Premature Ejaculation

What is Premature Ejaculation?

According to the International Society of Sexual Medicine, premature ejaculation (PE) is a sexual dysfunction characterized by a short ejaculatory latency (time from penetration to ejaculation), a perceived lack of control about the timing of ejaculation, and distress and interpersonal difficulty related to ejaculating too quickly. 

PE is generally divided into two types:

• Lifelong PE, in which symptoms have been present for all or most of a person’s sex life.

• Acquired PE, in which PE symptoms develop later in life after a period of normal ejaculatory latency.

And how common is premature ejaculation? Research shows that it's one of the most common forms of sexual dysfunction, affecting as many as 39 percent of the male population (although reports vary). It can affect men of all ages and may potentially contribute to everything from frustration during sex to issues such as depression.

As a medical condition, premature ejaculation is sometimes referred to as “rapid ejaculation” or “early ejaculation.” On the opposite end of the ejaculation trouble spectrum, you'll find delayed ejaculation or delayed orgasm — but those are topics for another day.

No matter what you choose to call it, premature ejaculation is a serious issue that can have significant personal consequences for both your sex life and your general well-being.

Premature Ejaculation Symptoms

The most significant symptoms of premature ejaculation are reaching orgasm and ejaculating very quickly during sexual activity.

If you think you might be dealing with premature ejaculation, some of the symptoms you may experience include:

• You ejaculate very soon after penetration. Mild PE typically involves ejaculating one to two minutes after penetration. In contrast, severe PE can involve ejaculating before you insert your penis into your sexual partner.

• You don’t want to ejaculate this early. For example, you aren’t in a hurry to finish during sex and would prefer to have sex for longer, but doing so is difficult or impossible.

• You feel distressed because of your early ejaculation. You might feel less interested in having sex due to embarrassment or anxiety, feel like you have a low sex drive or feel as if your short time to ejaculate affects your general quality of life.

However, it's important to remember that reaching orgasm and ejaculating quickly happens to everyone from time to time. To be considered premature ejaculation, these symptoms must occur during most or all sexual activity.

Not all cases of ejaculating early are explicitly viewed as premature ejaculation. For example, if you want to reach orgasm quickly during sex, this typically isn't considered a form of ejaculatory dysfunction.

However, if you often ejaculate within a minute or two of penetration, feel unhappy or concerned about it, or simply feel as if you don’t have normal ejaculation control or sexual stamina, you could be affected by some form of premature ejaculation.

Premature Ejaculation Causes

What causes premature ejaculation? Researchers believe that a range of factors could all contribute to premature ejaculation in certain ways, from physical factors to psychological ones. 

As with other sexual function issues (like erectile dysfunction), there are many widely shared — but scientifically inaccurate — “theories” about why PE develops in men.

You may have read that premature ejaculation occurs when you don’t have sex on a frequent enough basis or are using the wrong bedroom techniques. However, there's no scientific backing to support either of these hypotheses.

The reality is that researchers still aren’t sure what causes premature ejaculation to develop, nor is there a one-size-fits-all explanation for premature ejaculation and other forms of sexual dysfunction in men.

Physical Causes of Premature Ejaculation

Certain physical and biological factors may cause or contribute to premature ejaculation. These include:

• Abnormal hormone levels. Certain hormones, such as prolactin, luteinizing hormone (LH), and thyroid stimulating hormone (TSH) may contribute to premature ejaculation.

• Abnormal serotonin levels. Research suggests that low levels of the neurotransmitter serotonin may shorten the amount of time required to reach orgasm and ejaculate.

• Inflammation and/or infection. Infections and/or inflammation that affect your prostate or urethra may affect your sexual function and contribute to premature ejaculation.

Some experts also believe that the physical sensitivity level of your penis may play a role in the amount of time it takes for you to reach orgasm and ejaculate during sex.

Psychological Causes of Premature Ejaculation 

Research suggests that psychological factors may contribute to several different types of sexual dysfunction, including premature ejaculation.

Psychological factors linked to PE include:

• Depression

• Stress 

• Anxiety 

• Guilt 

• Poor body image 

• A lack of confidence

• A history of sexual abuse

Premature ejaculation may also be caused by performance anxiety, a form of anxiety related to sexual performance that can also play a role in issues such as erectile dysfunction (ED).

