Everything You Need to Know About This Extremely Common Male Sexual Disorder
When it comes to sex most men are very self-aware about how long they can last. Having an orgasm before you or your partner would like to can leave both of you disappointed.
If this happens too often you might be experiencing premature ejaculation. This condition could lead you to feel embarrassed and frustrated. It can put a damper on even the strongest of relationships.
Without a doubt, living with this disorder can be emotionally distressing. However, it’s nothing to be ashamed of. There are safe and effective ways in which PE can be treated, allowing you to take control of your sex life.
This article provides a comprehensive overview of premature ejaculation. We’ll cover everything from the symptoms and different forms of the disorder to treatment options and general tips for lasting longer in bed. At the end, we’ll provide links for further reading about specific issues related to premature ejaculation. So, let’s begin.
What is premature ejaculation?
Premature ejaculation (PE) is a common disorder in which a man climaxes too early during sex. In extreme cases, ejaculation may happen before penetration. For some, premature ejaculation affects them only occasionally; for others, it happens every time they have intercourse.
What officially counts as “too soon”? Opinions vary on the formal definition of PE and this has not yet been agreed upon. Some sex therapists believe that 1 minute is the magic number and that if you climax quicker than that, you have premature ejaculation. In a recent article, the ISSM determined that ejaculating within 3 minutes of penetration counts as PE.
But what if a man lasts, say, just under four minutes, causing him distress because his partner wasn’t able to enjoy the experience in that space of time? He lasted longer than 3 minutes – is this still a case of PE?
The definition that we – along with many other sex therapists – use is as follows: PE is a condition in which a man ejaculates before he or his partner are ready.
If you are unsure as to whether you have PE try our free online PE diagnosis tool.
How common is premature ejaculation?
Premature ejaculation is very common. Research shows that nearly one in three men around the world have PE! One study from the U.S showed that up to 78% of people had experienced features of PE at some point.
About 30% of men face the problem of premature ejaculation
Ultimately, PE can happen to any man, from any background or age group. While some think of it as a ‘young person’s disorder’, research shows that older men (above 31) are also affected, at times more so than younger men.
What are the symptoms of premature ejaculation
There are four types of premature ejaculation. If you have had PE since your very first sexual encounter, this is known as lifelong PE. Often, this is caused by genetic factors. On the other hand, acquired PE is diagnosed when a man experiences PE seemingly out of the blue, despite normal sexual functioning in the past. Often, this is caused by psychological, emotional or relationship issues.
What if you’re convinced that you have PE, but a doctor or urologist tells you that your ejaculatory timing is perfectly normal? This is called subjective PE. Finally, variable PE is diagnosed when ejaculatory problems come and go intermittently. At times your sexual functioning is normal; at others ejaculation occurs prematurely.
It’s very common to experience occasional ejaculatory problems from time-to-time; and variable PE is the most common form of the disorder. You can learn more about the different types of PE here.
How does premature ejaculation affect a man’s quality of life?
All forms of PE can negatively affect you and your partner’s emotional health and quality of life. For example, PE is linked to psychological disorders such as anxiety and depression. It can also increase your stress levels and lower your self-esteem. Single men might avoid dating as a result.
Importantly, PE can also put a large amount of strain on your relationship. If PE is causing you to ejaculate prior to penetration, obviously this poses a challenge for couples trying to conceive. Furthermore, emotional distress may affect your fertility. So, the emotional burden of PE may lead to fertility issues, which could strain your relationship even further.
If you want to learn more about the emotional impact of PE, take a look at article we wrote on the effects of premature ejaculation.
What causes premature ejaculation?
Premature ejaculation is typically caused by many interacting factors – often the exact cause cannot be pinpointed. However, nearly all men with PE share an inability to identify ‘the point of no return’. This is the moment at which your body starts signaling that you’re close to orgasm.
Men with PE may find themselves becoming overwhelmed or distracted, failing to notice the signs that they’re about to climax. This makes it difficult for them to pace themselves and prevent ejaculation from happening too soon. If their PE is lifelong this also means that their stamina never has a chance to improve.
