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Premature Ejaculation: Symptoms, Causes and Treatment

Mike Bohl, MD, MPH, ALM

Reviewed by Mike Bohl, MD

Written by Geoffrey C. Whittaker

Published 05/14/2018

Updated 02/22/2024

Research shows that premature ejaculation, or PE, is one of the most common forms of sexual dysfunction, affecting as much as 39 percent of the male population (although reports are subjective and estimates vary widely). 

Plenty of men worry whether things like penile sensitivity or psychological issues like depression or performance anxiety might be behind their less-than-ideal bedroom performance — and that’s completely normal.

Here’s the good news: while premature ejaculation might negatively affect your sex life in the short term, it’s usually treatable with a combination of medication, therapy and/or simple lifestyle changes.

Below, we’ve explained what premature ejaculation is, the potential causes, symptoms of premature ejaculation, as well as your options for treating premature ejaculation.

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According to the Diagnostic and Statistical Manual of Mental Disorders (DSM–5), PE is any type of ejaculation that occurs "during partnered sexual activity with approximately 1 minute following vaginal penetration and before the individual wishes it, during all or almost all sexual activity." Some sources distinguish lifelong premature ejaculation from acquired ejaculation, which occurs within 3 minutes of vaginal penetration.

So much for a concrete premature ejaculation definition, eh?

Despite its vague clinical definition, it’s pretty straightforward stuff: premature ejaculation is a common male sexual function issue in which you may reach orgasm and ejaculate early during sexual encounters. It can affect men of all ages, and can potentially contribute to everything from frustration during sex to issues such as depression.

Simply put, premature ejaculation occurs when you lack control over ejaculation, causing you to reach orgasm and ejaculate too early during sexual intercourse or other sexual activity.

As a medical condition, premature ejaculation is sometimes referred to as “rapid ejaculation” or “early ejaculation.” No matter what you choose to call it, it’s a serious issue that can have major personal consequences — both for your sex life and general well-being.

The most significant symptom of premature ejaculation is reaching orgasm and ejaculating very quickly during sexual activity — typically, in one minute or less after penetration.

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.

To be thought of as premature ejaculation (rather than simply reaching orgasm and ejaculating quickly, which can happen during normal sexual activity), ejaculation normally needs to happen before the affected person would like it to during most or all sexual activity.

If you’re affected by premature ejaculation, you may experience some or all of these symptoms:

  • You ejaculate very soon after penetration, or even before.

  • 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 find doing so difficult or impossible.

  • You feel distressed because of your early ejaculation. For example, 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.

To some extent, the jury is out on the exact amount of time that defines ejaculation as normal or premature.

While one minute might be the common standard, some experts use a slightly longer amount of time and define premature ejaculation as orgasm and ejaculation that occurs within three minutes of vaginal penetration.

Others use less specific, more subjective definitions. For example, some researchers define PE based on the satisfaction level of the female partner.

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

However, if you often ejaculate within a minute 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.

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What causes premature ejaculation? Just like with other sexual function issues such as erectile dysfunction, there are lots of widely shared but scientifically inaccurate “theories” about why PE develops in men.

Researchers believe that a range of factors could all contribute to premature ejaculation in certain ways, from physical factors to psychological ones. Physical factors might include prostate inflammation, alcohol and drug use and differences in anatomy that make the penis more sensitive. Psychological causes could include depression, anxiety and other psychological disturbances.

You may have read that premature ejaculation occurs when you don’t have sex on a frequent enough basis, or if you have some kind of problem with your sexual technique.

The reality is that researchers aren’t yet aware of exactly 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.

Put simply, most of the time, there’s no singular cause that your healthcare provider can point to as the problem behind this common condition.

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 and 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).

As we said above, premature ejaculation is common — probably more common than you think. Although data vary widely, some self-reported studies suggest that from four to 39 percent of men are affected by premature ejaculation at some point in life.

Other research suggests that up to 75 percent of otherwise healthy adult men experience some level of premature ejaculation.

In short, if you experience premature ejaculation, you definitely aren’t alone, nor should you feel alarmed. Premature ejaculation is highly common and happens in men of all ages, backgrounds and sexual experience levels.

Interestingly, despite many guys’ fears, research suggests that premature ejaculation really isn’t that big of a deal for most women.

One study published in the journal Archives of Sexual Behavior, which used data from more than 150 heterosexual couples, concluded that men view rapid ejaculation as more of an issue and potential cause of relationship problems than their female partners.

This study also revealed that while rapid ejaculation is typically associated with lower levels of sexual satisfaction, it doesn’t appear to cause significant interpersonal relationship issues.

So, take a deep breath. And then keep reading.

Because the average time to ejaculate can vary so much from one man to another, PE can be a challenging condition to diagnose. People can have different expectations when it comes to sex, and there isn’t a clear, agreed-upon definition of PE.

To be diagnosed with premature ejaculation, you’ll typically meet with a sex therapist or another health professional like a urologist to discuss your symptoms.

