Premature ejaculation

Premature ejaculation is a common sexual complaint. Many men occasionally ejaculate sooner during sexual intercourse than they or their partner would like. Estimates vary, but as many as one out of three men may be affected by this problem at some time. As long as it happens infrequently, it’s not cause for concern. However, if you regularly ejaculate sooner than you and your partner wish — such as before intercourse begins or shortly afterward — you may have a condition known as premature ejaculation.

Both psychological and biological factors can play a role in premature ejaculation. Although many men feel embarrassed to talk about it, premature ejaculation is a common and treatable condition.

The range of normal from the beginning of intercourse to ejaculation is generally considered to be two to 10 minutes.

Premature ejaculation symptoms

The primary sign of premature ejaculation is ejaculation that occurs before both partners wish, causing concern or distress. However, the problem may occur in all sexual situations, even including during masturbation.

Lifelong premature ejaculation is characterized by:

  • Ejaculation that always or nearly always occurs within one minute or less of vaginal penetration
  • The inability to delay ejaculation on all or nearly all vaginal penetrations
  • Negative personal consequences, such as distress, frustration or the avoidance of sexual intimacy

Premature ejaculation causes

The exact cause of premature ejaculation isn’t known. While it was once thought to be only psychological, we now know premature ejaculation is more complicated and involves a complex interaction of both psychological and biological factors.

Psychological causes
Some doctors believe that early sexual experiences may establish a pattern that can be difficult to change later in life, such as:

  • Situations in which you may have hurried to reach climax in order to avoid being discovered
  • Guilty feelings that increase your tendency to rush through sexual encounters

Other factors that can play a role in causing premature ejaculation include:

Erectile dysfunction. Men who are anxious about obtaining or maintaining their erection during sexual intercourse may form a pattern of rushing to ejaculate which can be difficult to change.
Anxiety. Many men with premature ejaculation also have problems with anxiety — either specifically about sexual performance, or caused by other issues.
Relationship problems. If you have previously had satisfying sexual relationships in which premature ejaculation happened infrequently or not at all, it’s likely that interpersonal issues between you and your current partner are contributing to the problem.

Biological causes
A number of biological factors may contribute to premature ejaculation, including:

  • Abnormal hormone levels
  • Abnormal levels of brain chemicals called neurotransmitters
  • Abnormal reflex activity of the ejaculatory system
  • Certain thyroid problems
  • Inflammation and infection of the prostate or urethra
  • Inherited traits

Rarely, premature ejaculation is caused by:

  • Nervous system damage resulting from surgery or trauma
  • Withdrawal from narcotics or a drug called trifluoperazine (Stelazine) that is used to treat anxiety and other mental health problems

Although both biological and psychological factors likely play a role in most cases of premature ejaculation, experts think a primarily biological cause is more likely if it has been a lifelong problem

In some cases, premature ejaculation may be caused by poor communication between partners or a lack of understanding of the differences between male and female sexual functioning. Women typically require more-prolonged stimulation than men do to reach orgasm, and this difference can cause sexual resentment between partners and add pressure to sexual encounters. For many men, feeling pressure during sexual intercourse increases the risk of premature ejaculation.

Complications

While premature ejaculation doesn’t increase your risk of serious health problems, it can cause problems in your personal life, including:

  • Relationship strains. The most common complication of premature ejaculation is relationship stress. If premature ejaculation is straining your relationship, ask your doctor about including couple’s therapy in your treatment program.
  • Fertility problems. Premature ejaculation can occasionally make fertilization difficult or impossible for couples who are trying to become pregnant. If premature ejaculation isn’t effectively treated, you and your partner may need to consider infertility treatment.

Premature ejaculation diagnosis

In addition to a detailed interview about your sex life, your doctor will want to know about your health history and may perform a general physical exam. He or she may refer you to a urologist who specializes in sexual dysfunction or to a mental health professional to help make the diagnosis.
If you have both premature ejaculation and trouble getting or maintaining an erection, your doctor may order blood tests to check your male hormone (testosterone) levels or other tests.

Premature ejaculation treatment

Treatment options for premature ejaculation include sexual therapy, medications and psychotherapy. For many men, a combination of these treatments works best.

Sexual therapy
In some cases, sexual therapy may involve simple steps, such as masturbating an hour or two before intercourse so that you’re able to delay ejaculation during sex. Your doctor may also recommend avoiding intercourse for a period of time and focusing on other types of sexual play so that pressure is removed from your sexual encounters.

The squeeze technique
Your doctor may instruct you and your partner in the use of a method called the squeeze technique. This method works as follows:

Step 1. Begin sexual activity as usual, including stimulation of the penis, until you feel almost ready to ejaculate.
Step 2. Have your partner squeeze the end of your penis, at the point where the head (glans) joins the shaft, and maintain the squeeze for several seconds, until the urge to ejaculate passes.
Step 3. After the squeeze is released, wait for about 30 seconds, then go back to foreplay. You may notice that squeezing the penis causes it to become less erect, but when sexual stimulation is resumed, it soon regains full erection.
Step 4. If you again feel you’re about to ejaculate, have your partner repeat the squeeze process.

By repeating this as many times as necessary, you can reach the point of entering your partner without ejaculating. After a few practice sessions, the feeling of knowing how to delay ejaculation may become a habit that no longer requires the squeeze technique.

Medications
Certain antidepressants and topical anesthetic creams are used to treat premature ejaculation. Although none of these drugs is specifically approved by the Food and Drug Administration to treat premature ejaculation, some are used for this purpose. You may need to try different medications or doses before you and your doctor find a treatment that works for you.

Antidepressants
A side effect of certain antidepressants is delayed orgasm. Doctors suggest that men who have premature ejaculation can take antidepressants to benefit from this specific side effect.

  • Your doctor may prescribe one of several selective serotonin reuptake inhibitors (SSRIs), such as sertraline (Zoloft), paroxetine (Paxil) or fluoxetine (Prozac), to help delay ejaculation.
  • If the timing of your ejaculation doesn’t improve, your doctor may prescribe the tricyclic antidepressant clomipramine (Anafranil), which also has been shown to benefit men with this disorder.
  • You may not need to take these medications every day to prevent premature ejaculation. Taking a low dose several hours before you plan to have sexual intercourse may be enough to improve your symptoms.

Other side effects of these antidepressants can include nausea, dry mouth, drowsiness and decreased libido.

Topical anesthetic creams
Topical anesthetic creams containing lidocaine or prilocaine dull the sensation on the penis to help delay ejaculation. Applied a short time before intercourse, these creams are wiped off when your penis has lost enough sensation to help you delay ejaculation.

Some men using topical anesthetic creams report reduced sexual pleasure because of lessened sensitivity. Although the cream is wiped off before intercourse, in some studies female partners reported that it also reduced their genital sensitivity and sexual pleasure. In rare cases lidocaine or prilocaine can cause an allergic reaction.

Psychotherapy

This approach, also known as counseling or talk therapy, involves talking with a mental health provider about your relationships and experiences. These talk sessions can help you reduce performance anxiety or find effective ways of coping with stress and solving problems. For many couples affected by premature ejaculation, talking with a therapist together may produce the best results.

Open communication between sexual partners, as well as a willingness to try a variety of approaches to help both partners achieve satisfaction, can help reduce conflict and performance anxiety. If you’re not satisfied with your sexual relationship, talk with your partner about your concerns. Try to approach the topic in a loving way and to avoid blaming your partner for your dissatisfaction.