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What is premature ejaculation?

Premature ejaculation is when you ejaculate sooner than you would like during sex and have trouble controlling when you orgasm. Experiencing this occasionally is normal — particularly if it’s the first time you’re having sex, or you haven’t ejaculated in a while. However, premature ejaculation is a problem if it’s happening frequently, which is the case for around 20-30% of men.

If you’re experiencing premature ejaculation, it means:

  • You almost always ejaculate within one minute of penetration
  • You are unable to delay ejaculation during sex
  • You feel stressed or frustrated at the thought of having sex.

Premature ejaculation may feel like an uncomfortable condition to talk about but take hope in the fact that it is something that you can work on either alone or with your partner., and there are several effective treatments for managing it.

Talking about your condition is an essential step in the right direction. A health professional will be able to offer you guidance on treatment options. If you are in a relationship, it’s also a good idea to keep lines of communication open with your partner so they can support you as you explore different treatments.

 
Premature ejaculation causes

The exact cause of premature ejaculation is unknown, but it’s believed to be related to a complex interaction between psychological and biological factors. This means it’s both a physical issue and a mental one.

You can have lifelong premature ejaculation — which is you when haven’t been able to control your ejaculation from your first sexual experience — or acquired premature ejaculation ­ — which is when you develop it over time. The cause(s) of your condition will depend on the type of premature ejaculation you have.

Lifelong premature ejaculation may be caused by a chemical imbalance in the brain that lowers the threshold for ejaculation, or it may be caused by psychological issues, such as performance anxiety.

Acquired premature ejaculation is often caused by performance anxiety. This anxiety can be related to sexual performance, shame around sexual acts, or worries around a specific sexual situation, such as getting intimate with a new partner for the first time. Depression and low self-esteem may contribute to premature ejaculation, as well as certain religious beliefs. Acquired premature ejaculation may also be caused by erectile dysfunction — when you struggle to get or maintain an erection — and the anxiety around it.

 

Premature ejaculation treatment

There are a range of treatments for premature ejaculation, the right one depends on a few variables like whether your condition is lifelong or acquired, and if you’re in a relationship. Sometimes a combination of treatments will be prescribed to help.

Treatment options for premature ejaculation include:

Psychological treatments

Your doctor may refer you to see a psychologist or a sex therapist as counselling can help you identify and work through any underlying sexual or relationship issues that could be behind your premature ejaculation.

You might attend your sessions solo, or if you’re in a relationship couple’s therapy can help uncover any issues within the partnership that are contributing to your condition. A couple’s psychologist or counsellor will be able to listen to both parties objectively and offer solutions and exercises that can help build trust and improve communication.  

Behavioral treatments

There are other things that you can do before and during sex to help control ejaculation. For instance, you can masturbate an hour or two before having sex or you could wear a thick condom to decrease the sensation during sex. Trying out new positions with your partner may also help you, as you can identify which positions make you feel the most aroused.

Additionally, it has been shown that there is a link1 between weak pelvic floor muscles and premature ejaculation. Pelvic floor exercises can help to strengthen your pelvic floor muscles, giving you better control. Learn more about how to do pelvic floor exercises.

There are also exercises you can practice alone or with your partner to help build tolerance and delay ejaculation. These exercises don’t guarantee a  long-lasting solution, but they may help in the short-term.

The Squeeze Method

You or your partner stimulate the penis until you are getting close to ejaculating. When you feel you’re about to ejaculate, you or your partner firmly squeezes the penis to decrease your erection. The squeeze method helps you to become aware of the sensations you feel in the lead up to ejaculating, to help you gain better control and slow down.

The Stop-Start Method

You or your partner stimulate your penis until you are about to orgasm. When you you’re about to ejaculate, you or your partner stops stimulating the penis until the urge to climax lessens. Once you have lost the urge, you repeat the process three more times, allowing yourself to ejaculate on the fourth time.  

 

Medical treatments

There are certain medical treatments that can be used, such as local anesthetic sprays and creams to reduce penile sensation and help delay ejaculation. These sprays and creams often don’t require a prescription but directions should be followed closely.

Your doctor may prescribe oral medications for premature ejaculation, such as antidepressants analgesics and phosphodiesterase inhibitors, which have been shown to slow men’s ability to reach orgasm.

 

Does premature ejaculation affect fertility?

Premature ejaculation doesn’t directly affect your sperm quality or fertility. It can affect your ability to get pregnant if you ejaculate before penetration as your sperm won’t be able to reach your partner’s egg.

If you have been trying some of the psychological and behavioral treatment options but are unable to delay ejaculation until penetration, you doctor may explore medical treatments or refer you to a fertility specialist.

Find some questions to ask your doctor about premature ejaculation and treatment here.

 

Premature ejaculation and mental health

The relationship between premature ejaculation and mental health goes both ways. Premature ejaculation may be caused by certain mental health issues like depression, low self-esteem, and anxiety, but it can also be the source of embarrassment, feeling down, a loss of confidence and anxiety.  

It’s completely normal to feel distressed about premature ejaculation but it’s important to remember that it’s a common condition that can often be treated. Don’t bury your head in the sand and hope it will go away ­— ignoring premature ejaculation can affect your ability to have a happy, healthy sex life. Being open and communicative with your partner is the best way to handle premature ejaculation and try to move past any awkwardness you might feel speaking to your doctor because it’s almost guaranteed they’ve dealt with it many times before.

 

Keep reading: Premature ejaculation factsheet  

Keep reading: Male mental health: What you need to know

 

1 Cohen, D., Gonzalez, J., and Goldstein, I., 2016. The Role of Pelvic Floor Muscles in Male Sexual Dysfunction and Pelvic Pain. Sexual Medicine Reviews, 4 (1), 53–62.

Keywords:
Sexual health

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