Premature Ejaculation

What is premature ejaculation?

Ejaculation is the release of semen from the penis during an orgasm. When ejaculation occurs faster than you or your partner would like, it’s known as premature ejaculation (PE).

PE is common. About one in three men between the ages of 18 and 59 experiences PE at some point.

PE is also known as:

• rapid ejaculation
• premature climax
• early ejaculation

Is premature ejaculation a type of sexual dysfunction?

PE is considered a type of sexual dysfunction. Sexual dysfunction refers to any of several types of problems that keep a couple from fully enjoying sexual activity.

PE isn’t the same as erectile dysfunction (ED). ED is the inability to achieve and maintain an erection that allows for a satisfying sexual experience. However, you may experience PE along with ED.

What are the symptoms of premature ejaculation?

Occasional episodes of PE usually aren’t anything to worry about. You may need treatment if PE occurs frequently or has occurred for an extended period of time.

The main symptom of PE is the regular inability to delay ejaculation for more than a minute after penetration during intercourse. Rapid climax during masturbation may also be an issue for some people.

If you experience premature ejaculation sometimes and normal ejaculation other times, you may be diagnosed with natural variable premature ejaculation.

PE is usually categorized as lifelong or acquired.

Lifelong (primary) PE means you’ve had this experience always or almost always since your first sexual experience.

Acquired (secondary) PE means you’ve had longer lasting ejaculations in your life, but have developed PE.

What causes premature ejaculation?

There are psychological or emotional components to PE, but there are also other factors that contribute to it.

Likewise, PE may become an issue as a person gets older and has more trouble maintaining an erection.

PE may be caused by underlying conditions or mental health concerns too, including:

• poor body image or poor self-esteem
• depression
• history of sexual abuse, either as the perpetrator, or as the victim or survivor

Guilt may also cause you to rush through sexual encounters, which can lead to PE.

Other things that can lead to PE include:

• worrying about ejaculating too early
• anxiety about limited sexual experience
• problems or dissatisfaction in your current relationship
• Stress

Physical causes can also play a major role in PE. If you have difficulty maintaining an erection because of ED, you may rush through intercourse so that you complete it before losing the erection.

Abnormal levels of certain hormones, such as testosterone, or chemicals produced by nerve cells called neurotransmitters may contribute to PE. Inflammation of the prostate or urethra can also cause numerous symptoms, including PE and ED.

When to seek help

Talk with a doctor if PE:

• Is occurring or has occurred enough times to cause relationship problems
• makes you feel self-conscious
• keeps you from pursuing intimate relationships

You may start with a primary care physician or seek out a urologist. A urologist is a doctor who specializes in the health of the urinary system and male sexual function.

When you see your doctor, have the following information available:

• How long have you been sexually active?
• When did PE become a concern?
• How often does PE occur?
• How long does it usually take before you ejaculate during intercourse and when you masturbate?
• Do you use drugs or medications that may affect sexual performance?
• Have you had sexual encounters that included “normal” ejaculation? If so, what was different about those experiences and the times when PE was an issue?

In addition to working with a urologist or other physician, you may be advised to work with a mental health professional who specializes in sexual dysfunction.

How to treat premature ejaculation

In some cases, you may be able to treat PE with some changes to your sexual routine.

Start-and-stop and squeeze methods

Certain muscle exercises may also help. In particular, you may benefit from male pelvic floor exercises.

To find your pelvic floor muscles, concentrate on stopping urination in midstream or using certain muscles to keep you from passing gas. Once you understand where the muscles are, you can practice exercises known as Kegel maneuvers. You can do them standing, sitting, or lying down.

To do Kegel maneuvers:

• Tighten your pelvic floor muscles for a count of three.
• Relax them for a count of three.
• Do this several times in a row throughout the day

Work your way up to three sets of 10 repetitions each day.

When doing Kegel exercises, be careful not to use your abdominal or buttock muscles instead of your pelvic floor muscles.

Training your muscles may also take weeks or months to make a difference, depending on whether this is at the root of your PE.

ED medications

If ED is a contributing factor, talk with your doctor about ED medications. They may help you maintain an erection, which could lead to delayed ejaculation.

These ED medications can sometimes take an hour to begin working. Getting the right dose may take some trial and error too, so be willing to work with your prescribing healthcare professional.

Talking with your partner

If you experience PE, it’s important to talk about it with your partner, rather than ignore it or deny that it exists. Be calm and discuss your options.

Both of you should understand that:

• PE is usually a treatable condition.
• It’s very common.
• Exploring the causes and treatments for PE may help resolve other relationship issues or lead to treatment for anxiety, depression, or other mood disorders, as well as hormonal or other physical causes.

1. Focus on foreplay

Some men believe that penetration is the most important, even the defining part of sex.

However, many who experience erectile dysfunction may be heartened to learn that they do not need an erection to please their partners. In fact, erectile dysfunction can even be an incentive to try new strategies that work better for their partner.

Foreplay may be especially important for women. A 2017 study found that very few women — around 18 percent — experience an orgasm from intercourse alone. According to the same findings, 36.6 percent of women said that clitoral stimulation was necessary for orgasm during intercourse.

2. Try the start-stop technique

Men who want to last longer during intercourse can try the start-stop technique .

