Understand what causes premature ejaculation, as well as how to treat it and prevent it.
Premature ejaculation occurs when a man ejaculates sooner during sexual intercourse than he or his partner would like. Premature ejaculation is a common sexual complaint. Estimates vary, but as many as 1 out of 3 men say they experience this problem at some time.
As long as it happens infrequently, it's not cause for concern. However, you might be diagnosed with premature ejaculation if you:
Both psychological and biological factors can play a role in premature ejaculation. Although many men feel embarrassed talking about it, premature ejaculation is a common and treatable condition. Medications, counseling and sexual techniques that delay ejaculation — or a combination of these — can help improve sex for you and your partner.
The main symptom of premature ejaculation is the inability to delay ejaculation for more than one minute after penetration. However, the problem might occur in all sexual situations, even during masturbation.
Premature ejaculation can be classified as:
Many men feel that they have symptoms of premature ejaculation, but the symptoms don't meet the diagnostic criteria for premature ejaculation. Instead these men might have natural variable premature ejaculation, which includes periods of rapid ejaculation as well as periods of normal ejaculation.
Talk with your doctor if you ejaculate sooner than you wish during most sexual encounters. It's common for men to feel embarrassed about discussing sexual health concerns, but don't let that keep you from talking to your doctor. Premature ejaculation is a common and treatable problem.
For some men, a conversation with a doctor might help lessen concerns about premature ejaculation. For example, it might be reassuring to hear that occasional premature ejaculation is normal and that the average time from the beginning of intercourse to ejaculation is about five minutes.
The exact cause of premature ejaculation isn't known. While it was once thought to be only psychological, doctors now know premature ejaculation involves a complex interaction of psychological and biological factors.
Psychological factors that might play a role include:
Other factors that can play a role include:
A number of biological factors might contribute to premature ejaculation, including:
Various factors can increase your risk of premature ejaculation, including:
Premature ejaculation can cause problems in your personal life, including:
In addition to asking about your sex life, your doctor will ask about your health history and might do a physical exam. If you have both premature ejaculation and trouble getting or maintaining an erection, your doctor might order blood tests to check your male hormone (testosterone) levels or other tests.
In some cases, your doctor might suggest that you go to a urologist or a mental health professional who specializes in sexual dysfunction.
Common treatment options for premature ejaculation include behavioral techniques, topical anesthetics, medications and counseling. Keep in mind that it might take time to find the treatment or combination of treatments that will work for you. Behavioral treatment plus drug therapy might be the most effective course.
In some cases, therapy for premature ejaculation might involve taking simple steps, such as masturbating an hour or two before intercourse so that you're able to delay ejaculation during sex. Your doctor also might 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.
Weak pelvic floor muscles might impair your ability to delay ejaculation. Pelvic floor exercises (Kegel exercises) can help strengthen these muscles.
To perform these exercises:
Your doctor might instruct you and your partner in the use of a method called the pause-squeeze technique. This method works as follows:
By repeating as many times as necessary, you can reach the point of entering your partner without ejaculating. After some practice sessions, the feeling of knowing how to delay ejaculation might become a habit that no longer requires the pause-squeeze technique.
If the pause-squeeze technique causes pain or discomfort, another technique is to stop sexual stimulation just prior to ejaculation, wait until the level of arousal has diminished and then start again. This approach is known as the stop-start technique.
Condoms might decrease penis sensitivity, which can help delay ejaculation. "Climax control" condoms are available over the counter. These condoms contain numbing agents such as benzocaine or lidocaine or are made of thicker latex to delay ejaculation. Examples include Trojan Extended, Durex Performax Intense and Lifestyles Everlast Intense.
Anesthetic creams and sprays that contain a numbing agent, such as benzocaine, lidocaine or prilocaine, are sometimes used to treat premature ejaculation. These products are applied to the penis 10 to 15 minutes before sex to reduce sensation and help delay ejaculation.
A lidocaine-prilocaine cream for premature ejaculation (EMLA) is available by prescription. Lidocaine sprays for premature ejaculation are available over-the-counter.
Although topical anesthetic agents are effective and well-tolerated, they have potential side effects. For example, some men report temporary loss of sensitivity and decreased sexual pleasure. Sometimes, female partners also have reported these effects.
Many medications might delay orgasm. Although none of these drugs are specifically approved by the Food and Drug Administration to treat premature ejaculation, some are used for this purpose, including antidepressants, analgesics and phosphodiesterase-5 inhibitors. These medications might be prescribed for either on-demand or daily use, and might be prescribed alone or in combination with other treatments.
Antidepressants. A side effect of certain antidepressants is delayed orgasm. For this reason, selective serotonin reuptake inhibitors (SSRIs), such as escitalopram (Lexapro), sertraline (Zoloft), paroxetine (Paxil) or fluoxetine (Prozac, Sarafem), are used to help delay ejaculation.
Of those approved for use in the United States, paroxetine seems to be the most effective. These medications usually take five to 10 days to begin working. But it might take two to three weeks of treatment before you'll see the full effect.
If SSRIs don't improve the timing of your ejaculation, your doctor might prescribe the tricyclic antidepressant clomipramine (Anafranil). Unwanted side effects of antidepressants might include nausea, perspiration, drowsiness and decreased libido.
Analgesics. Tramadol (Ultram) is a medication commonly used to treat pain. It also has side effects that delay ejaculation. Unwanted side effects might include nausea, headache, sleepiness and dizziness.
It might be prescribed when SSRIs haven't been effective. Tramadol can't be used in combination with an SSRI.
Research suggests that several drugs that might be helpful in treating premature ejaculation, but further study is needed. These drugs include:
This approach involves talking with a mental health provider about your relationships and experiences. Sessions can help you reduce performance anxiety and find better ways of coping with stress. Counseling is most likely to help when it's used in combination with drug therapy.
With premature ejaculation, you might feel you lose some of the closeness shared with a sexual partner. You might feel angry, ashamed and upset, and turn away from your partner.
Your partner also might be upset with the change in sexual intimacy. Premature ejaculation can cause partners to feel less connected or hurt. Talking about the problem is an important step, and relationship counseling or sex therapy might be helpful.
Several alternative medicine treatments have been studied, including yoga, meditation and acupuncture. However, more research is needed to evaluate the effectiveness of these therapies.
It's normal to feel embarrassed when talking about sexual problems, but you can trust that your doctor has had similar conversations with many other men. Premature ejaculation is a very common — and treatable — condition.
Being ready to talk about premature ejaculation will help you get the treatment you need to put your sex life back on track. The information below should help you prepare to make the most of your appointment.
The list below suggests questions to ask your doctor about premature ejaculation. Don't hesitate to ask more questions during your appointment.
Your doctor might ask very personal questions and might also want to talk to your partner. To help your doctor determine the cause of your problem and the best course of treatment, be ready to answer questions such as:
Deciding to talk with your doctor is an important step. In the meantime, consider exploring other ways in which you and your partner can connect with one another. Although premature ejaculation can cause strain and anxiety in a relationship, it is a treatable condition.
March 2nd, 2021