Premature (Early) Ejaculation

A key symptom of premature ejaculation is consistent early ejaculation that occurs within one minute of penetration and is uncontrollable, often causing distress or frustration to the individual. A healthcare provider may aim to identify specific symptoms to diagnose PE and develop a treatment plan. Below are some of the typical signs and symptoms of premature ejaculation:

• Ejaculation before or soon after penetration: PE is characterized by ejaculation occurring sooner than desired, either before or shortly after penetration.
• Inability to control or delay ejaculation: People with PE often cannot control the timing of ejaculation and may experience distress because of it.
• Frequent or occasional episodes of PE: Some people may experience occasional episodes of PE, while others might experience it more frequently.

Rare instances of PE may not qualify for a diagnosis. The diagnostic criteria for PE may differ across various organizations. However, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) outlines the following criteria to diagnose PE:

• During all, or almost all, instances of sexual engagement (75% to 100%), ejaculation occurs within roughly one minute of vaginal penetration and earlier than the person desires.
• These symptoms must persist for at least six months and cause considerable distress to the affected person and their sex life.
• Other health conditions, mental health disorders, medications, or significant interpersonal problems do not cause the symptoms. 

Premature ejaculation can be further categorized into lifelong and acquired premature ejaculation. These categories have different symptoms and potential causes:

• Lifelong premature ejaculation: This type of PE occurs all or nearly all the time, from the first sexual encounter. This problem has been persistent from the start of a person’s sexual activity and continues to occur consistently without any improvement.
• Acquired premature ejaculation: Unlike lifelong PE, acquired premature ejaculation occurs in people with penises who have previously had normal sexual function. In other words, they did not always have problems with PE but developed it over time. Acquired PE can happen gradually or suddenly, depending on the underlying cause.

If you or someone you know is experiencing these symptoms, consult a healthcare professional. They may help you identify the possible causes and suggest appropriate treatment options to help manage the condition and any co-occurring challenges, such as erectile dysfunction or relationship problems.

Premature ejaculation (PE) may be caused by various factors, which may be divided into psychological and biological causes. Psychological factors that may cause someone to ejaculate prematurely and contribute to PE include:

• Stress
• Anxiety
• Depressive mood
• Guilt or remorse
• Fear of underperforming sexually
• General self-doubt or negative body perception
• Thoughts of self-hate
• Egocentric behavior
• Relationship conflict
• Misguided thinking patterns 
• False assumptions regarding sexual activity 
• Previous instances of sexual mistreatment or negative encounters
• Negative attitudes toward women
• Other mental health challenges

Biological factors that may cause PE include:

• Disruption in levels of certain hormones,⁵ such as LH and prolactin
• Imbalance in the brain’s serotonin levels
• Neurological conditions, such as multiple sclerosis
• Swelling or infection in the prostate or urethra
• Overactive ejaculatory reflex
• Genetic factors
• Hypogonadism
• Hyperthyroidism
• Diabetes
• Lack of sufficient sleep
• Dependency on alcohol
• Use of drugs

Early ejaculation may also be a result of external factors or situational circumstances. These may include the sensitivity of the penis, lack of sexual experience, or infrequent sexual activity. A combination of risk factors and causes may induce PE. However, with the appropriate treatment and support, those who experience PE may be able to improve their ejaculation control and have more satisfying sexual experiences.

Treatment for PE may be recommended for managing control over ejaculation, improving sexual satisfaction, and reducing any stress related to sexual performance. Various options, such as therapy, medication, and self-care, may be available to help treat the underlying causes of PE. People experiencing symptoms of premature ejaculation are encouraged to consult healthcare professionals who can offer diagnostic evaluation and tailored treatment options, helping to overcome both the physical and psychological aspects of PE.

Medication

In addition to therapy, certain medications may help people manage premature ejaculation. Some commonly prescribed medications include:

• Selective serotonin reuptake inhibitors (SSRIs): These antidepressants may delay ejaculation as a side effect. Common SSRIs used for PE may include fluoxetine, paroxetine, and sertraline.
• Topical anesthetics: Desensitizing creams or sprays applied to the penis may reduce sensitivity and delay ejaculation. These products should only be used as directed to prevent reduced sexual pleasure or unwanted side effects.

