In recent years, the medical world has improved its recognition and understanding of male sexual dysfunction, including the problems men can experience when engaging in sexual intercourse.
Premature ejaculation (PE) is a form of sexual dysfunction that can adversely affect the quality of a man's sex life.
PE might occasionally complicate reproduction, but it can also adversely affect sexual satisfaction, both for men and their partners.
The information here aims to demystify PE and outline effective treatment options.
Contents of this article:
Fast facts on premature ejaculation
Here are some key points about premature ejaculation. More detail and supporting information is in the main article
- In the majority of cases, an inability to control ejaculation is rarely due to a medical condition, although doctors will need to rule this out
- PE can lead to secondary symptoms such as distress, embarrassment, anxiety, and depression.
- Treatment options range from reassurance from a doctor that the problem might improve in time, through to home methods of "training" the timing of ejaculation
What is premature ejaculation?
Premature ejaculation can cause significant distress.
PE is a form of male sexual dysfunction and means having an orgasm or "climaxing" sooner than wanted.
Medically, the most persistent form of PE (primary or lifelong PE) is defined by the presence of the following three problems:
- Ejaculation always, or nearly always, happening before sexual penetration has been achieved, or within about a minute of penetration
- The man finding an inability to delay his ejaculation every time, or nearly every time, he does achieve penetration
- Negative personal consequences, such as distress and frustration, or avoidance of sexual intimacy
PE can cause a lot of embarrassment in boys and men, with a significant degree of stigma often attached to male sexual performance.
How many men experience premature ejaculation?
Information obtained through surveys puts the "self-reported" prevalence of PE in men as somewhere between 15 percent and 30 percent.
However, the prevalence of medically diagnosed and diagnosable PE is much lower.
This statistical disparity does not in any way diminish the suffering experienced by men who do not meet the strict criteria for diagnosis.
In one analysis of nearly 5,000 men in nine Asia-Pacific countries, 16 percent of men met the criteria for a diagnosis of PE on the five-question Premature Ejaculation Diagnostic Tool (PEDT). Probable PE was found in 15 percent of respondents, while 13 percent of men self-reported PE.
Primary or lifelong PE is the most persistent problem in men and describes a condition where men have rarely experienced sex without prematurely ejaculating. This is the least common form of the condition and is thought to affect around 2 percent of men.
However, more loosely defined, PE remains the most common form of male sexual dysfunction.
Causes of premature ejaculation
Below we will discuss some of the potential causes of PE:
Most cases of PE are not related to any disease and are instead due to psychological factors, including:
- Sexual inexperience
- Novelty of a relationship
- Overexcitement or too much stimulation
- Relationship stress
- Guilty feelings
- Issues related to control and intimacy
These common psychological factors can affect men who have previously had normal ejaculation; such cases are often referred to as secondary, or acquired, PE.
Most cases of the rarer, more persistent form - primary or lifelong PE - are also believed to be caused by psychological problems.
The causes of primary or lifelong PE can often be traced back to early trauma, such as:
- Strict sexual teaching and upbringing
- Traumatic experiences of sex
- Conditioning - for example, a teenager learning to ejaculate quickly to avoid being found masturbating
Medical causes of premature ejaculation
Biological causes of PE are much less common than psychological ones. In rare cases, the cause can be more serious, such as nervous system damage as a result of surgery or physical trauma.
The following are also possible medical causes of PE (doctors will focus on diagnosis and management of the underlying condition first and monitor for improvement in sexual function):
- Multiple sclerosis
- Prostate disease
- High blood pressure (hypertension)
- Thyroid problems
- Illicit drug use
- Excessive alcohol consumption
Symptoms of premature ejaculation
Put simply, PE involves a man ejaculating sooner than he and his partner desire.
Other symptoms that result from the ejaculatory problem include feelings of dissatisfaction and frustration. Those feelings can cause distress.
Premature ejaculation, in some cases, can lead to depression.
These psychological symptoms are secondary to the physical ejaculatory events and can be experienced by a man, his partner, or both.
Secondary symptoms caused by PE include:
- Loss of confidence in the relationship
- Interpersonal difficulty
- Mental distress
Men may be more worried than their partners about premature ejaculation
Men who ejaculate too soon can experience psychological distress, but their anxieties about the effect of PE on their relationship are often greater than the actual effect on their partner(s) and relationship(s).
