Health Library

Premature Ejaculation

Definition

Ejaculation occurs when a man reaches sexual climax and semen is ejected from his penis. Premature ejaculation is:

  • Ejaculation before the man wishes it to occur
  • Ejaculation too quickly to sexually satisfy his partner

Causes

Many men experience premature ejaculation at one time or another. For example, some men experience it after not having had sex for a long period of time. Premature ejaculation is only a problem when it becomes a persistent condition.

Ejaculation occurs automatically after a certain degree of sexual stimulation. Persistent premature ejaculation usually results from a man's inability to recognize that he is about to ejaculate. This inability prevents him from taking steps to delay the process.

Psychological factors may contribute to premature ejaculation. This may include difficulty in the relationship with a partner, guilt about sex, or fears related to sex.

In rare cases, premature ejaculation can be caused by:

  • Prostate problems, such as prostatitis
  • A problem with the nerves
  • Medications that increase sexual stimulation
  • Certain medical conditions (such as thyroid problems)
The Prostate
Anatomy of the Prostate Gland
© 2011 Nucleus Medical Media, Inc.

Risk Factors

Factors that may increase your chance of premature ejaculation include:

  • Lack of sexual experience
  • Lack of knowledge of male and female sexual responses
  • Fear of:
    • Causing pregnancy
    • Contracting a sexually transmitted disease
    • Poor sexual performance
  • Guilt about sex
  • Interpersonal problems between sexual partners
  • Early sexual experiences that precondition a man to rapid ejaculation, usually from fear of being caught

Symptoms

The primary symptom is persistent episodes of premature ejaculation during sex.

Diagnosis

Most men experiencing premature ejaculation will notice the condition themselves. The doctor will ask about your symptoms and medical history. A physical exam will be done.

The doctor may search for an underlying medical cause if:

  • You suddenly developed persistent premature ejaculation and have never experienced it before
  • You have other neurological symptoms
  • You are taking medication that may cause premature ejaculation
  • The condition is getting much worse or causing severe problems for you

Treatment

Treatments may include:

Behavior Therapy

This aims to improve your ability to:

  • Recognize when you are about to ejaculate
  • Take steps to delay it

It may include:

  • Biofeedback—electrical feedback that helps you learn to control the muscles that cause ejaculation
  • Start and stop method—stopping sexual stimulation for 30 seconds when nearing climax, then resuming
  • Squeeze method—same as start and stop method, but includes gently squeezing the base of penis before the 30-second stop period
  • Sexual positions—trying different sexual positions that may allow greater control over the muscles that cause ejaculation

Psychological Counseling

Counseling may be offered for an individual or for a couple. It is aimed at identifying and treating:

  • Fears or guilt
  • Interpersonal problems with your partner that may contribute to the condition

Medication

In some cases, a doctor may prescribe a desensitizing cream. It can be applied to the penis to lessen sexual stimulation.

In other cases, a doctor may prescribe an antidepressant. Some antidepressants have been found to prolong the interval from intromission to ejaculation. However, these drugs do not cure the underlying cause of premature ejaculation.

Prevention

To help reduce your chance of premature ejaculation:

  • Learn how male and female sexual responses work
  • Improve communication with your partner before engaging in sexual activity
  • Have sex in situations that are private and relaxed

Resources

Urology Care Foundation
http://www.urologyhealth.org

Family Doctor—American Academy of Family Physicians
http://familydoctor.org

Canadian Resources

Health Canada
http://www.hc-sc.gc.ca

Sex Information and Education Council of Canada
http://www.sieccan.org

References

Montague DK, Jarow J, et al. AUA guideline on the pharmacologic management of premature ejaculation. J Urol 2004; 172:290-294.

Premature ejaculation. American Academy of Family Physicians Family Doctor website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/premature-ejaculation.html. Updated April 2014. Accessed September 25, 2014.

Premature ejaculation. Urology Care Foundation website. Available at: http://www.urologyhealth.org/urology/index.cfm?article=122. Updated June 2014. Accessed September 25, 2014.

Premature ejaculation. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated November 19, 2013. Accessed September 25, 2014.

Pryor JL, Althof SE, et al. Efficacy and tolerability of dapoxetine in treatment of premature ejaculation: an integrated analysis of two double-blind, randomised controlled trials. Lancet 2006; 368:929-927.