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Premature Ejaculation: Causes, Symptoms and Treatment Options

Kristin Hall, FNP

Medically reviewed by Kristin Hall, FNP

Written by Our Editorial Team

Last updated 5/18/2021

Worried about premature ejaculation? You’re not alone. Research shows that premature ejaculation, or PE, is one of the most common forms of sexual dysfunction, affecting as much as 39 percent of the male population.

A variety of factors can contribute to premature ejaculation, from penile sensitivity to psychological issues such as depression, performance anxiety and stress.

Here’s the good news: While premature ejaculation might negatively affect your sex life in the short term, it’s usually treatable with a combination of medication, therapy and/or simple lifestyle changes.

Here, we explain what premature ejaculation is, as well as the numerous factors that may play a role in its development. We’ve also listed related symptoms,  as well as how these differ from other sexual health issues. 

Finally, below you’ll find options for treating premature ejaculation, enhancing your sexual performance and improving your sex life.

What is Premature Ejaculation?

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM–5), premature ejaculation is any ejaculation that occurs "during partnered sexual activity with approximately 1 minute following vaginal penetration and before the individual wishes it, during all or almost all sexual activity."

Simply put, premature ejaculation occurs when you reach orgasm and ejaculate too early during sexual intercourse or other sexual activity. 

Premature ejaculation is occasionally referred to as “rapid ejaculation” or  “early ejaculation, ” and no matter what you call it, it’s never much fun for anyone.

The jury is out on the exact amount of time that defines ejaculation as normal or premature.

While one minute might be the common standard, some experts use a slightly longer amount of time and define premature cum as ejaculation that occurs in two minutes or less after vaginal penetration in at least 50% of sexual attempts.

Others use less specific, more subjective definitions. For example, some researchers define PE based on the satisfaction level of the female partner.

Not all cases of ejaculating early are considered premature ejaculation. For example, if you want to reach orgasm and cum quickly during sex, this generally isn't considered to be premature ejaculation.

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Premature Ejaculation Symptoms

Premature ejaculation can sometimes be difficult to diagnose. People can have different expectations when it comes to sex, and there isn’t a clear, agreed-upon definition of PE.

It takes the average guy about five to seven minutes to ejaculate once having sex. Yet because there are so many factors that can vary in the bedroom, this stat can be different for each individual. 

Most of the time, healthcare professionals will diagnose a patient with premature ejaculation if he:

  • Unintentionally ejaculates soon after penetrative sex, typically within one minute.

  • Has recurring symptoms that have occurred for six months or longer.
    Experiences distress as a result of these symptoms.

  • Has no other medical problems that can be identified as a potential cause.

Premature ejaculation can be mild, moderate or severe. Mild premature ejaculation occurs 30 seconds to one minute after penetration, while moderate premature ejaculation usually occurs within 15 to 30 seconds. 

Severe premature ejaculation occurs within 15 seconds of penetration, during foreplay or even before sexual activity begins.

In some cases, you may reach orgasm and ejaculate earlier than you’d like, even if you don’t have clinical premature ejaculation.

For example, it’s far from uncommon to ejaculate relatively quite quickly if you haven’t had sex in a long time. In this situation, it’s normal to feel more aroused than usual, and reach orgasm faster than you typically might.

It’s also quite common to feel like you reach orgasm and ejaculate too fast, even if your ejaculatory latency time (the time it takes you to ejaculate) is within the normal range. 

While these issues may be annoying, they generally aren’t viewed as symptoms of premature ejaculation or sexual dysfunction.

How Common is Premature Ejaculation?

Premature ejaculation is extremely common. Although data can vary, most self-reported studies indicate that anywhere from four to 39 percent of men are affected by premature ejaculation at some point in life.

Other research suggests that up to 75 percent of men are affected by premature ejauclation to some degree.

In short, if you experience premature ejaculation, you definitely aren’t alone, nor should you feel alarmed. Premature ejaculation is very common and affects men of all ages.

For some men, premature ejaculation is a lifelong form of sexual dysfunction that’s existed since their first sexual experience. This is often referred to as lifelong premature ejaculation.

For others, it’s an acquired issue that develops after a period of normal sexual functioning. Premature ejaculation can also be situational, meaning it only occurs with certain types of stimulation or with specific sexual partners.

