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.
The information here aims to demystify the causes of PE and outline effective treatment options.
Here are some key points about premature ejaculation.
- 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.
Symptoms of premature ejaculation
Premature ejaculation, in some cases, can lead to depression.
Put simply; PE involves a man ejaculating sooner than he and his partner desire.
Psychological symptoms are secondary to the physical ejaculatory events and can be experienced by the man, his partner, or both.
Secondary symptoms caused by PE include:
- decreased 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. However, their anxiety about the effect of PE on their relationship is 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.
Treatments for premature ejaculation
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 (psychological) 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.
Topical 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.
Notable examples include lidocaine or prilocaine, which can improve the amount of time before ejaculation. However, 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.
Home remedies to improve ejaculation timing
Here are two methods that could be helpful for men:
- 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, and resuming once the sensation of impending orgasm has subsided.
- 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. It is essential to practice, and if there is a persistent problem with PE, it may be worth talking to a doctor.
Causes of premature ejaculation
Most cases of PE are not related to any disease and are instead due to psychological factors, including:
- sexual inexperience
- issues with body image
- novelty of a relationship
- overexcitement or too much stimulation
- relationship stress
- feelings of guilt or inadequacy
- 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. The following are possible medical causes of PE:
- multiple sclerosis
- prostate disease
- thyroid problems
- illicit drug use
- excessive alcohol consumption
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.
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."
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?