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 have premature ejaculation at one time or another. It is only a problem when it happens often.

Ejaculation happens after a certain degree of sexual stimulation. Men can take steps to delay the process. Premature ejaculation often happens when a man is not able to recognize that he is about to ejaculate.

Psychological factors may also lead to premature ejaculation. This may include problems 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
  • Medicine that increase sexual stimulation
  • Certain health issues (such as thyroid problems)

The Prostate
Anatomy of the Prostate Gland

© 2011 Nucleus Medical Media, Inc.

Risk Factors

Things that may increase the 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
  • Problems between sexual partners
  • Early sexual experiences that encouraged rapid ejaculation, usually from fear of being caught

Symptoms

Regular premature ejaculation is the only symptom.

Diagnosis

Premature ejaculation cannot be diagnosed until symptoms are shared with the doctor. The doctor will ask about symptoms and past health. A physical exam will be done.

The doctor may look for medical causes if this is a sudden change or it is causing severe problems. Other medical issues or treatments will also be reviewed for a possible link.

Treatment

The goal of treatment is to stop or decrease number of events. The choice of treatments will depend on individual needs. Choices may include:

Behavior Therapy

To help recognize when ejaculation is about to happen and how to delay it. Steps may include:

  • Biofeedback—electrical feedback to teach muscles of ejaculation
  • Start and stop method—stop 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—different positions may allow greater control

Psychological Counseling

Counseling may be offered for an individual or for a couple. It can help with fear, guilt, or relationship problems.

Medicine

A desensitizing cream may help. It is put on the penis to lessen sexual stimulation.

Some antidepressant medicine may also slow the process to ejaculation. They do not cure the cause of premature ejaculation.

Prevention

To help reduce your chances of premature ejaculation:

  • Learn more about male and female sexual responses.
  • Improve communication with your partner before engaging in sexual activity.
  • Have sex in private and relaxed settings.
RESOURCES:

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

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

CANADIAN RESOURCES:

Health Canada
https://www.canada.ca

Sex & U—The Society of Obstetricians and Gynaecologists of Canada
http://www.sexandu.ca

REFERENCES:

Althof SE, McMahon CG, Waldinger MD, et al. An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation (PE). J Sex Med. 2014 Jun;11(6):1392-422.

Hatzimouratidis K, Giuliano F, Moncada I, et al; European Association of Urology (EAU). Guideline on Male Sexual Dysfunction. EAU 2019

Premature ejaculation. Family Doctor—American Academy of Family Physicians website. Available at: https://familydoctor.org/condition/premature-ejaculation. Accessed September 4, 2020.

Premature ejaculation. EBSCO DynaMed website. Available at:http://www.dynamed.com/topics/dmp~AN~T115092/Premature-ejaculation. Accessed September 4, 2020.

What is premature ejaculation? Urology Care Foundation website. Available at: http://www.urologyhealth.org/urologic-conditions/premature-ejaculation?article=122. Accessed September 4, 2020.

Last reviewed September 2020 by EBSCO Medical Review Board Adrienne Carmack, MD  Last Updated: 9/4/2020