What Is Premature Ejaculation?

About 30% of men have been affected by premature ejaculation globally at some point in their lives. It can occur as either a lifetime condition or acquired due to psychological factors, lifestyle, and health status. Premature ejaculation can cause low self-esteem, relationship problems, and depression.

Premature ejaculation (PE) is when a male reaches orgasm and ejaculates sooner than he, and sometimes his partner, intended during sexual activity. It is the most common of the four major sexual dysfunctions in adult males.

Read on as we explore what premature ejaculation is, how to manage and treat it, and what to do to prevent acquiring it as you get older.

Overview

Ejaculation is the term given to the act of a man releasing semen as he reaches orgasm during sexual intercourse. Ejaculation typically occurs within 5-7 minutes of commencing penetrative sex, although the duration can differ in individuals.¹

Men typically have some control over their ejaculation during sexual encounters and masturbation. If they lack control and experience distress, they may have premature ejaculation or delayed ejaculation. These conditions can be a hindrance to sexual satisfaction and cause relationship stress.²

Although not quite definitive, premature ejaculation or ejaculatory dysfunction occurs when a man ejaculates before he or his partner would like him to. The timing for ejaculation varies from person to person, but premature ejaculation is typically defined as ejaculation within two minutes of sexual intercourse.³

Premature ejaculation (PE) is a fairly common sexual dysfunction in men that can significantly impair sexual satisfaction and quality of life. However, this condition is frequently underreported because of embarrassment for both the patient and the physician and a lack of awareness.⁴ It exists in two forms; lifelong premature ejaculation and acquired premature ejaculation.⁵

• Lifelong premature ejaculation is defined as poor ejaculatory control that has been present since the first time a male had sexual intercourse

• Acquired premature ejaculation is defined as persistently poor ejaculatory control, associated bother, and ejaculation latency characterised by a significant decrease in ejaculatory time compared to prior sexual experience

Causes of premature ejaculation

The causes of premature ejaculation are multifactorial and often include psychological and biological factors.¹ For example, men who suffer from anxiety, depression, or performance anxiety can experience premature ejaculation.⁵ Furthermore, men with low serotonin levels in the brain may be more prone to premature ejaculation.¹ 

Other common causes of premature ejaculation include the following:^1,3,5,6,7

• Hormonal imbalances
• Hypersensitivity of the penis
• Guilt
• Unrealistic expectations about sexual performance
• History of sexual repression
• Lack of trust
• Financial problems
• Poor body image in general
• History of sexual abuse
• Relationship problems
• Starting sexual intercourse at a young age
• Genetics
• Chronic prostatitis (inflammation or infections of the prostate gland)
• Erectile dysfunction (ED)
• Metabolic syndrome (MetS)
• Thyroid dysfunction
• Drug or alcohol use

Signs and symptoms of premature ejaculation

The primary symptom of premature ejaculation is ejaculating earlier than a person desires. This condition can lead to feelings of embarrassment, frustration, and shame, which can exacerbate the problem. Men who suffer from premature ejaculation may also struggle with low self-esteem and confidence in their ability to please their partners.⁵

Premature ejaculation should not be confused with erectile dysfunction, also known as ED, which is the inability of a male to have and sustain an erection or low libido when a man has little to no interest in sexual intercourse. Premature ejaculation is not determined by size and does not denote male infertility, as the man can still get a woman pregnant if ejaculation occurs inside the vagina.

Management and treatment for premature ejaculation

The treatment for premature ejaculation will depend on the underlying cause of the condition. If the cause of PE is psychological, such as anxiety or depression, counselling or therapy may be effective. Referring people with premature ejaculation to a mental health professional with expertise in sexual health should also be considered during the course of treatment for people with biologically caused premature ejaculation.⁵

First-line drug treatment includes daily SSRIs (Selective Serotonin Reuptake Inhibitors), primarily used to treat depression and anxiety disorders. SSRI works by increasing the serotonin levels in the brain, which is thought to improve mood and reduce symptoms of depression and anxiety.^4,5,7

Other options for treatment may include medications, such as on-demand clomipramine or dapoxetine, and topical penile anaesthetics can also help to desensitise the penis, which in turn helps to improve ejaculation time. Tramadol may be considered for men who have failed first-line therapy. α1-adrenoreceptor antagonists may be used for those who have failed initial treatment. Comorbid erectile dysfunction should be treated according to AUA Guidelines.^4,5 