Interestingly, despite many guys’ fears, research suggests that premature ejaculation really isn’t that big of a deal for most women. 

In fact, a study published in Archives of Sexual Behavior, which used data from more than 150 heterosexual couples, concluded that men view rapid ejaculation as more of a problem than their partners do. 

This study also revealed that while rapid ejaculation is typically associated with lower levels of sexual satisfaction, it doesn’t appear to cause relationship problems.

Premature Ejaculation Causes

What causes premature ejaculation? Just like with erectile dysfunction, there are lots of widely shared but inaccurate “theories” about why premature ejaculation develops. 

For example, you may have heard that premature ejaculation is caused by masturbation, especially masturbating overly quickly, aggressively or often in adolescence, or that it's caused by not having sex on a regular basis. 

The reality is that researchers don’t yet know what causes premature ejaculation to develop. Most of the time, there’s no definite cause that a healthcare care professionals or patient can point to as the primary factor in PE.

Instead, researchers think that a range of factors may contribute to premature ejaculation, from physical issues to psychological ones. We’ve listed these factors below.

Psychological Causes of Premature Ejaculation 

Research suggests that psychological factors may contribute to several different types of sexual dysfunction, including premature ejaculation. 

Psychological factors linked to PE include depression, stress, anxiety, guilt, poor body image, a lack of confidence and a history of sexual abuse.

Premature ejaculation may also be caused by performance anxiety: a form of anxiety related to sexual performance that can also play a role in issues such as erectile dysfunction (ED).

Physical Causes of Premature Ejaculation

Certain physical and biological factors may cause or contribute to premature ejaculation. These include:

  • Abnormal hormone levels. Certain hormones, such as prolactin, luteinizing hormone (LH) and thyroid stimulating hormone (TSH) may contribute to premature ejaculation.

  • Abnormal serotonin levels. Research suggests that low levels of the neurotransmitter serotonin may shorten the amount of time required to reach orgasm and ejaculate.

  • Inflammation and/or infection. Infections and/or inflammation that affect your prostate or urethra may affect your sexual function and contribute to premature ejaculation.

Some experts also believe that the physical sensitivity level of your penis may play a role in the amount of time it takes for you to reach orgasm and ejaculate during sex.

How to Treat Premature Ejaculation

A variety of different techniques are used to treat premature ejaculation, including several types of medication, behavioral techniques and counseling. 

Antidepressants For Premature Ejaculation 

Currently, there are no medications approved in the United States specifically as treatments for premature ejaculation. However, premature ejaculation is often treated with a class of antidepressants called selective serotonin reuptake inhibitors, or SSRIs.

Although these medications aren’t approved to treat PE, research shows they can increase ejaculation latency. 

If you normally ejaculate in a short amount of time, an SSRI may help you last longer and enjoy more fulfilling, satisfying sex. 

Several SSRIs are prescribed off-label to increase ejaculatory time, including escitalopram, sertraline, fluoxetine, paroxetine, clomipramine and other medications.

Sertraline for Premature Ejaculation

Sertraline, the active ingredient in Zoloft®, is one of the most common SSRIs for treating premature ejaculation.

Although sertraline isn’t designed specifically to treat PE, numerous studies have found that it’s effective at delaying ejaculation and increasing intravaginal ejaculatory latency time.

For example, in one study from 1998, men affected by premature ejaculation who were treated using sertraline increased their average ejaculatory interval (the amount of time before reaching orgasm and ejaculating) from one minute to a maximum of 16.4 minutes.

Like other SSRIs, sertraline can cause side effects. However, for many men, it’s an effective and helpful treatment that allows for more fulfilling, satisfying sex.

We offer sertraline for premature ejaculation online, following a consultation with a licensed healthcare provider who will determine if a prescription is appropriate.

Creams and Sprays for Premature Ejaculation

Premature ejaculation is often treatable using topical creams and sprays that alter the sensitivity level of your penis.

These creams and sprays contain topical anesthetics such as lidocaine or prilocaine and are designed for use before sex. The ingredients are absorbed by your skin, meaning they’ll help to alter your penis’s sensitivity without affecting your partner.

Like SSRIs, research shows that sprays and anesthetic creams for premature ejaculation can help to increase time-to-ejaculation and enhance sexual performance.

For example, one study found that men with premature ejaculation who used a lidocaine spray before sex were able to have sex for longer on average. 

