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 is one form of sexual dysfunction that can adversely affect the quality of a man's sex life.
Reaching climax and ejaculating semen during penetrative sex is the typical route by which babies are conceived, but premature ejaculation does not just complicate reproduction, it can also adversely affect sexual satisfaction, both for men and their partners. The information here aims to demystify premature ejaculation and outline active treatment options for those cases where it is desired.
Contents of this article:
Fast facts about premature ejaculation
Here are some key points about premature ejaculation. More detail and supporting information is in the body of this article.
- In medical terms, premature ejaculation is a form of sexual dysfunction where a man has always, or consistently climaxes and ejaculates before or very soon after sexual penetration, causing distress. Under strict criteria, premature ejaculation is relatively rare.
- Cases of premature ejaculation that do not meet the strict medical criteria for the sexual disorder are more common and are defined simply as a man climaxing and ejaculating sooner than he or his partner desire. Often, a man's partner is less concerned than the man himself.
- 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, including checking for erectile dysfunction
- Most cases of premature ejaculation have psychological causes - ranging from common anxieties about sex and relationships resulting in a temporary problem, to more serious psychological factors contributing to a persistent problem.
- Premature ejaculation can lead to secondary symptoms such as distress, embarrassment, relationship stress, anxiety and depression.
- Treatment options range from reassurance from a doctor that the problem can go away in time, through home methods of "training" the timing of ejaculation (alone or with the help of a trusted partner), to talking therapies and couples counselling.
- Drug options are available, there are currently no medicines approved for use in treating premature ejaculation.
- Doctors may consider offering "off-label" prescription of a certain type of antidepressant to help with premature ejaculation, but such medication can have side-effects. Additionally, some men find it helpful to apply a local anaesthetic cream to their penis to delay ejaculation by decreasing sensation.
What is premature ejaculation?
Premature ejaculation is a form of male sexual dysfunction. From the point of view of the man and his sexual partner, premature ejaculation means the man having an orgasm or "climaxing" sooner than wanted.1
Estimates of the number of men affected by premature ejaculation vary depending on how the problem is defined. A high proportion of men report being affected by premature ejaculation, whereas a very small proportion of men actually meet the medical criteria for the most persistent form.2
Premature ejaculation is often simply due to the excitement of a new sexual relationship.
Medically, the most persistent form of premature ejaculation (primary or lifelong premature ejaculation) is defined by the presence of the following three problems from the point at which a man becomes sexually active:2-4
- 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.
Premature ejaculation was once known, in Latin as ejaculatio praecox (the translation being "precocious ejaculation").2 It is also called rapid or early ejaculation.
An internet search will also reveal a lot of slang or colloquial phrases for premature ejaculation, although these often have little bearing on the reality of lived experience and may instead reinforce false ideas that are harmful to men's mental health. For example, such slang terms can lead men to feel they are to blame, have failed, are alone in their problem, or cannot be treated, while the opposite is usually the case. Premature ejaculation can cause a lot of embarrassment in boys and men, with a significant degree of stigma often attached to male sexual performance.5
How many men experience premature ejaculation?
Information obtained through surveys puts the "self-reported" prevalence of premature ejaculation in men as somewhere between 15% and 30%.2,6
However, the prevalence of medically diagnosed and diagnosable premature ejaculation is much lower.2,6 This statistical disparity does not in any way diminish the suffering experienced by men who do not meet the strict criteria for diagnosis.2,6
In one analysis of nearly 5000 men in nine Asia-Pacific countries, 16% of men met the criteria for a diagnosis of premature ejaculation (PE) on the five-question Premature Ejaculation Diagnostic Tool (PEDT).19 Probably PE was found in 15% of respondents, while 13% of men self-reported PE.
Average penis size
Psychological misconceptions about sex are not confined to premature ejaculation. Men's expectations can also be skewed in relation to penis size.
Interestingly, less than half (just 40%) of the men with PEDT-diagnosed PE self-reported the condition, and just 19% of those with probable PE self-reported having the condition. A large number of men (some 6% of respondents) had a negative PE diagnosis on the PEDT but reported PE.19
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% of men.7
However, more loosely defined premature ejaculation remains the most common form of male sexual dysfunction - more common than erectile dysfunction.6,7
Causes of premature ejaculation
Let's discuss the causes of premature ejaculation, from psychological factors to medical causes and erectile dysfunction.
Most cases of premature ejaculation are not related to any disease and are instead due to psychological factors.
Examples of psychological causes of premature ejaculation include:8,9
- 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 premature ejaculation.7
Most cases of the rarer, more persistent form - primary or lifelong premature ejaculation - are also believed to be caused by psychological problems. The cause(s) of primary or lifelong PE can often be traced back to early trauma, such as:7
- Strict sexual teaching and upbringing - affecting young men who have been brought up under strict ideas that sex should be prohibited until marriage, for example, making enjoyment of sex more difficult because of a feeling that it is wrong or a sin
- Traumatic experiences of sex - anxiety and premature ejaculation can result from problems ranging from a loss of privacy when masturbating ("being caught" masturbating), to sexual abuse
- Conditioning - it is thought that early sexual behaviors can feed into later experiences of sex. One example is a teenager learning to ejaculate quickly to avoid being found masturbating.
Premature ejaculation is not the only problem men can have with reaching orgasm.
Learn about delayed ejaculation
Medical causes of premature ejaculation
Biological causes of premature ejaculation 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.10
The following are also possible medical causes of PE7 (doctors will focus on diagnosis and management of the underlying condition first and monitor for improvement in sexual function8):
- Multiple sclerosis
- Prostate disease
- High blood pressure (hypertension)
- Thyroid problems (overactive or underactive thyroid gland)
- Illicit drug use
- Excessive alcohol consumption.
Erectile dysfunction is a condition that doctors will want to rule out or treat first when working with a patient concerned about premature ejaculation.6,7
Some men may confuse erectile dysfunction and premature ejaculation, believing themselves to have the former when they actually have the latter. This is because the penis normally loses its firmness after ejaculation.6
In some cases of erectile dysfunction, heightened sensitivity caused by changes to the normal pattern of nerve signals means that much less stimulation is needed to cause ejaculation.7
Finally, some studies have found an association between levels of serotonin - a natural neurotransmitter chemical involved in mood and depression - and ejaculation problems. Men with low brain levels of serotonin may have problems with premature ejaculation.10 However, the role of such factors remains largely theoretical, especially given that scientists still have a fairly poor understanding of the normal physiological processes that produce ejaculation.2
On the next page we look at the symptoms of premature ejaculation and the methods of diagnosis. On the final page we discuss the available treatments for premature ejaculation.