Premature Ejaculation: Causes and Treatment

What counts as premature ejaculation

Many men ejaculate quickly on occasion, especially with a new partner or after a long break. That is normal. Doctors diagnose PE when three things are present:

1. Short time: ejaculation usually happens within about 1 minute of penetration (lifelong PE), or there is a clear drop to about 3 minutes or less (acquired PE).
2. Little control: you cannot delay ejaculation on all or nearly all occasions.
3. Negative effects: distress, frustration, avoidance of sex or relationship strain.

For comparison, studies measuring the time from penetration to ejaculation find a median of about 5 to 6 minutes in men without PE, with a wide range.

Types of premature ejaculation

Causes

Psychological factors

• Performance anxiety: worrying about lasting long enough creates a cycle of anxiety and quicker ejaculation.
• Stress and depression.
• Relationship problems or unresolved conflict.
• Early sexual experiences where finishing quickly was learned, for example from fear of being discovered.
• Guilt or shame about sex.

Physical factors

• Erectile dysfunction: men who worry about losing their erection may rush to ejaculate. Treating erectile dysfunction often improves PE.
• Prostatitis: inflammation of the prostate is linked to acquired PE, sometimes with pain.
• Thyroid problems: an overactive thyroid (hyperthyroidism) is associated with PE.
• Genetic and neurochemical factors: differences in serotonin signaling in the brain likely explain much lifelong PE.
• Penile hypersensitivity.
• Withdrawal from some medicines or opioids.

How PE is diagnosed

A primary care doctor or urologist diagnoses PE from your history. They will ask how long you usually last, whether it has always happened, whether it happens with masturbation or only with a partner, how much control you have, and about erections, relationships, mood, medicines and alcohol. A short questionnaire such as the Premature Ejaculation Diagnostic Tool may be used. A physical exam checks the genitals and prostate. Blood tests are not routine but thyroid tests may be done for acquired PE.

Treatment

Most men improve with one or a combination of the following.

Behavioral techniques

These retrain the body's response and work best with a supportive partner. Practice during masturbation first, then with a partner.

• Stop-start technique: stimulate until you feel close to the point of no return, stop until the urge passes (about 30 seconds), then restart. Repeat 3 to 4 times before allowing ejaculation.
• Squeeze technique: at the same point, you or your partner squeeze the head of the penis where it meets the shaft for several seconds until the urge fades.
• Pelvic floor (Kegel) exercises: strengthening the muscles you use to stop urinating can improve control. Contract for 3 seconds, relax for 3 seconds, 10 times, 3 times a day. Benefits appear over about 12 weeks.
• Change position or pace: positions with less friction or where you are less aroused, and slower movements, can help.

Numbing products

• Topical anesthetic sprays or creams containing lidocaine, prilocaine or benzocaine reduce sensitivity. Apply 5 to 20 minutes before sex as directed on the label, and wipe off or use a condom to avoid numbing your partner.
• Desensitizing condoms contain a small amount of anesthetic inside the tip. Thicker condoms also reduce sensation.

Side effects include numbness and, if overused, loss of erection.

Medicines

• SSRIs: certain antidepressants delay ejaculation and are the most effective medical treatment. They are prescribed off-label in the US, either daily or a few hours before sex. Dapoxetine, a short-acting SSRI designed for PE, is approved in many countries but not in the US.
• PDE5 inhibitors such as sildenafil or tadalafil are helpful when PE comes with erectile dysfunction.
• Tramadol is sometimes used, but its risk of dependence limits its use.

Your doctor will explain side effects such as nausea, dizziness and reduced libido.

Counseling and sex therapy

Psychosexual or couples therapy addresses anxiety, relationship issues and expectations. It works well combined with behavioral techniques or medicines, especially when psychological factors are prominent. See psychosexual disorders.

Treating the underlying cause

Treating prostatitis, a thyroid problem or erectile dysfunction often resolves acquired PE.

Tips that help many men

• Masturbate 1 to 2 hours before sex.
• Focus on foreplay and other ways to give pleasure, which reduces pressure on penetration.
• Talk openly with your partner. Reducing anxiety is part of the treatment.
• Limit alcohol, which can impair erections and control.
• Avoid unproven supplements sold online, some of which contain hidden prescription drugs.

Frequently asked questions

What counts as premature ejaculation?

Doctors define PE as regularly ejaculating within about 1 minute of penetration (or about 3 minutes if it developed later), with little ability to delay it and distress as a result. Occasional quick ejaculation is normal and is not PE.

What causes premature ejaculation?

Lifelong PE is mainly linked to genetics and differences in serotonin signaling. Acquired PE is often linked to anxiety, relationship problems, erectile dysfunction, prostatitis or thyroid problems. Psychological and physical factors often combine.

Can premature ejaculation be cured?

Many men improve significantly, and acquired PE often resolves when its cause is treated. Lifelong PE is usually controlled rather than cured, using techniques, numbing products or medicine. A combination of approaches works best.

How can I last longer in bed naturally?

The stop-start and squeeze techniques, pelvic floor exercises, masturbating a couple of hours beforehand, using thicker condoms, slowing down and changing positions all help. Reducing performance anxiety through open communication with your partner is also important.

Is premature ejaculation linked to erectile dysfunction?

Yes. Many men with erectile dysfunction ejaculate quickly because they rush before losing their erection. Treating erectile dysfunction, for example with a PDE5 inhibitor, often improves ejaculatory control as well.