Understand what may cause ejaculation to happen earlier than wanted during sex. Also learn how to treat and prevent it.
Premature ejaculation occurs in men when semen leave the body (ejaculate) sooner than wanted during sex. Premature ejaculation is a common sexual complaint. As many as 1 out of 3 people say they have it at some time.
Premature ejaculation isn't cause for concern if it doesn't happen often. But you might be diagnosed with premature ejaculation if you:
Premature ejaculation is a treatable condition. Medications, counseling and techniques that delay ejaculation can help improve sex for you and your partner.
The main symptom of premature ejaculation is not being able to delay ejaculation for more than three minutes after penetration. But it might occur in all sexual situations, even during masturbation.
Premature ejaculation can be classified as:
Many people feel that they have symptoms of premature ejaculation, but the symptoms don't meet the criteria for a diagnosis. It's typical to experience early ejaculation at times.
Talk with your health care provider if you ejaculate sooner than you wish during most sexual encounters. It's common to feel embarrassed about discussing sexual health concerns. But don't let that keep you from talking to your provider. Premature ejaculation is common and treatable.
A conversation with a care provider might help lessen concerns. For example, it might be reassuring to hear that it's typical to experience premature ejaculation from time to time. It may also help to know that the average time from the beginning of intercourse to ejaculation is about five minutes.
The exact cause of premature ejaculation isn't known. It was once thought to be only psychological. But health care providers now know that premature ejaculation involves a complex interaction of psychological and biological factors.
Psychological factors that might play a role include:
Other factors that can play a role include:
A number of biological factors might contribute to premature ejaculation. They may include:
Various factors can increase the risk of premature ejaculation. They may include:
Premature ejaculation can cause issues in your personal life. They might include:
Your health care provider asks about your sex life and your health history. Your provider might also do a physical exam. If you have both early ejaculation and trouble getting or keeping an erection, your provider might order blood tests. The tests may check your hormone levels.
In some cases, your care provider might suggest that you go to a urologist or a mental health provider who specializes in sexual problems.
Common treatment options for premature ejaculation include behavioral techniques, medications and counseling. It might take time to find the treatment or combination of treatments that work for you. Behavioral treatment plus drug therapy might be the most effective.
In some cases, therapy for premature ejaculation involves simple steps. They may include masturbating an hour or two before intercourse. This may allow you to delay ejaculation when you have sex with your partner.
Your care provider might recommend avoiding intercourse for a period of time. Focusing on other types of sexual play may remove the pressure you might feel during sexual intercourse.
Weak pelvic floor muscles might make it harder to delay ejaculation. Pelvic floor exercises (Kegel exercises) can help strengthen these muscles.
To perform these exercises:
Your health care provider might instruct you and your partner to use the pause-squeeze technique. This method works as follows:
By repeating as many times as needed, you can reach the point of entering your partner without ejaculating. After some practice, delaying ejaculation might become a habit that no longer requires the pause-squeeze technique.
If the pause-squeeze technique causes pain or discomfort, you can try the stop-start technique. It involves stopping sexual stimulation just before ejaculation. Then waiting until the level of arousal has diminished and starting again.
Condoms might make the penis less sensitive, which can help delay ejaculation. Specially designed "climax control" condoms are available without a prescription. These condoms contain numbing agents such as benzocaine or lidocaine to delay ejaculation. They might also be made of thicker latex. Examples include Trojan Extended Pleasure and Durex Prolong.
Creams, gels and sprays that contain a numbing agent — such as benzocaine, lidocaine or prilocaine — are sometimes used to treat premature ejaculation. They're applied to the penis 10 to 15 minutes before sex to reduce sensation and help delay ejaculation. They're available without a prescription. However, a cream containing both lidocaine and prilocaine (EMLA) is available by prescription.
Although topical numbing agents are effective and well tolerated, they have potential side effects. They may cause decreased feeling and sexual pleasure in both partners.
Many medications might delay orgasm. These drugs aren't approved by the Food and Drug Administration to treat premature ejaculation, but some are used for this purpose. They include antidepressants, pain relievers and drugs for erectile dysfunction.
These medications might be prescribed for either on-demand or daily use. Also, they may be prescribed alone or with other treatments.
Antidepressants. A side effect of certain antidepressants is delayed orgasm. For this reason, selective serotonin reuptake inhibitors (SSRIs) are used to treat premature ejaculation. SSRIs include paroxetine (Paxil, Pexeva, Brisdelle), escitalopram (Lexapro), citalopram (Celexa), sertraline (Zoloft) or fluoxetine (Prozac).
The SSRI dapoxetine is often used as the first treatment for premature ejaculation in some countries. It's not currently available in the United States.
Of the drugs approved for use in the United States, paroxetine seems to be the most effective. These medications usually take 5 to 10 days to begin working. But it might take 2 to 3 weeks of treatment to see the full effect.
If SSRIs don't improve the timing of your ejaculation, your health care provider might prescribe the tricyclic antidepressant clomipramine (Anafranil). Side effects of antidepressants might include nausea, perspiration, drowsiness and decreased sex drive.
Pain relievers. Tramadol (Ultram, Conzip, Qdolo) is a medication used to treat pain. It also has side effects that delay ejaculation. Tramadol might be prescribed when SSRIs haven't been effective. Tramadol can't be used in combination with an SSRI.
Side effects might include nausea, headache, sleepiness and dizziness. Tramadol can become habit-forming when taken long-term.
Research suggests that several drugs might be helpful in treating premature ejaculation. But more study is needed. These drugs include:
This approach involves talking with a mental health provider about your relationships and experiences. Sessions can help you reduce performance anxiety and find better ways of coping with stress. Counseling is most likely to help when it's used in combination with drug therapy.
With premature ejaculation, you might feel that you lose some of the closeness shared with a sexual partner. You might feel angry, ashamed and upset, and turn away from your partner.
Your partner also might be upset with the change in sexual intimacy. Premature ejaculation can cause partners to feel less connected or hurt. Talking about the problem is an important step. Relationship counseling or sex therapy also might be helpful.
The male pelvic floor muscles support the bladder and bowel and affect sexual function. Kegel exercises can help strengthen these muscles.
Several alternative medicine treatments have been studied, including yoga, meditation and acupuncture. However, more research is needed to determine their effectiveness.
It's typical to feel embarrassed when talking about sexual problems. But you can trust that your health care provider has had similar conversations with many others. Premature ejaculation is a very common condition. And it's one that can be treated.
Being ready to talk about premature ejaculation will help you get the treatment you need to put your sex life back on track. The information below should help you prepare to make the most of your appointment.
The list below suggests questions to ask your health care provider about premature ejaculation. Don't hesitate to ask more questions during your appointment.
Your health care provider might ask very personal questions and might also want to talk to your partner. To help your provider determine the cause of your problem and the best course of treatment, be ready to answer questions, such as:
Deciding to talk with your health care provider is an important step. In the meantime, consider exploring other ways in which you and your partner can connect. Although premature ejaculation can cause strain and anxiety in a relationship, it is a treatable condition.