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What is premature ejaculation?

Premature ejaculation is a condition in which a man ejaculates too quickly, often before or very shortly after he has penetrated his partner, resulting in an unsatisfactory sex life.

There is no clear definition of ‘too quickly’: it varies from person to person and relationship to relationship. ‘Too quickly’ can be defined as ejaculating before you would like to, or before your partner is satisfied. Most men experience premature ejaculation at some time, but it becomes a problem with sexual relations if it occurs during most sexual encounters.

Premature ejaculation is common, especially in adolescents because the younger a man is, often, the more quickly he will get an erection and ejaculate (‘come’), and the less time he needs between erections before he can have sex again.

Types of premature ejaculation

There are 2 main types of premature ejaculation.

• Lifelong (or primary) premature ejaculation is when the man has experienced premature ejaculation – ejaculation that always or nearly always occurs before or within about one minute of penetration – since becoming sexually active.
• Acquired (secondary) premature ejaculation occurs in men who have had previous sexual experiences not affected by premature ejaculation. They tend to have a significant reduction in the time to ejaculation (often to about 3 minutes or less).

Men with premature ejaculation are unable to control or delay ejaculation during sex, and tend to have associated feelings of frustration and stress, which can lead to avoiding sexual intimacy.

Causes of premature ejaculation

Both psychological and biological factors may play a role in causing premature ejaculation.

Psychological causes include:

• anxiety (including performance anxiety, fear of losing an erection, fear of being caught in the act, or previous traumatic sexual experiences);
• relationship problems;
• stress; and
• depression.

Physical causes of premature ejaculation can include:

• increased penile sensitivity and lower ejaculatory threshold (in primary premature ejaculation);
• erectile dysfunction;
• an underlying condition such as high blood pressure or a hormone imbalance;
• alcohol; and
• side effects from medicines.

Diagnosis and tests

Your doctor will ask about your symptoms and perform a physical examination. Depending on the results, certain tests such as blood tests may be suggested to determine any underlying causes for premature ejaculation. Often tests are not necessary.

Treatment

Treatment will depend on whether you have primary or secondary premature ejaculation, and on your relationship status. Often, a combination of treatments works best.

Possible treatment options include:

• psychological, couples or sex therapy;
• behavioural techniques;
• medicines; and
• treatment of any co-existing erectile dysfunction or other underlying conditions.

Often, the problem of premature ejaculation diminishes as you become more secure with your partner or the circumstances in which you’re having sex. It is important to include your partner as much as possible in therapy, and to remove as much as possible feelings of pressure, shame or failure. Generally it is wise to avoid intercourse and associated feelings of failure until the premature ejaculation is treated. Your general practitioner, counsellor or therapist will be able to show you and your partner techniques to help delay ejaculation.

Therapy

For couples in a long-term relationship, couples or sex therapy may help to uncover and resolve any relationship or communication issues that could be affecting your sex life.

Cognitive behavioural therapy (CBT) is type of psychological therapy that involves identifying and challenging negative thinking patterns and developing alternative ways of thinking and acting. CBT can help you deal with performance anxiety and stress. It tends to work best in combination with medicines.

Behavioural techniques

The stop-and-start technique allows your partner to stimulate your penis until you feel you are about to ejaculate. On your signal, your partner stops stimulation, waits for 20 or 30 seconds and then begins stimulation again. Over time, and with practice, this technique has been shown to help many men to get improved control of their ejaculation.

The squeeze technique has also been commonly used. This involves withdrawing the penis (or stopping foreplay) before orgasm and squeezing the end of the penis, where the head (glans) joins the shaft, for several seconds until the urge to ejaculate passes. Sexual activity can then be resumed.

Other measures that may help include:

• masturbating an hour or 2 before sex; and
• wearing a thick condom or 2 condoms to reduce sensation.

Medicines

A variety of medicines has been used to treat premature ejaculation.

Topical anaesthetics are sometimes prescribed to delay ejaculation by reducing sensation in the penis. They need to be applied up to half an hour before sex, and a condom should be worn so that the anaesthetic is not absorbed by your partner. Some men report reduced sexual pleasure when using topical anaesthetics. Local allergic or irritant reactions are possible side effects.

Selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant, have been found to have delayed ejaculation as a side effect, and so are often used to treat premature ejaculation. Some SSRIs are more effective than others, but most can help delay ejaculation significantly. An SSRI called dapoxetine (brand name Priligy) is available as a specific treatment for premature ejaculation for some men. SSRIs can sometimes be taken on an ‘as needed’ basis, 1-3 hours before intercourse, or they can be taken on a regular basis. Possible side effects associated with SSRIs include nausea, tiredness, headaches, dry mouth, sweating and decreased libido.

A tricyclic antidepressant —clomipramine — is another type of antidepressant medicine that can help treat premature ejaculation.

Erectile dysfunction treatments

Treatments that are normally used for erectile dysfunction can also be used to treat premature ejaculation where there is also a component of erectile dysfunction.

Premature ejaculation and fertility

Premature ejaculation does not usually cause infertility, but couples having trouble conceiving may need to see a fertility specialist for advice on becoming pregnant.

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