Sexual partners are typically less worried about PE than the man experiencing PE. One study that looked at 152 men and their female partners found that views differed between the men and women.
In general, women saw PE as less of a problem than did their male partners, although the study did find that both men and women enjoyed less sexual satisfaction if PE was present. However, this did not affect overall contentment for the relationship.
Diagnosis of premature ejaculation
The manual used by psychiatrists and psychologists for making a clinical diagnosis (known as the DSM-V) defines PE as a sexual disorder only when the following description is true:
"Ejaculation with minimal sexual stimulation before or shortly after penetration and before the person wishes it. The condition is persistent or occurs frequently and causes significant distress."
The first step involves the man, or couple, visiting a doctor. This will prompt a conversation designed to "take a history" before any diagnosis can be established.
There is no biological test or device that can confirm PE - instead, the doctor will enquire about the individual's or couple's experiences in order to gain a better understanding of the problem.
A doctor will ask certain questions that are intended to help them assess symptoms, such as asking for an estimate of the time taken before ejaculation occurs (known as latency). Questions might include:
- How often do you experience PE?
- How long have you had this problem?
- Does it happen in every sexual encounter, or only at certain times?
- How much stimulation brings on an ejaculation?
- How has PE affected your sexual activity?
- Can you delay your ejaculation until after penetration?
- Do you or your partner feel annoyed or frustrated?
- How does PE affect your quality of life?
Treatments for premature ejaculation
The good news for most men worried about PE is that the majority of cases have a psychological cause, and a good prognosis.
If the problem occurs at the beginning of a new sexual partnership, the difficulties often resolve as the relationship goes on.
If, however, the problem is more persistent, doctors may recommend treatment in the form of counseling from a therapist specializing in sexual relationships, or "couples therapy."
Pills to treat premature ejaculation
Some medications might help with premature ejaculation.
Although no medications are officially licensed in the United States for use in treating PE, some antidepressants have been found to help some men delay ejaculation.
Doctors will not prescribe any medicines before taking a detailed sexual history to reach a clear diagnosis of PE. Drug treatments can have unwanted side effects and these should be discussed prior to patients taking any medications.
In more than 50 countries, including the United Kingdom, Australia, and New Zealand, dapoxetine (brand name Priligy) (a rapid-acting SSRI) has been given a specific license to treat PE.
While some doctors recommend dapoxetine, in some 'acquired' cases of PE as well as "lifelong" ones, the official license restricts its use to a man who meets all of these criteria:
- Has vaginal sex for less than two minutes before ejaculating
- Persistently or recurrently ejaculates after very little sexual stimulation and before, during, or shortly after initial penetration, and before he wishes to climax
- Has marked personal distress or interpersonal difficulty because of the PE
- Has poor control over ejaculation
- Describes a sexual history of prematurely ejaculating during most attempts at sexual intercourse in the past 6 months
Side-effects from dapoxetine can include nausea, diarrhea, dizziness, and headache.
Drugs applied to the penis to treat premature ejaculation
Another option for men with PE is a topical therapy - applied to the penis before sex, with or without a condom. These local anesthetic creams reduce stimulation:
- Lidocaine or prilocaine cream used 20-30 minutes before intercourse
While using lidocaine or prilocaine can improve the amount of time before ejaculation, longer use of anesthetics can result in numbness and loss of erection. The reduced sensation created by the creams may not be acceptable to the man, and the numbness can affect the woman, too.
Practice can make perfect - home methods to improve ejaculation timing
Here are two methods that - with practice - could be helpful for men who feel they are ejaculating too soon and would like to improve sexual intercourse. They can be tried in the privacy of the home without any other treatment intervention:
- The start-and-stop method - aims to improve a man's control over ejaculation. It means stopping sexual stimulation (by himself or his partner) at the point he feels he is about to have an orgasm.
- The squeeze method - similar to above but the man gently squeezes the end of his penis - or his partner does this for him - for the duration of the 30-second pause before restarting stimulation.
Stimulation then resumes after this feeling has subsided. A man tries to achieve this three or four times, and up to several times, before allowing himself to ejaculate.
Both methods take practice, and if there is a persistent problem with PE, it may be worth talking to a doctor.
To conclude, PE can occur for a number of reasons, but there are many ways to address the issue.