Premature Ejaculation Risk Factors

Just like researchers don’t exactly understand the causes of premature ejaculation, it can also be difficult to pinpoint the risk factors. Having a physical or mental health condition that could cause PE — such as abnormal hormone levels or stress — puts you at an increased risk.

Additionally, ED is sometimes considered a risk factor for PE. People with erectile dysfunction have difficulty getting or maintaining an erection that’s hard enough for satisfying sex. 

This could be a risk factor for PE because if you have ED, you might feel compelled to “rush” through sex in the hopes that your erection lasts the whole time, even if you aren’t conscious of doing so. The end result might be ejaculating much sooner than you'd like.

Premature Ejaculation Diagnosis

Because the average time to ejaculate can vary so much from one man to another, PE can be a challenging condition to diagnose. 

To be diagnosed with premature ejaculation, you’ll typically need to have the symptoms listed above — such as rapid ejaculation after penetrating your partner and some level of distress due to your lack of ejaculatory control — and experience those symptoms consistently for at least six months.

Your symptoms will also need to occur without a clear explanation, such as medication or drug use, a related medical condition, or an issue in your relationship that affects your sexual function and performance.

Confusing PE Symptoms With Common Experiences

In some cases, you may reach orgasm and ejaculate earlier than you’d like to, even if you don’t have clinical premature ejaculation.

It’s not uncommon to ejaculate relatively quite quickly if you haven’t had sex in a long time. In this situation, it’s normal to feel more sexually aroused than usual and reach orgasm faster than you typically might because of it.

It’s also common to feel as if you reach orgasm and ejaculate too fast, even if your ejaculatory latency time (the time it takes you to ejaculate) is within the normal range.

During a consultation for PE, your healthcare provider may ask you about your sexual history to determine how long you’ve been affected by these symptoms.

Lifelong vs. Acquired Premature Ejaculation

As we mentioned above, premature ejaculation can be lifelong (meaning it’s present since your first sexual encounter) or acquired (meaning it develops after some amount of normal sexual function). It can also occur generally or in certain situations, such as when you have sex with a specific partner.

If your healthcare provider asks you questions about your average time to ejaculation, “success rate” during sex, or about other factors that may play a role in ejaculation, try to answer them as clearly and honestly as you can.

While ejaculation can be an embarrassing and awkward topic to discuss, keep in mind that your healthcare provider is there to help you — not to make any assumptions about your general sexual life or current relationship.

The more information you can provide and the more accurately you can answer your provider’s questions, the more likely it is that they’ll be able to provide an accurate diagnosis, help you to overcome PE, and improve your sexual experiences.

Premature Ejaculation Treatment

Is premature ejaculation treatable? Although premature ejaculation can be frustrating to deal with, there are a variety of different techniques are used as treatments for premature ejaculation, including several types of medication, behavioral techniques, and counseling.

Antidepressants For Premature Ejaculation

Currently, there are no medications that are approved by the U.S Food and Drug Administration (FDA) specifically as treatments for premature ejaculation. However, your healthcare provider — likely a urologist — may treat premature ejaculation off-label with a class of antidepressants called selective serotonin reuptake inhibitors, or SSRIs.

Research shows that SSRIs may help men last longer.

For example, in one study from 1998, men affected by premature ejaculation who were treated with sertraline — an SSRI — observed an increase in their average ejaculatory interval (the amount of time before reaching orgasm and ejaculating) from one minute to a maximum of 16.4 minutes.

Sertraline, the generic for Zoloft®, is one of the most widely used SSRIs for premature ejaculation.

Other SSRIs prescribed by providers off-label to treat PE include: 

• Escitalopram

• Fluoxetine

• Paroxetine

Like other SSRIs, sertraline can cause side effects. 

We offer sertraline as a treatment for premature ejaculation online, following a consultation with a licensed healthcare professional who will determine if a prescription is appropriate for you.

Erectile Dysfunction (ED) Medications for Premature Ejaculation

Research shows that some medications for erectile dysfunction may also help with premature ejaculation. Namely, these are the phosphodiesterase type 5 inhibitors (PDE5 inhibitors).

For example, several studies have found that sildenafil, the active ingredient in Viagra® or generic Viagra, either increases ejaculatory latency time or improves sexual satisfaction and self-confidence in men affected by PE.

There are several proposed mechanisms for how PDE5 inhibitors could help with PE. They might have actions on the sensitivity of the penis, the muscles involved in ejaculation, or the nervous system. 

