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Dr Samantha Miller

Reviewed by Dr Samantha Miller MB ChB
(2017, University of Glasgow)
GMC number: 7561464

Information last reviewed 20/05/2021

About

What is premature ejaculation?

Premature ejaculation (PE) is defined as a man ejaculating sooner than desired during sexual intercourse. This is a common issue that roughly 1 in 3 men will experience at some point in their lives. If it only happens occasionally, then this is nothing to worry about. The following signs can lead to a diagnosis of PE: 

  • Frequently ejaculating within one minute of penetration 
  • Finding it impossible to delay ejaculation during sexual intercourse 
  • Avoiding sex due to feeling frustrated or inadequate

What are ejaculation disorders?

There are different types of ejaculation problems in men. These include: 

  • Premature ejaculation – when male ejaculation occurs sooner than either partner would like 
  • Delayed ejaculation – when a male is either unable to ejaculate or experiences a noticeable delay in being able to
  • Retrograde ejaculation – a rarer issue that causes semen to travel backwards towards the bladder. It causes either no or a small amount of semen during ejaculation
  • Anejaculation – where a male does not ejaculate. This can be experienced with or without orgasmic sensations.
  • Anorgasmia – where the male does not experience orgasm. This may include anorgasmic ejaculation, where the male ejaculates but does not experience orgasm.
  • Painful ejaculation – where ejaculating is physically painful
  • Haematospermia – the presence of blood in the ejaculate

What causes premature ejaculation?

Often there is no identifiable cause of premature ejaculation however there are various factors that may contribute:

  • Thyroid problems e.g. an overactive or underactive thyroid 
  • Prostate problems e.g. enlarged prostate
  • Drug and substance abuse e.g cannabis
  • Stress and anxiety 
  • Depression 
  • Relationship issues 
  • Anxiety around sexual performance 
  • Anxiety caused by past sexual experiences
  • Traumatic childhood experiences relating to sex
  • Conditioning and certain beliefs being instilled about sex from a young age 
  • Anatomy e.g. having a very sensitive penis

Can premature ejaculation be controlled?

There are various things you can try to control premature ejaculation before seeking medical help. These methods can help to relieve sensitivity and regain control: 

  • Use a thicker condom such as the “extra safe” variety
  • Masturbate 1–2 hours prior to having sex 
  • Stop the ejaculatory reflex by taking a deep breath
  • Engage in a sexual position where your partner is on top so that they can pull away if you come close to ejaculation 
  • Take breaks or think about something neutral during sex

Psychological causes of premature ejaculation

There are many psychological factors that can cause premature ejaculation. These include: 

  • Negative early sexual encounters 
  • Sexual abuse 
  • Negative body image 
  • Depression and anxiety 
  • Anxiety surrounding sexual performance  
  • Erectile dysfunction 
  • Problems in your relationship 

If any of these factors strike a chord with you then this may be the root cause of your ejaculation problems. If you are unsure, consult a doctor so that they can rule out underlying physical conditions.

Biological causes of premature ejaculation

Biological factors which can cause premature ejaculation include: 

  • Disruption to hormone levels 
  • Disruption to the level of neurotransmitters in the brain 
  • Infection or inflammation of the prostate (prostatitis)
  • Infection or inflammation of the urethra (urethritis or urinary tract infection)
  • Thyroid problems 
  • Using drugs 
  • Drinking too much alcohol

Complications of premature ejaculation

Premature ejaculation can be distressing to experience, enhancing stress or anxiety. This can cause problems within relationships, particularly if you have not communicated with your partner about what is going on. Ejaculation problems can also make it difficult to father a child if sperm does not reach the vagina.

Symptoms

How quickly does premature ejaculation occur?

Premature ejaculation is defined as occurring within one minute of penetration. This may differ from person to person, however, as there is no right or wrong way to have sex. In general, if ejaculation happens much sooner than either you or your partner would like, causing frustration or problems in your relationship, then this is where it becomes a problem.

Primary vs secondary premature ejaculation

There are two types of premature ejaculation: primary and secondary. Primary premature ejaculation is something that has happened consistently since your first sexual experience. 

Secondary premature ejaculation or “acquired premature ejaculation” occurs later in life, after your first sexual experience.

Treatment

How can you treat premature ejaculation?

Premature ejaculation can be treated in a number of ways depending on the cause, including: 

  • Counselling – either solo or couples
  • Behavioural modifications e.g. the “squeeze technique” or the “stop-start” method
  • Dapoxetine (a selective serotonin reuptake inhibitor (SSRI) medication) 
  • Antidepressants (e.g. other SSRIs)
  • Topical anaesthetics
  • Using condoms
  • Phosphodiesterase type 5 (PDE-5) inhibitors e.g. Viagra, Cialis or Levitra 

You should speak to your doctor about starting medications for PE

Self-help for premature ejaculation

There are several self-help methods that you can try yourself to help you overcome premature ejaculation: 

