remember to practice. For best results, perform this exercise three times a day or more in sets of ten. Try to breathe freely and avoid tensing the muscles around your pelvic floor, such as your glutes or psoas.
Analgesic wipes or sprays can be purchased over the counter and help to reduce sensation through the application of a numbing agent. Simply apply to the penis before sexual activity, wait for the topical application to dry and engage in sex as you would otherwise. The resulting reduction in sensation can help prolong the time between penetration and ejaculation.
Analgesics are effective and have no long term side effects; however, some men report a loss of sensation or sexual pleasure. If this occurs, you might try a different wipe or spray, or discontinue use. Topical analgesics can also transfer to your partner and reduce their sensation or pleasure; condom use can eliminate that issue. Topical analgesics have been shown to be effective up to 90% in increasing stamina to over one minute.11
Sex therapy can be sought as an individual who is experiencing sexual symptoms or as a couple impacted by Premature Ejaculation in a male partner. A sex therapist will take a detailed sexual and psychosocial history to assess for psychological factors contributing to sexual dysfunction. The clinician will explore the onset and context of the symptoms being experienced, especially any changes in the situations or cues that have triggered ejaculation in the past.
They will then likely offer coaching on mindfulness and behavioral techniques that either an individual or couple can explore. Co-occurring psychological conditions, such as mood disorders, will also be assessed and treated. Counseling can provide an effective adjunct to any other treatment for PE, as performance anxiety and relational difficulties are common issues resulting from PE symptoms.
Medications should be sought as a last resort, as they frequently have side effects that the other treatment approaches discussed within this article will not have. Your Primary Care Provider (PCP), General Practitioner (GP) or Urologist will determine if one of the following medications would be appropriate as an adjunct to counseling or behavioral techniques.
Selective Serotonin Reuptake Inhibitors (SSRIs)
Typically prescribed for depression or anxiety, this class of medication has been shown to have some level of effectiveness in treating PE. This is because delayed orgasm is a common side effect of SSRIs. Other side effects exist and include drowsiness, nausea, and decreased libido. You may want to consider whether increased sexual stamina is worth it if you may no longer desire to have sex when taking this medication.
Medications such as Ultram (tramadol) are commonly prescribed for pain management. However, similar to SSRIs, these medications have the side effect of delayed ejaculation and may be prescribed “off-label” for this purpose. Other side effects may include nausea, dizziness, and headaches.
Phosphodiesterase-5 Inhibitors (PDE5s)
Medications such as Viagra (sildenafil) and Cialis (tadalafil) are typically prescribed for Erectile Disorder (ED). The coexistence of ED and PE is common, occurring in up to 50% in some studies.12 The exact relationship between these two disorders is unclear; however, the use of PDE5 medications has been shown to be moderately effective for PE in some cases and may be worth exploring with your doctor.
How to Get Help for Premature Ejaculation
Premature Ejaculation is a common and treatable issue. Outcomes for medical and psychological approaches to ejaculatory symptoms are promising, with many men discovering or returning to healthy sexual function in a relatively short period of time.
If you are consistently unable to control your orgasms, speak with your doctor about whether your symptoms are clinically concerning and what treatment approach might be appropriate. A Primary Care Provider (PCP), a General Practitioner (GP), or Urologist are all suitable providers to consult with on ejaculatory issues. While it may be embarrassing to bring up the topic of sexual problems, don’t let that keep you from seeking care.
Your doctor will assess whether medical treatment would be helpful and whether referrals to other medical providers should be made. It’s important to ensure that there are no underlying medical conditions, hormone imbalances, or side effects to current medications before treating the psychological components of Premature Ejaculation.
Even if the ejaculatory issues are treatable through medication or topical analgesics, anxiety or relational distress can often develop as a side effect to the primary problem. Often, psychological counseling can be helpful to address the overall issue and achieve consistent sexual satisfaction.
When consulting a therapist for the psychological treatment of sexual issues, make sure that your mental health practitioner is AASECT (American Association of Sexuality Educators Counselors and Therapists) certified. “Sex therapist” and “sex therapy” are not protected terms, meaning that anyone can call themselves a sex therapist in their marketing.
Additionally, most mental health licensure requirements contain little or no instruction in human sexuality. AASECT certified providers receive an additional 18-24 months of training and a minimum of 300 additional hours of supervision in sex specific psychological issues.
Typical rates for an AASECT certified sex therapist are on the upper end of private pay therapy rates in your area. Most sex therapists see individual clients for 45-60 minute sessions at rates between $120-$180, and couples for 75-90 minute sessions at rates between $190-$310. These rates may vary widely based on the availability of certified sex therapists in your area and on general mental health costs in your state.
You can find an AASECT certified sex therapist here.
Premature Ejaculation Statistics
Prior to the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published in 2013, criteria for Premature Ejaculation was ambiguous, leading to a lack of accurate data on the problem. However, the prevalence of men reporting issues with early ejaculation has consistently been high and remains one of the most commonly reported sexual issues.
- Approximately 1 in 3 men report experiencing early ejaculation issues in their lifetime13,14
- In international studies, more than 20-30% of men ages 18-70 report concern about how rapidly they ejaculate15
- According to the current, narrowly-defined criteria cited in this article for Premature Ejaculation as defined by the DSM-5, only 1-3% of men reporting ejaculatory issues would be diagnosed with the disorder.16 (Remember, the average time between penetration and orgasmic release for a man is approximately 5 minutes.17)
- Men typically care more than their female heterosexual partners about their Premature Ejaculation.18
Living with Premature Ejaculation: Coping & Managing
Premature Ejaculation may necessitate utilizing treatment options on an ongoing basis, such as medication, topical analgesics, or behavioral techniques. Incorporating methods that work for you into a sexual routine will become more manageable over time.
Acquired PE brought on by stressors or other medical issues may be overcome without continuous treatment. Lifelong PE symptoms may require ongoing attention in order to control orgasmic release.
Overcoming shame associated with PE and being able to talk honestly with partners will help decrease the anxiety cycle and any negative repercussions associated with PE symptoms. PE is one of the most common sexual complaints and has multiple effective treatment options with low risk of side effects.