Additionally, men can engage in kegel exercises, which help to strengthen the pelvic floor muscles and improve ejaculatory control. In patients with PE, wearing a condom during intercourse reduces sensitivity and helps to delay ejaculation. Other behavioural techniques include extended foreplay, alternate sex positions, mental distraction,  interval sex, and increasing the frequency of sex. Acupuncture is also believed to be effective in boosting IELT (intravaginal ejaculatory delay time).^3,4,7,8

Furthermore, two common behavioural therapies for premature ejaculation are the "start-stop" and "squeeze" techniques. The "start-stop" technique involves discontinuing stimulation of the penis once there is a desire to ejaculate until the desire passes. Squeezing the glans of the penis until the desire passes is the "squeeze" technique. While both techniques were once extremely effective, recent research has questioned their effectiveness.⁴

Combining behavioural and pharmacological approaches may be more effective than either treatment method alone. Alternative therapies lack evidence to support their use, and surgical management should only be considered in the context of an approved clinical trial.^3,4,8

Diagnosis

Diagnosing premature ejaculation may seem like a straightforward process; however, it involves various testing procedures, conversations about sexual history, and physical evaluation performed to determine if there are any underlying medical issues. Validated instruments can assist with the diagnosis, but additional testing will not be used for lifelong premature ejaculation. 

Premature ejaculation is diagnosed when ejaculation happens within a minute of penetration, consistently happening for over six (6) months and causing distress, while no other medical issues are apparent. This clinical diagnosis is prevalent in about 5% of men worldwide. However, occasional premature ejaculation or quicker arousal and orgasm after a long abstinence are not considered medical problems. Additionally, if the time it takes to ejaculate is within the normal range but still feels too short, it is not classified as premature ejaculation.¹

The American Urological Association advises that men showing signs of premature ejaculation should visit their healthcare provider, preferably a urologist, a doctor who specialises in issues of the urinary tract and the male reproductive system, who would evaluate them to assess their medical, relationship (psychosocial), and sexual history, in addition to a thorough selective laboratory testing and physical examination.^4,7

Risk factors

Several risk factors can contribute to the development of premature ejaculation. These include anxiety, stress, depression, medical conditions like diabetes, and relationship problems.

Complications

Premature ejaculation can lead to significant physical and emotional complications. These can include feelings of embarrassment, low self-esteem, and relationship problems. Furthermore, men who suffer from premature ejaculation may struggle with erectile dysfunction and reduced libido, leading to a decreased quality of life.

Personal problems can also arise as a result of premature ejaculation. These problems could include stress and relationship issues, with relationship stress being a common complication of premature ejaculation.⁵ Additionally, premature ejaculation may cause fertility issues when it is difficult for a partner to become pregnant, especially when ejaculation does not occur after penetrative sex.

FAQs

Can premature ejaculation be prevented

It may not be possible to prevent premature ejaculation completely. Certain factors can reduce the likelihood of the condition. These include practising good sexual hygiene, controlling anxiety and depression, exercising regularly, and avoiding drugs or alcohol.

How common is premature ejaculation

Premature ejaculation (PE) is a highly common condition that affects an estimated 30% of men worldwide, making it the most common sexual dysfunction to affect sexually active males at some point in their lifetime. However, the actual percentage of men who have been properly diagnosed with PE is approximately 5%.

When should I see a doctor

If you think you may be suffering from premature ejaculation, it is recommended that you see a urologist, a doctor who specialises in the male reproductive system. Seeing a urologist is especially important if the condition is causing significant distress to your sexual life, emotional well-being, or relationship. A medical professional can help to identify the underlying cause of the problem and offer effective treatment options. 

Summary

Premature ejaculation (PE), also known as ejaculatory dysfunction, is not the same as having a low libido when an adult male has little to no desire to have sex or erectile dysfunction. This condition is characterised by having a weak or no erection. Premature ejaculation exists in two forms, lifelong premature ejaculation, which is present from the first time a male has sex, and acquired premature ejaculation, brought on by other factors.

Premature ejaculation is a common sexual dysfunction that leads to ejaculating too soon during sexual activity. The causes of premature ejaculation can be psychological or biological, and the treatment options vary depending on the underlying cause. Men who experience premature ejaculation can use a range of options to manage their condition.

Seek the advice of a medical professional to rule out any underlying medical conditions that may be causing the problem. It is crucial to not self-medicate, as your doctor will be the best person to prescribe the best medication or other treatment for your case after a proper diagnosis.