To use this technique, stop sexual activity every time ejaculation feels imminent. Breathe deeply and start again slowly, then stop to delay ejaculation for as long as desirable.

This method can train the body to hold off ejaculation and help a man to feel more comfortable with not ejaculating, even during intense sexual activity.

3. Try something new

Sexual pleasure thrives in an environment of passion and excitement.

If a person has been with one partner for a long time, sex can begin to feel routine, and it may seem increasingly difficult to feel excited, remain focused, or please the partner.

It may help to try a new sexual activity or position or to have sex in a different location. Also, talking about sexual fantasies can make sex more exciting.

In addition, it can help to do something new with a partner outside the bedroom, such as:

• cooking together
• kayaking or hiking
• going to a museum
• seeing a new band
• trying a new sport

4. Manage anxiety and stress

Anxiety and stress can make it hard to get or maintain an erection. These feelings can also distract people from sexual intimacy.

If a man feels anxious about how he will perform sexually, he may feel less excited about sex and less engaged during it.

Strategies for managing anxiety and stress include:

• focusing more on physical sensations than sexual performance
• exercising
• getting more sleep
• working to improve relationships
• meditating
• spending more time on a favorite hobby
• going to therapy
• taking psychiatric medications

5. Quit smoking

Smoking cigarettes can lead to high blood pressure and other heart-related problems that cause erectile issues.

Smoking is also independently linked to erectile dysfunction. A 2015 analysis of 13 studies on smoking and sexual performance found that quitting smoking often improves sexual function and reduces erectile dysfunction.

6. Open communication

Speaking freely can significantly improve sexual experiences.

If issues related to sex have created tension or worry, it is best to bring this up with a partner. Working together on a solution can help a man to feel less isolated and address any concern or guilt.

A partner may be able to ease fears about sexual dysfunction, and they may have practical suggestions.

7. Address relationship issues

Issues outside the bedroom can lead to sexual dysfunction. For example, a man who feels that a partner criticizes them too much may feel anxious during sex, leading to less satisfying experiences.

Communication that focuses on feelings, not blame, can help partners to address relationship challenges. Some people also benefit from relationship or sex therapy.

8.Get more exercise

Being physically active can reduce risk factors for heart conditions and improve sexual function and overall health.

Conditions such as high blood pressure, heart disease, and diabetes can damage nerves and change the amount of blood that flows to the penis. This can make it more difficult to get or maintain erections.

In addition, some men find that regular exercise improves their mental health, reducing anxiety and helping them to feel better about their bodies.

Men can also benefit from exercising the muscles involved in arousal and ejaculation. The following exercise may help:

• While urinating, stop the flow of urine. Repeat several times and learn to identify the muscles involved.
• When not urinating, try to contract these muscles for 10 seconds. Relax them for 10 seconds, then contract them for another 10 seconds.
• Repeat this cycle of contracting and relaxing 10 times each day.

9. Practice mindfulness

Mindfulness is the practice of becoming more aware in the present moment. It is a popular form of meditation for beginners, and it may improve sexual function.

Research published in 2017 suggests that mindfulness-based therapies can change negative attitudes about sex, improve sexual relationships, and help people to be more present during sexual activity.

Mindfulness and meditation can also help to manage stress unrelated to sexual activity. This can indirectly address sexual dysfunction and improve a man’s ability to focus in the moment.

10. Try an herbal remedy

Some herbal remedies may improve sexual satisfaction, especially if erectile dysfunction is a concern. In 2018, researchers published a review of 24 trials involving herbal remedies as treatments for erectile dysfunction.

Ginseng provided significant improvements, while a type of pine called Pinus pinaster and the maca root, or Lepidium meyenii, showed early positive benefits. Other herbs, namely saffron and Tribulus terrestris, did not show clear results.

However, results of a small study published in 2017 indicated that Tribulus terrestris may help with erectile dysfunction.

Before trying herbal remedies, speak with a doctor.

It is important to see a healthcare provider who is knowledgeable about supplements and who can monitor the progress of symptoms.

11. Consider counseling

Erectile dysfunction is often due in part to psychological factors. These can include:

• anxiety and depression
• relationship problems
• social stigma associated with aging or penis size
• untreated mental health conditions
• a history of trauma

Individual counseling can help a man to address the role of these and other factors in sexual satisfaction.

Relationship counseling can help partners to speak openly about sexuality without shame or judgment.

When a man has an underlying health issue, for example, counseling can help him to cope with the stress of erectile dysfunction while communicating about options with a partner.

12. Talk to a doctor

Several medications can help with sexual function.

Medication can be the most rapid treatment option for some men. If a man taking medication for erectile dysfunction also makes lifestyle changes and participates in therapy, they may eventually be able to stop taking the drugs.

13. Manage chronic health problems

Erectile dysfunction can be an early warning sign of health issues. It is important to take good care of the body by eating a balanced diet, remaining physically active, and managing stress.

Treating chronic health issues, such as diabetes and heart disease, is also essential. Take medications as recommended and try lifestyle changes that can improve overall health.

If symptoms of these conditions worsen, seek medical care.

A man who takes drugs with sexual side effects should discuss changing the medication, stopping the treatment, or lowering the dosage with a doctor.