The sexual process of men with PE
The point of no return is an important concept when it comes to treating PE – you can read more about it here.
What other factors are linked to PE?
Psychological factors
The following are some of the psychological factors that can cause or contribute to PE:
- Depression
- Anxiety disorders
- Sexual performance anxiety
- Anxiety linked to new relationships or sexual inexperience
- Stress
- Guilt
- Body image concerns
- Low self-esteem
- Relationship problems
PE may also be affected by conservative attitudes toward sex. For example, men brought up in cultural, religious or family contexts that viewed sex as dirty or immoral may be at risk. Having experienced sexual abuse is also a risk factor; or any past traumatic sexual encounter that triggers PE as a result of shame or anxiety.
Finally, unrealistic expectations about one’s penis size and sexual stamina may cause premature ejaculation. Often, these expectations develop in men who watch porn excessively.
Genetics
Research suggests that PE runs in families: a genetic link is likely. Your genes can affect your serotonin levels. This is a neurotransmitter (or brain chemical) that’s linked to feelings of happiness and is affected in disorders such as depression. Evidence suggests that premature ejaculation may in part be caused by lowered levels of serotonin.
Lifestyle factors
Improper masturbation techniques may also put you at risk. For example, adolescents who are ashamed about masturbating often rush the process so as not to get caught. By doing it this way, you might accidentally be training yourself to ejaculate too soon.
Erectile dysfunction
This is a sexual disorder in which you struggle to get or maintain an erection. Premature ejaculation and erectile dysfunction often co-occur. If you have erectile dysfunction, you might rush yourself to climax during sex because you’re worried about losing your erection. This can train your body to ejaculate prematurely through a process called conditioning (or behavioral learning).
When should you see a doctor?
We must note that in rare cases, premature ejaculation can be caused by an underlying medical condition such as Diabetes, Multiple Sclerosis or Urethritis. For this reason, it’s important to have a medical check-up, especially if your symptoms begin suddenly. Furthermore, we recommend regular wellness check-ups to ensure overall good health.
Premature ejaculation treatments
Premature ejaculation is not a condition you have to live with. PE can be treated using behavioral sex therapy exercises. Alternatively, the symptoms can be alleviated by using medications or numbing materials that are applied to the penis.
In this section we provide a brief overview of the alternative treatment options. If you would like to learn more about the pros and cons of the different approaches we have discussed here, take a look at this article on how to prevent premature ejaculation.
Behavioral sex therapy exercises
Behavioral sex therapy uses masturbation or penetration-based exercises as a tool to teach men how to control their ejaculation.
This form of sex therapy is usually taught in face-to-face sessions with a licensed sex therapist and is then practiced at home. Since many men are reluctant to see a professional we developed the Premature Ejaculation Program – an online exercise program for the treatment of premature ejaculation.
Two effective techniques are used as part of this treatment protocol.
The stop-start technique requires you (or your partner) to stimulate your penis up until the point of orgasm, but to stop before climaxing. You’ll take a few moments to relax and allow your arousal levels to subside before starting stimulation again.
The squeeze technique requires you to squeeze firmly at the base of your penis below the glans to stop yourself from climaxing. The thumb should be placed on the frenulum which is on the inferior surface of the penis and the first and second fingers are placed on the superior surface of the penis. The pressure is applied for 3-4 seconds. With both exercises, the process should be repeated several times before you finally ejaculate.
The exercises teach you to identify your point of no return and delay your orgasm. Once the treatment protocol is completed, you should be able to control your ejaculation without using these techniques – just like a man without PE does.
We believe that sex therapy exercises should be the first-line approach for most healthy man struggling with PE. These techniques are evidence-based and have been used by sex therapists to treat PE for more than half a century. Additionally, they are safe, effective and lack negative side effects.
If you’re interested in the research behind these techniques, take a look at our review of the studies on this topic. Alternatively, follow this link to learn more about the Between Us Clinic’s Premature Ejaculation Program; or click here to find a registered sex therapist.
