Premature Ejaculation Symptoms, Causes, and Treatment
Feeling worried about premature ejaculation? You’re definitely 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 potentially 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.
Below, we’ve explained what premature ejaculation is, as well as the numerous factors that may play a role in its development. We’ve also listed the symptoms of premature ejaculation, as well as how these differ from other sexual health issues.
Finally, we’ve discussed your options for treating premature ejaculation, enhancing your sexual performance and improving your sex life.
What is Premature Ejaculation?
Premature ejaculation is a common male sexual function issue in which you may reach orgasm and ejaculate early during sexual encounters. It can affect men of all ages, and can potentially contribute to everything from frustration during sex to issues such as depression.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM–5), PE is any type of 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 lack control over ejaculation, causing you to reach orgasm and ejaculate too early during sexual intercourse or other sexual activity.
As a medical condition, premature ejaculation is sometimes referred to as “rapid ejaculation” or “early ejaculation.” No matter what you choose to call it, it’s a serious issue that can have major personal consequences, both for your sex life and for your general wellbeing.
What Are the Symptoms of Premature Ejaculation?
The most significant symptom of premature ejaculation is reaching orgasm and ejaculating very quickly during sexual activity -- typically, in one minute or less after penetration.
To be thought of as premature ejaculation (rather than simply reaching orgasm and ejaculating quickly, which can happen during normal sexual activity), ejaculation normally needs to happen before the affected person would like it to during most or all sexual activity.
If you’re affected by premature ejaculation, you may experience some or all of these symptoms:
You ejaculate very soon after vaginal penetration. Mild PE typically involves ejaculating 30 to 60 seconds after penetration, while severe PE can involve ejaculating before you insert your penis into your sexual partner.
You don’t want to ejaculate this early. For example, you aren’t in a hurry to finish during sex and would prefer to have sex for longer, but find doing so difficult or impossible.
You feel distressed because of your early ejaculation. For example, you might feel less interested in having sex due to embarrassment or anxiety, feel like you have a low sex drive, or feel as if your short time to ejaculate affects your general quality of life.
To some extent, 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 ejaculation as orgasm and ejaculation that occurs within four minutes of vaginal penetration.
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 viewed specifically as premature ejaculation. For example, if you want to reach orgasm and cum quickly during sex, this typically isn't considered a form of ejaculatory dysfunction.
However, if you often ejaculate within a minute of penetration, feel unhappy or concerned about it, or simply feel as if you don’t have normal ejaculation control or sexual stamina, you could be affected by some form of premature ejaculation.
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How is Premature Ejaculation Diagnosed?
Because the average time to ejaculate can vary so much from one man to another, PE can be a challenging condition to diagnose. People can have different expectations when it comes to sex, and there isn’t a clear, agreed-upon definition of PE.
To be diagnosed with premature ejaculation, you’ll typically need to have the symptoms that are listed above, such as rapid ejaculation after penetrating your partner and some level of distress due to your lack of ejaculatory control.
Your symptoms will also need to happen without a clear explanation, such as medication or drug use, a related medical condition or an issue in your relationship that affects your sexual function and performance.
In some cases, you may reach orgasm and ejaculate earlier than you’d like to, 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 sexually aroused than usual, and reach orgasm faster than you typically might.
It’s also common to feel as if 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.
Because it’s normal to occasionally reach orgasm and ejaculate faster than you might like, you’ll typically need to display symptoms for at least six months to be diagnosed with PE.
During a consultation for PE, your healthcare provider may ask you about your sexual history to determine how long you’ve been affected by these symptoms.
Premature ejaculation can be lifelong (meaning it’s present since your first sexual encounter) or acquires (meaning it develops after some amount of normal sexual function). It can also occur generally or in certain situations, such as when you have sex with a specific partner.
If your healthcare provider asks you questions about your average time to ejaculation, “success rate” during sex or about other factors that may play a role in ejaculation, try to answer them as clearly and honestly as you can.
While ejaculation can be an embarrassing and awkward topic to discuss, it’s important to keep in mind that your healthcare provider is there to help you, not to make any assumptions about your general sexual life or current relationship.
The more information you can provide and the more accurately you can answer your provider’s questions, the more likely it is that they’ll be able to provide an accurate diagnosis and help you to overcome PE and improve your sexual performance.
How Common is Premature Ejaculation?
Premature ejaculation is extremely common. Although data can vary, most self-reported studies suggest that 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 otherwise healthy adult men experience some level of premature ejaculation.