You’ll need to experience symptoms such as rapid ejaculation after penetrating your partner and some level of distress due to your lack of ejaculatory control for a diagnosis.

Your symptoms will also need to happen 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.

Because it’s normal to occasionally reach orgasm and ejaculate faster than you might like, you’ll typically need to display symptoms for at least six months to be diagnosed with PE.

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.

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, it’s important to 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 and help you to overcome PE and improve your sexual performance.

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 a competitive athlete, 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 such as depression or some 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.

  • 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 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 to overcome it together.

Although premature ejaculation can be frustrating to deal with, the good news is that it’s usually treatable, allowing you to increase your sexual stamina and enjoy a higher sexual quality of life with the right approach.

A variety of different techniques are used to treat 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, premature ejaculation is often treated off-label with a class of antidepressants called selective serotonin reuptake inhibitors, or SSRIs, as one of the most common “side effects” of these medications is delayed ejaculation.

If you normally ejaculate in a short amount of time, an SSRI — like escitalopram, sertraline, fluoxetine, paroxetine and others — may help you last longer and enjoy more fulfilling, satisfying sex.

Sertraline for Premature Ejaculation

We already mentioned antidepressants, so what makes sertraline so special?

Well, sertraline, the active ingredient in Zoloft®, is one of the most widely-used SSRIs for premature ejaculation.

Although sertraline isn’t designed specifically to treat PE, numerous studies have found that it’s effective at delaying ejaculation and increasing intravaginal ejaculatory latency time.

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

Like other SSRIs, sertraline can cause side effects. However, for many men, it’s an effective and helpful treatment that allows for more fulfilling, satisfying sex.

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

Creams and Sprays for Premature Ejaculation

Premature ejaculation is often treatable using topical creams, wipes and sprays containing topical anesthetics such as lidocaine, benzocaine or prilocaine and are designed for use before sex. The ingredients are absorbed by the skin on your penis to limit sensitivity without affecting your partner.

Like with SSRIs, research shows that sprays and anesthetic creams for PE can slow down the process of reaching orgasm and ejaculating.

Unlike SSRIs, which require a prescription, most creams, wipes and sprays 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, increasing stamina and improving your sexual function.

Behavioral Therapy for Premature Ejaculation

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

Studies have found that a combination of psychotherapy and medication can be more effective for treating PE than medication alone.

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 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.

For example, research shows that kegel exercises — exercises that involve training your pelvic floor muscles — can improve control over the 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 to discuss your PE symptoms, their effects on your quality of life and the factors that you think may contribute to them.

Over time, counseling can help you to 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.

We offer mental health services, allowing you to talk to a provider from the privacy and comfort of your own home.

Erectile Dysfunction (ED) Medications for Premature Ejaculation

Research shows that some medications for erectile dysfunction, or ED, may also offer benefits as medical treatment for premature ejaculation.

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.

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 (Levitra®) and avanafil (Stendra®).

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

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Premature ejaculation is a common, normal form of sexual dysfunction that can affect men of all ages and backgrounds. It can be a serious annoyance when it occurs, but the good news is that options are available to help you bring it under control and improve your sexual function.

Most of the time, premature ejaculation can be treated with behavioral therapy, evidence-based prescription medications such as sertraline or sildenafil, or over-the-counter products such as sprays, wipes, creams and condoms.

In some cases, making changes to your lifestyle or practicing certain techniques could also help you increase control over your orgasms and ejaculation.

If you have premature ejaculation, it’s best to talk to a healthcare provider about your options for increasing ejaculatory time and improving your sexual performance.

You can also take part in an online consultation for premature ejaculation to talk to a healthcare provider and, if appropriate, access our range of premature ejaculation treatments.

10 Sources

  1. McMahon, C.G. (2007). Premature Ejaculation. Indian Journal of Urology. 23 (2), 97-108. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2721550/
  2. Crowdis, M. & Nazir, S. (2022, June 27). Premature Ejaculation. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK546701/
  3. Byers, E.S. & Grenier, G. (2003, June). Premature or rapid ejaculation: heterosexual couples' perceptions of men's ejaculatory behavior. Archives of Sexual Behavior. 32 (3), 261-270. Retrieved from https://pubmed.ncbi.nlm.nih.gov/12807298/
  4. McMahon, C.G. (1998, September). Treatment of premature ejaculation with sertraline hydrochloride. International Journal of Impotence Research. 10 (3), 181-185. Retrieved from https://pubmed.ncbi.nlm.nih.gov/9788108/
  5. El-Hamd, M.A. (2021, January). Effectiveness and tolerability of lidocaine 5% spray in the treatment of lifelong premature ejaculation patients: a randomized single-blind placebo-controlled clinical trial. International Journal of Impotence Research. 33 (1), 96-101. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31896832/
  6. Althof, S.E. (2016, August). Psychosexual therapy for premature ejaculation. Translational Andrology and Urology. 5 (4), 475-481. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5001981/
  7. Pastore, A.L., et al. (2014, June). Pelvic floor muscle rehabilitation for patients with lifelong premature ejaculation: a novel therapeutic approach. Therapeutic Advances in Urology. 6 (3), 83-88. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4003840/
  8. Wang, W.F., Wang, Y., Minhas, S. & Ralph, D.J. (2007, April). Can sildenafil treat primary premature ejaculation? A prospective clinical study. International Journal of Urology: Official Journal of the Japanese Urological Association. 14 (4), 331-335. Retrieved from https://pubmed.ncbi.nlm.nih.gov/17470165/
  9. McMahon, C.G., et al. (2005, May). Efficacy of sildenafil citrate (Viagra) in men with premature ejaculation. The Journal of Sexual Medicine. 2 (3), 368-375. Retrieved from https://pubmed.ncbi.nlm.nih.gov/16422868/
  10. Yildiz, Y., Kilinc, M.F. & Doluoglu, O.G. (2018, September). Is There Any Association Between Regular Physical Activity and Ejaculation Time? Urology Journal. 15 (5), 285-289. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29681052/
Editorial Standards