Our full guide to sildenafil and premature ejaculation goes into more detail about these treatments, as well as the potential benefits they may offer.

In addition to sildenafil, other medications for treating ED include

• Tadalafil (the active ingredient in Cialis®) 

• Vardenafil (the active ingredient in Levitra®) 

• Avanafil (only available as brand name Stendra®)

We offer numerous oral ED medications online, following a consultation with a licensed healthcare provider who will determine if a prescription is appropriate.

Creams, Sprays, and Wipes for Premature Ejaculation

Premature ejaculation is often treatable using topical creams, sprays, and wipes that alter the sensitivity level of your penis.

These products are designed for use before sex and contain topical anesthetics like lidocaine, benzocaine, or prilocaine. The ingredients are absorbed by the skin on your penis to limit sensitivity without affecting your partner.

Research shows that sprays, wipes, and anesthetic creams for PE can slow down the process of reaching orgasm and ejaculating.

One placebo-controlled study found that benzocaine wipes significantly increased time to ejaculation in men with premature ejaculation when applied to the penis before sex.

Unlike SSRIs and PDE5 inhibitors that require a prescription, most creams, sprays, and wipes for premature ejaculation are available over the counter.

Our Delay Spray for Men, which contains lidocaine, is available online as a convenient option for reducing sensitivity, which can help increase ejaculatory latency. We also offer Clockstopper Climax Delay Wipes, formulated with benzocaine.

Behavioral Therapy for Premature Ejaculation

Behavioral therapy involves identifying unhealthy or harmful behaviors and then taking meaningful steps to change them. When this type of therapy is used to treat sexual health issues like premature ejaculation, it’s often referred to as sex therapy.

Behavioral therapy for PE may involve a combination of psychotherapy and physical techniques to delay or prevent ejaculation.

Common physical techniques involve the “stop-start” approach, which involves stopping during sex to prevent orgasm and ejaculation, and then starting again after the urge goes away. Another is the “squeeze technique", which involves squeezing the penis where the head meets the shaft during a pause in sex.

You can learn more about these techniques and their effects in our guide to home remedies for premature ejaculation.

Some physical exercises that strengthen the muscles around your penis and bladder may help improve ejaculatory control and reduce the severity of premature ejaculation.

Research shows that kegel exercises — exercises that involve training your pelvic floor muscles — can improve control over ejaculatory reflex and increase ejaculatory latency for men with PE.

Counseling for Premature Ejaculation

Counseling is a helpful and effective treatment option for many sexual function issues, including premature ejaculation.

During counseling, you’ll work with a mental health provider or sex therapist to discuss your PE symptoms, their effects on your quality of life, and the factors that you think may contribute to them, such as relationship or sexual problems.

Over time, counseling can help you gain control over your feelings and deal with issues that could play a role in premature ejaculation, such as sexual performance anxiety or body image issues.

Premature Ejaculation Prevention Tips

Although there’s limited research on the most effective ways to prevent premature ejaculation, living a physically and mentally healthy lifestyle can help improve your sexual performance and reduce your risk of developing many common sexual issues.

Try to:

• Exercise regularly. Research shows that men who exercise regularly are less likely to experience premature ejaculation than those with a sedentary lifestyle. While there’s no need to train like an Olympian, maintaining a regular workout routine can improve your physical health and sexual performance.

• Focus on your mental health. Like other sexual issues, premature ejaculation often occurs at the same time as mental health issues like depression or certain anxiety disorders. If you’re concerned about premature ejaculation, focus on improving and maintaining your mental health. 

If you’re affected by premature ejaculation or if you simply think you reach orgasm too early, you can also try the following techniques to enhance your sexual experiences.

• Masturbate before sex. Many men find that they’re more able to delay ejaculation on “round two.” If you’re prone to PE, try masturbating a few hours before sex — just make sure to keep your refractory period (the time after orgasm during which it is difficult or impossible to orgasm again) in mind.

• Use premature ejaculation condoms. Some condoms contain a topical anesthetic to reduce sensitivity, which may allow you to last longer during sex. You can find these in most convenience stores and supermarkets.

• Talk to your partner. When premature ejaculation is caused by a psychological issue or a problem in your sexual relationship, talking openly and honestly with your partner may help you overcome it together. Deciding to focus on foreplay, for example, is one way you can extend your intimate time together and have other types of sexual stimulation.