In short, if you experience premature ejaculation, you definitely aren’t alone, nor should you feel alarmed. Premature ejaculation is highly common and happens in men of all ages, backgrounds and sexual experience levels.
Interestingly, despite many guys’ fears, research suggests that premature ejaculation really isn’t that big of a deal for most women.
In fact, one study published in the journal Archives of Sexual Behavior, which used data from more than 150 heterosexual couples, concluded that men view rapid ejaculation as more of an issue than their female partners.
This study also revealed that while rapid ejaculation is typically associated with lower levels of sexual satisfaction, it doesn’t appear to cause significant interpersonal relationship issues.
What Causes Premature Ejaculation?
What causes premature ejaculation? Just like with other sexual function issues such as erectile dysfunction, there are lots of widely shared but scientifically inaccurate “theories” about why PE develops in men.
For example, you may have heard that premature ejaculation can develop if you masturbate too frequently, or if you use an overly aggressive grip during masturbation (a problem referred to as “death grip” syndrome).
Alternatively, you may have read that premature ejaculation occurs when you don’t have sex on a frequent enough basis, or if you have some kind of problem with your sexual technique.
The reality is that researchers aren’t yet aware of exactly what causes premature ejaculation to develop, nor is there a one-size-fits-all explanation for premature ejaculation and other forms of sexual dysfunction in men.
Put simply, most of the time, there’s no singular cause that your healthcare provider can point to as the problem behind this common condition.
Instead, researchers believe that a range of factors could all contribute to premature ejaculation in certain ways, from physical health issues such as inflammation in certain areas of your penis and prostate to depression, anxiety and other psychological disturbances.
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.
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).
How to Treat Premature Ejaculation
Although premature ejaculation can be frustrating to deal with, the good news is that it’s usually treatable, allowing you to increase your sexual stamina and enjoy a higher sexual quality of life with the right approach.
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 that are approved by the FDA specifically as treatments for premature ejaculation. However, premature ejaculation is often treated off-label with a class of antidepressants called selective serotonin reuptake inhibitors, or SSRIs.
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 used 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 widely-used SSRIs for 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 with 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 as a treatment 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 topical creams and sprays contain topical anesthetics such as lidocaine or prilocaine and are designed for use before sex. The ingredients are absorbed by the skin on your penis to limit sensitivity without affecting your partner.
Like with SSRIs, research shows that sprays and anesthetic creams for PE can slow down the process of reaching orgasm and ejaculating.
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 than men with PE who used a placebo treatment.
They also had sex on a more frequent basis, suggesting that the spray helped to improve their overall sexual experience and performance.
Unlike SSRIs, which require a prescription, most creams and sprays for premature ejaculation are available over the counter.
Our Delay Spray for Men, which contains lidocaine, is available online as a convenient option for reducing sensitivity, increasing stamina and improving your sexual function.
Behavioral Therapy for Premature Ejaculation
Behavioral therapy involves identifying unhealthy or harmful behaviors, then taking meaningful steps to change them. When this type of therapy is used to treat sexual health issues such as premature ejaculation, it’s often referred to as sex therapy.
Studies have 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” approach, which involves stopping during sex to prevent orgasm and ejaculation, and the “squeeze” technique, 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 that strengthen the muscles around your penis and bladder 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 function issues, including premature ejaculation.
During counseling, you’ll work with a mental health provider to discuss your PE symptoms, their effects on your quality of life and the factors that you think may contribute to them.
Over time, counseling can help you to gain control over your feelings and deal with issues that could play a role in premature ejaculation, such as sexual performance anxiety or body image issues.
We offer counseling online as part of our range of mental health services, allowing you to talk to a licensed counselor and make progress from the privacy and comfort of your own home.
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, severalstudies 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 medications online on ejaculatory latency. Our full guide to sildenafil and premature ejaculation goes into more detail about these treatments, as well as the potential benefits they may offer.
In addition to sildenafil, other medications for treating ED include tadalafil (the active ingredient in 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 also 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. It can be a serious annoyance when it occurs, but the good news is that options are available to help you bring it under control and improve your sexual function.
Most of the time, premature ejaculation can be treated with behavioral therapy, evidence-based prescription medications such as sertraline, or over-the-counter products such as sprays, wipes and condoms.
In some cases, making changes to your lifestyle or practicing certain techniques could 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.
You can also take part in an online consultation for premature ejaculation to talk to a healthcare provider and, if appropriate, access our range of premature ejaculation treatments.
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 or medication.