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Mike Bohl, MD

Dr. Mike Bohl is a licensed physician, a Medical Advisor at Hims & Hers, and the Director of Scientific & Medical Content at a stealth biotech startup, where he is involved in pharmaceutical drug development. Prior to joining Hims & Hers, Dr. Bohl spent several years working in digital health, focusing on patient education. He has also worked in medical journalism for The Dr. Oz Show (receiving recognition for contributions from the National Academy of Television Arts and Sciences when the show won Outstanding Informative Talk Show at the 2016–2017 Daytime Emmy® Awards) and at Sharecare. He is a Medical Expert Board Member at Eat This, Not That! and a Board Member at International Veterinary Outreach.

Dr. Bohl obtained his Bachelor of Arts and Doctor of Medicine from Brown University, his Master of Public Health from Columbia University, and his Master of Liberal Arts in Extension Studies—Journalism from Harvard University. He is currently pursuing a Master of Business Administration and Master of Science in Healthcare Leadership at Cornell University. Dr. Bohl trained in internal medicine with a focus on community health at NYU Langone Health.

Dr. Bohl is Certified in Public Health by the National Board of Public Health Examiners, Medical Writer Certified by the American Medical Writers Association, a certified Editor in the Life Sciences by the Board of Editors in the Life Sciences, a Certified Personal Trainer and Certified Nutrition Coach by the National Academy of Sports Medicine, and a Board Certified Medical Affairs Specialist by the Accreditation Council for Medical Affairs. He has graduate certificates in Digital Storytelling and Marketing Management & Digital Strategy from Harvard Extension School and certificates in Business Law and Corporate Governance from Cornell Law School.

In addition to his written work, Dr. Bohl has experience creating medical segments for radio and producing patient education videos. He has also spent time conducting orthopedic and biomaterial research at Case Western Reserve University and University Hospitals of Cleveland and practicing clinically as a general practitioner on international medical aid projects with Medical Ministry International.

Dr. Bohl lives in Manhattan and enjoys biking, resistance training, sailing, scuba diving, skiing, tennis, and traveling. You can find Dr. Bohl on LinkedIn for more information.

Publications

  • Younesi, M., Knapik, D. M., Cumsky, J., Donmez, B. O., He, P., Islam, A., Learn, G., McClellan, P., Bohl, M., Gillespie, R. J., & Akkus, O. (2017). Effects of PDGF-BB delivery from heparinized collagen sutures on the healing of lacerated chicken flexor tendon in vivo. Acta biomaterialia, 63, 200–209. https://www.sciencedirect.com/science/article/abs/pii/S1742706117305652?via%3Dihub

  • Gebhart, J. J., Weinberg, D. S., Bohl, M. S., & Liu, R. W. (2016). Relationship between pelvic incidence and osteoarthritis of the hip. Bone & joint research, 5(2), 66–72. https://boneandjoint.org.uk/Article/10.1302/2046-3758.52.2000552

  • Gebhart, J. J., Bohl, M. S., Weinberg, D. S., Cooperman, D. R., & Liu, R. W. (2015). Pelvic Incidence and Acetabular Version in Slipped Capital Femoral Epiphysis. Journal of pediatric orthopedics, 35(6), 565–570. https://journals.lww.com/pedorthopaedics/abstract/2015/09000/pelvic_incidence_and_acetabular_version_in_slipped.5.aspx

  • Islam, A., Bohl, M. S., Tsai, A. G., Younesi, M., Gillespie, R., & Akkus, O. (2015). Biomechanical evaluation of a novel suturing scheme for grafting load-bearing collagen scaffolds for rotator cuff repair. Clinical biomechanics (Bristol, Avon), 30(7), 669–675. https://www.clinbiomech.com/article/S0268-0033(15)00143-6/fulltext

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