Consult a medical doctor before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis. 

Other treatment options

If therapy and medications are not effective, other treatment options may be considered, such as:

• Pelvic floor exercises: Strengthening the pelvic floor muscles may improve ejaculation control. These exercises involve contracting and relaxing the muscles that support the pelvic organs, often referred to as kegel exercises.
• Pause-squeeze technique: During sexual activity, the individual or their partner squeezes the head of the penis when they are close to ejaculating. This technique may train the body to delay ejaculation and regain control.
• Condoms: Using thicker condoms may reduce sensitivity on the penis to improve ejaculation control.
• Start-stop method: This involves stimulation of the penis until the sensation to ejaculate is almost reached and then stopping stimulation until it subsides. Repeating this cycle may increase control over ejaculation timing.
• Masturbation: Masturbating an hour or two before intercourse can decrease the likelihood of premature ejaculation.

Self-care

In addition to professional treatments, men may treat premature ejaculation at home by trying self-care practices to manage premature ejaculation. These might include:

• Engaging in relaxation techniques, such as deep breathing exercises and meditation, to reduce anxiety and stress
• Practicing mindfulness to improve focus on the present moment and decrease performance anxiety
• Communicating openly with partners about your sexual needs and preferences to help alleviate performance anxiety
• Masturbating before engaging in sexual activity to potentially prolong the time until ejaculation

Mental health care resources may be available to support individuals who experience premature ejaculation. Online therapy platforms, such as BetterHelp, connect individuals to licensed professionals who can assist in resolving mental health concerns related to premature ejaculation, as well as other mental health challenges. 

In addition to online therapy, there are mental health organizations and support groups that help people who experience sexual health challenges. An example of an organization is the Urology Care Foundation, which provides educational materials on urologic health, including premature ejaculation. The International Society for Sexual Medicine (ISSM) also offers educational resources and guidelines for healthcare professionals and individuals seeking information on sexual health conditions like premature ejaculation. 

In addition, local sexual health clinics or medical centers may offer specialized services and treatments for premature ejaculation. It may be worth checking with healthcare providers in local areas for treatment and further resources.

For help with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357).

Numerous studies have been conducted to better understand PE, its causes, and potential treatments. In one study of almost 500 men with PE, researchers discovered that the problem with PE might not lie in the orgasm phase (as previously thought) but in the arousal phase. 

In the experiment, participants performed a masturbation exercise to extend the arousal phase. The results showed that it was more difficult for participants to control their arousal as the exercise progressed, leading to ejaculation. The results suggest that PE might be more about difficulty in controlling arousal, which could change how individuals think about and treat this condition in the future.

One review evaluated different non-drug treatments for PE. Finding the proper treatment can be challenging because the cause of PE isn’t completely understood. The review concludes that physical activity, behavioral treatments, and surgical procedures may effectively treat PE. However, the authors believe more large-scale studies would be valuable to help healthcare professionals choose the best treatment individually.

Below are several statistics on premature ejaculation:

• One study finds that approximately 20% to 30% of sexually active men experience PE. That same study indicates that about 80% to 90% of men with lifelong PE ejaculate within 60 seconds, while the remaining ejaculate within 2 minutes.
• Data shows that men with PE are more likely to report severe erectile dysfunction. One study found that 52.4% of people with severe ED also have PE, compared to 29.5% of individuals with mild ED.
• In men with hyperthyroidism, PE has been found in 50% of cases, but this number drops to 15% when thyroid hormone levels are brought back to normal. On the other hand, only 7.1% of men with hypothyroidism may experience PE.
• In cases where men have both ED and PE, phosphodiesterase type-5 (PDE5) inhibitors may be recommended. In one study, this treatment helped 11% of patients partially recover and 19% fully recover from PE.