Premature ejaculation is the inability to control orgasmic urge during partnered sex, resulting in ejaculation within one minute of penetration. In international studies, more than 20-30% of males 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.
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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.
Is Premature Ejaculation a Type of Sexual Dysfunction?
Premature ejaculation is a type of sexual dysfunction in that someone is unable to hold ejaculation for more than 1-2 minutes after penetration or beginning any sexual activity. This is different from erectile dysfunction (ED) as ED is an inability to maintain an erection. While both are technically classified as sexual dysfunctions, they are remarkably different.
Is Premature Ejaculation Harmful or a Sign of a Medical Problem?
PE itself is not harmful or a medical problem in itself, however PE can cause someone distress and may need to be addressed. PE can be linked with ED, however not everyone with PE has ED. PE can also lead to pelvic pain and vice versa, as pain can be limiting when trying to have a sexual experience. There are other medical issues such as thyroid problems and drug use that can impact the severity of PE.
How Common Is Premature Ejaculation?
PE is very common. Although many men may not publicly discuss or speak up about this, it is the most common type of sexual dysfunction experienced by males. Although estimates vary, one in three males 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.
What Time Frame Medically Defines Ejaculation as Premature?
“Premature” in PE refers to ejaculation before a man is wanting to ejaculate, so there is a lot of subjectivity in that range. There isn’t a specific time frame, but it is generally described as within two minutes of penetration. Usually PE leaves at least one partner feeling unsatisfied or stressed.
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 five minutes.3
Symptoms of Premature Ejaculation
The main symptom of premature ejaculation is a persistent and recurrent inability to control orgasm during penetrative sex, resulting in ejaculation prior to or within one minute of penetration.
In order to meet the diagnostic criteria for premature ejaculation, the inability to control orgasm must:1
- Have been present for at least six 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
When to See a Doctor
If you feel you are ejaculating sooner than you would like to during sexual intercourse or sexual activity, it may be time to see a doctor. A doctor will help you review all your symptoms against PE criteria to help make sense of the symptoms and determine if it is a symptom of something larger or a true PE diagnosis. It’s important to know that PE is common from time to time and treatments can help.
What Causes Premature Ejaculation?
There is no current research to substantiate any theories regarding a consistent root cause for premature ejaculation, but there are theories about several potential causes, such as:4
- Sudden onset of PE may be related to thyroid or prostate dysfunction
- Recreational drug use may be a component in sudden onset PE
- Higher sensitivity to sexual stimulation and/or psychological triggers
- Anxiety
- Depression
- Stress
- Trauma
Complications 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 relational or psychological distress, like orgasm anxiety.
People experiencing PE may identify with the following repercussions of this disorder:2
- Loss of self-esteem/feelings of inadequacy
- Inability to achieve an erection due to performance anxiety
- Loss of libido or desire for sex due to sexual anxiety
People in relationships may find that:2
- 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 males typically care more than their female heterosexual partners about PE)
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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.
Sex Therapy
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.
Topical Analgesics
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 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.4
Medications
Medications should be sought as a last resort, as they frequently have side effects that other treatment approaches will not have. Your primary care provider or urologist will determine if medication would be appropriate as an adjunct to counseling or behavioral techniques. Typical medications for premature ejaculation include Selective Serotonin Reuptake Inhibitors (SSRIs), oral analgesics, and phosphodiesterase-5 inhibitors (PDE5s).
How to Get Help for Premature Ejaculation
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. 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.
Finding a Sex Therapist
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 finding 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.
Cost of Sex Therapy
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.
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What to Try At Home
There are several techniques and exercises you can try on your own or with a partner that can help delay ejaculation.
Wearing a Condom
The use of condoms in penetrative sex can reduce sensation, which often allows males 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 males.5 People 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 males, the refractory period tends to be between 12-24 hours.6 Masturbating prior to sex, for some males even on the same day, can prolong the time between penetration and orgasm. For some, 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, 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.7 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 males; long term benefits are less clear.8
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.5 Although Kegel exercises are typically recommended for females, males 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.
What’s the Outlook for Those With Premature Ejaculation?
The outlook for those with PE is positive as there are many interventions, treatments and strategies available. It’s important to take time and ensure that you have a good understanding of what PE is and to seek treatment if you are in distress about it. Those with PE may have to make some lifestyle changes or try medications or therapy, but it’s very possible and probable that if you stick to these changes, you can have a very fulfilling sexual life.
Premature Ejaculation Statistics
The prevalence of males reporting issues with early ejaculation has consistently been high and remains one of the most commonly reported sexual issues.
Here are some statistics regarding premature ejaculation:
- Approximately 1 in 3 men report experiencing early ejaculation issues in their lifetime3,4
- In international studies, more than 20-30% of men ages 18-70 report concern about how rapidly they ejaculate1
- 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 disorder1
- Men typically care more than their female heterosexual partners about their Premature Ejaculation.2
Additional Resources
Education is just the first step on our path to improved mental health and emotional wellness. To help our readers take the next step in their journey, Choosing Therapy has partnered with leaders in mental health and wellness. Choosing Therapy may be compensated for marketing by the companies mentioned below.
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