They also had more sex, suggesting that the spray helped to improve their overall sexual experience and performance.

Our delay spray for men, which contains lidocaine, is available online as a convenient option for treating premature ejaculation and helping you to last longer in bed.

Behavioral Therapy for Premature Ejaculation

Behavioral therapy involves identifying unhealthy or negative behaviors and taking steps to change them. When this type of therapy is used to treat sexual issues such as premature ejaculation, it’s often referred to as sex therapy.

Research shows that certain behavioral techniques can help reduce the severity of premature ejaculation and improve sexual performance. Studies have also found that a combination of psychotherapy and medication can be more effective for treating PE than medication alone.

Behavioral therapy for PE may involve a combination of psychotherapy and physical techniques to delay or prevent ejaculation. 

Common physical techniques involve the “stop-start,”, which involves stopping during sex to prevent orgasm and ejaculation, and the “squeeze,” which involves squeezing the base of the penis during sex.

You can learn more about these techniques and their effects in our guide to home remedies for premature ejaculation

Some physical exercises may help improve ejaculatory control and reduce the severity of premature ejaculation.

For example, research shows that kegel exercises–exercises that involve training your pelvic floor muscles–can improve control over the ejaculatory reflex and increase ejaculatory latency for men with PE.

Counseling for Premature Ejaculation

Counseling is a helpful and effective treatment option for many sexual dysfunctions, including premature ejaculation. 

During counseling, you’ll work with a mental health provider to discuss your symptoms and the factors that may contribute to them.

Over time, counseling can help you to gain control over your feelings and deal with issues that may contribute to premature ejaculation, such as sexual performance anxiety.

Erectile Dysfunction (ED) Medications for Premature Ejaculation

Research shows that some medications for erectile dysfunction, or ED, may also offer benefits as treatments for premature ejaculation.

For example, several studies have found that sildenafil, the active ingredient in Viagra®, or generic Viagra, either increases ejaculatory latency time or improves sexual satisfaction and self-confidence in men affected by PE.

However, it’s important to note that there isn’t a large amount of research into the effects of ED medication on ejaculatory time. You can learn more in our full guide to sildenafil and premature ejaculation

Other medications for erectile dysfunction include tadalafil (Cialis®), vardenafil (Levitra®) and avanafil (Stendra®).

We offer numerous ED medications online, following a consultation with a licensed healthcare provider who will determine if a prescription is appropriate.

Can You Prevent Premature Ejaculation?

Although there’s limited research on the most effective ways to prevent premature ejaculation, living a physically and mentally healthy lifestyle can help improve your sexual performance and reduce your risk of developing many common sexual issues. Try to:

  • Exercise regularly. Research shows that men who exercise regularly are less likely to experience premature ejaculation than those with a sedentary lifestyle. While there’s no need to train like a competitive athlete, maintaining a regular workout routine can improve your physical health and sexual performance.

  • Focus on your mental health. Like other sexual issues, premature ejaculation often occurs at the same time as mental health issues such as depression or some anxiety disorders. If you’re concerned about premature ejaculation, focus on improving and maintaining your mental health. If you’re affected by premature ejaculation, or if you simply think you reach orgasm too early, you can try the following techniques:

  • Masturbate before sex. Many men find that they’re more able to delay ejaculation on “round two.” If you’re prone to PE, try masturbating a few hours before sex—just make sure to keep your refractory period in mind.

  • Use premature ejaculation condoms. Some condoms contain a topical anesthetic to reduce sensitivity, which may allow you to last longer during sex. You can find these in most convenience stores and supermarkets.

  • Talk to your partner. When premature ejaculation is caused by a psychological issue or a problem in your sexual relationship, talking openly and honestly with your partner may help you to overcome it together.

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Premature Ejaculation Is Treatable 

Premature ejaculation is a common, normal form of sexual dysfunction that can affect men of all ages and backgrounds. 

Most of the time, premature ejaculation can be treated with behavioral therapy or science-based medications such as sertraline or lidocaine spray for PE.

In some cases, making lifestyle changes or practicing certain techniques can also help you increase control over your orgasms and ejaculation. 

If you have premature ejaculation, it’s best to talk to a healthcare provider about your options for increasing ejaculatory time and improving your sexual performance.

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This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

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