Premature Ejaculation

Premature ejaculation (PE) is when you have an orgasm before intercourse or less than a minute after you start. There is no set time when a man should ejaculate during sex, but if you ejaculate and lose your erection this soon, you and your partner may feel there’s not enough time to enjoy it.

Causes of Premature Ejaculation

  • Stress

  • Depression

  • Anxiety

  • Guilt

  • Relationship problems

  • Lack of confidence or poor body image

  • Concern over your sexual performance

  • Negative feelings about the idea of sex (sexual repression)

Symptoms of Premature Ejaculation

  • Occasional episodes of PE usually aren’t anything to worry about. You may need treatment if PE occurs frequently or has occurred for an extended period of time.

  • The main symptom of PE is the regular inability to delay ejaculation for more than a minute after penetration during intercourse. Rapid climax during masturbation may also be an issue for some people.

  • If you experience premature ejaculation sometimes and normal ejaculation other times, you may be diagnosed with natural variable premature ejaculation.

  • PE is usually categorized as lifelong or acquired.

  • Lifelong (primary) PE means you’ve had this experience always or almost always since your first sexual experience.

  • Acquired (secondary) PE means you’ve had longer lasting ejaculations in your life, but have developed PE.

Diagnosis of Premature Ejaculation

  • Your doctor probably will start by asking if you’ve always had the problem or if it’s a new thing.

  • They may ask about your sex life or your relationships. You’ll probably get a physical exam, too.

  • If your doctor thinks emotional issues are causing your PE, they may refer you to a mental health professional who works with people who have trouble with sex.

  • If a physical problem is causing it, they might recommend that you see a doctor called a urologist, who specializes in conditions that affect your urinary system.

Complications of Premature Ejaculation

  • If your relationship is affected by PE, talking about the problem is an important first step.

  • A relationship counselor or sex therapist may be able to help.

  • Premature ejaculation may also make it hard to start a family because the sperm may not reach an egg to fertilize it or depression related to PE might affect your sex drive or performance.

  • A fertility specialist can talk with you and your partner about some other options.

Treatment of Premature Ejaculation

Stop and start

You or your partner stimulate your penis until you feel like you’re going to have an orgasm. Stop the arousal for about 30 seconds or until the feeling passes. Start the stimulation again and repeat three or four more times before you ejaculate.

The Squeeze

  • It works the same way as the start and stop method.

  • But, when you feel like you’re reaching orgasm, you or your partner squeezes the head of your penis until you lose the erection.

  • Repeat this a few times before ejaculating.

  • Some men find that if they think of something else during sex they can last longer.

Strengthen your muscles

  • Weak pelvic floor muscles sometimes contribute to PE.

  • Kegel exercises may help strengthen them.

  • Find the right muscles to tighten by stopping your urine in midstream.

  • Hold them tight for 3 seconds and then release them for 3 seconds.

  • Do this 10 times, at least three times a day.

Use a condom

It may desensitize you enough so you can last longer.

Get busy before you ‘get busy’

Some men find that masturbating a few hours before sex helps them stay in control during intercourse.

Seek counseling

  • A psychologist or psychiatrist can help you work through problems like depression, anxiety, or stress that may be contributing to your PE.

  • If none of these help enough, your doctor may talk with you about medication.

  • While there aren’t any drugs specifically approved to treat PE, medicines used to treat other things may help in some cases. This is called an off-label use.

Medications

  • If ED is a contributing factor, talk with your doctor about ED medications, such as tadalafil (Cialis) and sildenafil (Viagra).

  • They may help you maintain an erection, which could lead to delayed ejaculation.

  • These and other ED medications can sometimes take an hour to begin working.

  • Getting the right dose may take some trial and error too, so be willing to work with your prescribing healthcare professional.

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