Premature ejaculation medications
Sometimes, doctors prescribe antidepressants (such as paroxetine and Prozac/Fluoxetine) or pain-killers (such as Tramdol) to help men with PE. These drugs weren’t designed to treat PE, but their side-effects may help delay orgasm – this practice is called ‘off-labelling’.
A new drug – Dapoxetine (or Priligy) – is a prescription SSRI (a form of antidepressant) that has recently been developed to treat premature ejaculation. However, this drug has not yet been approved in the U.S. research suggests that after 12 months most people (roughly 90%) drop out of treatment.
Why did people drop out? This was because the medication’s effect did not meet their expectations (24.4%) or because of the expense involved (22.1%). Others dropped out because of the side effects (19.8%), a loss of interest in sex (19.8%) or because the medication did not work (13.9%). Unfortunately, while effective, medications can’t cure PE. Instead, they simply mask the symptoms temporarily.
Desensitizers / topical anesthetics
Desensitizing creams or sprays containing numbing agents (such as lidocaine or prilocaine) may be used to delay orgasm. These materials are applied to the penis 10-20 minutes prior to sex. Some studies have shown these materials can help men last up to 6.3 times longer. However, because you’re using an anesthetic, this approach may decrease sexual pleasure.
numbing materials usually come in the form of a spray or cream which you apply to the penis
Psychological therapy
As mentioned above, premature ejaculation can be caused by psychological issues – depressive and anxiety symptoms are the biggest culprits. If your psychological disorder is causing premature ejaculation, it’s recommended that you see a psychotherapist to treat your underlying psychiatric condition. Psychotherapy can also be used in tandem with sex therapy programs for best results.
Kegels
Kegels are physical exercises which require you to tense and strengthen muscles in your pelvic floor. Kegels have been used to help people struggling with urinary incontinence and recovering from prostate surgery. They have also been used to improve sexual function in men with erectile dysfunction and premature ejaculation. However, in our opinion there is not enough evidence that Kegels are effective for treating premature ejaculation, which is why they are not included in the PE program.
A word about alternative treatments
An online search reveals extensive alternative treatment options which claim to cure premature ejaculation. These range from Chinese and Ayurvedic herbal medicines to acupuncture, yoga, zinc supplements and dietary changes. But do they work?
To the best of our knowledge – “no”. We are unaware of any other treatments that have been sufficiently tried and tested from a scientific perspective. In other words, there is insufficient evidence for these approaches to be used as a sole treatment for men with premature ejaculation. Beware of false promises.
What about tips for delaying ejaculation?
There are some strategies that can be useful for men who don’t have PE. But, they should not be used to replace proper treatment in men with sexual dysfunction.
These are some of the tips, tricks and pointers that are usually recommended to men:
- Masturbate before you have sex to help you last longer.
- Wear a condom so that your penis is less sensitive.
- Mentally distract yourself during sex.
- Take a break from sex altogether, to give yourself a chance to reduce stress and performance-related anxiety.
However, some of these strategies that men use to delay orgasm can negatively affect men with PE. To learn more, take a look at this article on the dangers of self-treating premature ejaculation. Alternatively, you could read our comprehensive guide to lasting longer in bed. This article is relevant for men without PE.
Get help for your premature ejaculation
Premature ejaculation is a remarkably common sexual disorder, affecting men from all walks of life. Despite this, it often goes untreated. This is highly unfortunate, because PE can cause much unnecessary emotional distress: shame, guilt, anxiety, depression and relationship problems. Furthermore, premature ejaculation is a treatable condition and effective strategies exist to help you overcome it.
It’s important that we talk openly about this disorder, so that people can feel more comfortable getting the support they need. This article has provided everything you need to know about premature ejaculation – from prevalence and symptoms to causes and treatment options. The necessary resources are now at your fingertips, so act now to improve your sexual health and overall quality of life!
* Learn how you can overcome premature ejaculation using the Between Us Clinic’s Premature Ejaculation Program.
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