  • “Stop-start” method: this is where the penis is stimulated until ejaculation almost occurs, stopping at this point before beginning again. This helps you to recognise the sensations that occur prior to ejaculation, and learn to control your ejaculation.
  • “Squeeze” method: this is where the penis is stimulated until the point ejaculation almost occurs, and then squeezing the head of the penis until this sensation decreases 
  • Try masturbating an hour or two before sex, this may help to increase the time taken to achieve orgasm during sex
  • Take breaks during sex, or distract yourself with non-erotic thoughts

Medication to help premature ejaculation

The following medications can help to treat premature ejaculation:  

  • Topical anaesthetics – these are applied directly to the penis before sex to decrease sensation to aid in delaying ejaculation
  • Dapoxetine – an SSRI medication specifically designed to treat premature ejaculation 
  • Phosphodiesterase-5 inhibitors e.g. Viagra, Cialis and Levitra which are usually used to treat erectile dysfunction 
  • Other antidepressants e.g. escitalopram, sertraline and fluoxetine
  • Tramadol – usually used for treating pain, the side effects can delay ejaculation 

Speak to your doctor about medications for PE. 

How do premature ejaculation treatments work?

Dapoxetine is the only pharmacological agent specifically designed to treat premature ejaculation. It is a short-acting selective serotonin reuptake inhibitor (SSRI) that works by delaying orgasm. 

Anaesthetic creams numb the penis and reduce physical sensations, making it more difficult to stimulate yourself to the point of ejaculation. 

Other medications such as antidepressants and painkillers are used “off label” and utilise some of the side effects such as delayed orgasm to aid in treating PE. 

Are there different treatments for primary and secondary premature ejaculation?

The best treatment for either primary or secondary premature ejaculation will depend on the underlying cause. Secondary premature ejaculation which has occurred as a result of negative experiences or anxiety may be best treated by talking therapy or couples counselling.

What is the start-stop technique?

The start-stop technique is a method which you, or your partner, can use to help overcome premature ejaculation. It involves stimulating the penis until you feel you are about to ejaculate, and then stopping before ejaculation actually occurs. Wait until the feeling has passed before commencing stimulation again. This can help to get your body used to sexual stimulation lasting longer.

What is the squeeze technique?

The squeeze technique involves stimulating the penis, but stopping just before ejaculation occurs. At this point, you squeeze the head of the penis for 30 seconds until the feeling subsides. You can do this by yourself or with your partner.

How to discuss premature ejaculation with your partner

Premature ejaculation can leave you feeling inadequate and frustrated and it may feel daunting to bring it up with your partner. Being open and honest with them is a positive step forward. Let them know what the problem is, what type of stress or worries you have and what they can do to help. If you are struggling to do this, couples counselling may be a good environment to start a discussion in a safe space. If you want to try any self-help techniques such as the squeeze technique or the stop-start technique, it may be helpful to involve your partner, showing them how to conduct these techniques.

Can watching porn help premature ejaculation?

Watching porn may be a contributing factor in causing premature ejaculation and there is no evidence to suggest it may help overcome it. 

Does masturbation help overcome premature ejaculation?

Masturbation can help to overcome premature ejaculation by taking it slowly to regain control. You can also implement the start-stop technique to train your body to delay orgasm. It may take a bit of practice to get it right but this has been proven to help.

Does circumcision help premature ejaculation?

Several studies and meta-analysis have concluded that circumcision does not have a significant effect on premature ejaculation, however, some studies have suggested that circumcision as a child may have a beneficial effect on male sexual function. Circumcision is not a recommended treatment for adult premature ejaculation.

Will my premature ejaculation get better as I age and get more experience?

Premature ejaculation may go away on its own as you gain confidence, learn more about your body and sex, and leave anxieties about sexual performance behind. Premature ejaculation is more common in younger men, which suggests that the prevalence of PE declines with age. If it’s a significant problem for you, however, regardless of age, it’s worth addressing.

Q&A

Does alcohol affect premature ejaculation?

Drinking too much alcohol can cause premature ejaculation to occur. It can also delay ejaculation. 

Can drugs cause premature ejaculation?

Drug abuse is a known cause of premature ejaculation and may contribute to other ejaculation and erectile problems, particularly cocaine, amphetamines and cannabis.

When should I see a doctor for my premature ejaculation?

If premature ejaculation only happens occasionally, then it's unlikely to cause any issues. However, if you experience this most or all of the time during sex, then you should see a doctor. They may recommend treatment or may wish to conduct some investigations to rule out underlying causes.

Does premature ejaculation only apply to sex, or to masturbation as well?

Premature ejaculation can occur during masturbation as well as sex. This can happen due to conditioning, for example, if you're used to rushing through masturbation through fear of someone walking in or hearing.

Is premature ejaculation dangerous?

Premature ejaculation is not dangerous but it could be a sign of a thyroid or prostate issue. This is why it's important to see your doctor so that they can rule out any physical causes. 

Does stress influence premature ejaculation?

Stress is a common cause of premature ejaculation. It can be a vicious cycle: feeling under pressure to perform and then feeling stressed and frustrated about ejaculating prematurely. Talking to your partner about how you feel can help. 

Can medications cause premature ejaculation?

Medications can cause PE, particularly certain medications used to treat Parkinson's disease. Check-in with your doctor to see if any of your regular medications may be contributing to PE.

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