Nobody likes to think about sexual problems, especially their own. This can make it uncomfortable to talk about with sexual partners and prevent men from finding medical help. Part of the problem is that it seems like nobody else has them. In reality, many men are sexually dissatisfied in some way.

One kind of sexual problem that men can have is a problem with ejaculation. As you know, ejaculation is when sperm shoots out of the tip of the penis. For some men, how much sexual stimulation (touching, rubbing and penetration) before ejaculation happens is a problem. Ejaculation can happen quickly. Sometimes it happens even before any touching of the penis occurs. Ejaculating early, before you or your partner wants it to happen, is called premature ejaculation. Other men can have ejaculation only after a really long time, or not at all. This is called delayed ejaculation.

In this section, we’ll focus on premature ejaculation. It is very common, occurring in 20-30 percent of men.1 That’s more than one out of every five of your buddies! The good news is that there are many ways to help improve sexual function and satisfaction.

The Normal Sexual Cycle

To understand premature ejaculation, we have to understand what normal sexual function looks like in men. Normal sexual function follows what’s called the “sexual cycle.” There are four parts to this cycle: desire, arousal, orgasm and resolution.2

Desire and arousal are the first two parts of the cycle. Desire is wanting to have sex while arousal is having an erection.3 What stimulates desire in different people can be very complicated.3After getting an erection, men can enjoy sex with their partners. The man’s part normally ends with ejaculation, which is accompanied by that great feeling: — the orgasm. Finally, there’s some delay — the resolution  — before men are ready to go again. How long depends on each individual and can vary quite a lot.

Now that we understand the sexual cycle, how does it fit with premature ejaculation? For men who have premature ejaculation, the time between getting an erection (arousal) and ejaculating (orgasm) is too short.1 How short is too short? Experts disagree on this. Typically if you find that how quickly you ejaculate is a bother to you or your partner, you may be suffering premature ejaculation.

Definition and Types of Premature Ejaculation

The medical definition of premature ejaculation has three parts. The first part is that ejaculation almost always happens within three minutes or less after inserting the penis.4 The second part is that the man can’t keep himself from ejaculating quickly.4 The final part is that this early ejaculation causes the man to feel bad, angry, frustrated or embarrassed and sometimes causes him to avoid sex because of these feelings.4 Just to complicate matters, there are four different types of premature ejaculation with slightly different definitions of their own. They include: lifelong premature ejaculation, acquired premature ejaculation, natural variable premature ejaculation and subjective premature ejaculation.5 We’ve included information on each type below, but it’s a bit technical so feel free to skip down to the end if you aren’t interested.

Lifelong Premature Ejaculation

This is when for a man’s entire life, whenever he has penetration he almost always ejaculates faster than one minute.5 This started with his first sexual encounter and has happened with all of his sexual partners throughout his life.6 This seems to run in the family — someone with lifelong premature ejaculation is more likely to have a family member with the same problem.6 Talk to your doctor, who may prescribe medications.

Acquired Premature Ejaculation

With this, a man who used to have normal ejaculation times develops fast ejaculation later in life — with all the bothersome problems listed above.6 This fast ejaculation is typically less than three minutes after penetration.5 Sometimes this is related to troubles within a relationship.6 Other times, acquired premature ejaculation is linked to a new medical problem.6 This can include inflammation in the prostate or problems with the thyroid gland, which produces hormones.6 If this sounds like you, it’s important to talk to your doctor to make sure that you can get the right tests and treatment.

Natural Variable Premature Ejaculation

This is when a man only occasionally experiences premature ejaculation.5 Differences in time to ejaculation may be related to changing situations. This could include a new sexual partner or a change in the dynamics of the relationship.6 Overall, this type of premature ejaculation is just part of the natural variation of ejaculation time. Still, it’s still something that you should discuss with your doctor, who will provide you with strategies to manage it.

Subjective Premature Ejaculation

This last kind of premature ejaculation is when a man feels like he’s ejaculating too quickly but when timed it turns out to be of normal duration.5 It can still be very bothersome though, so talk to your doctor.

Remember that figuring out which type of premature ejaculation a man has is a physician’s job. There are lots of factors other than the ones listed above that help doctors identify the type of premature ejaculation and the treatment options.

Treatment Options And Strategies

You’re probably wondering how premature ejaculation is treated. The treatment each man gets depends on the type of premature ejaculation he has. Here are some of the main treatment options.

Counselling And Behaviour

Sometimes, being worried about premature ejaculation can be the worst part. For some guys, simply discussing it with your doctor will help. There can be underlying personal or relationship problems that causing premature ejaculation.7 Counselling sessions, either with or without the romantic partner, can help.7

There are some physical techniques as well, which aim to help teach guys to control their ejaculation. One of these is the start-stop method. Right before a man feels the urge to ejaculate, he will stop all sexual stimulation and allow the urge to pass.7 Then, he slowly restarts sexual activity. This can be practiced alone or with a partner. Another kind of physical technique is the squeeze technique. Just before feeling the urge to ejaculate, a man will stop and squeeze the tip of his penis until the urge passes.7 Finally, sensate focusing is a technique where a man and his partner will focus first on non-sexual touching to help with body awareness and then progress to sexual touching.7 Pelvic floor muscle strengthening exercises may also help.7 Overall, the counselling and behaviour techniques may not work all that well but they’re something that some guys might want to start with.7

Medications

There are a few options of medications, which are often used in addition to counselling or behavioural techniques. All of these have some possible side effects that should be discussed with your doctor.

The first is to use numbing gel called a topical anaesthetic to temporarily decrease the sensitivity of the penis.2 These gels are similar to what dentists use for teeth but instead of using needles, guys rub it on their skin. It makes the penis temporarily less sensitive and can help men last longer.

There’s also a pill called dapoxetine that seems to help.2 It can be taken an hour or two before sex and helps guys with premature ejaculation last longer and thus feel greater satisfaction with their sex lives. Other pills related to dapoxetine can be taken on a daily basis instead of before sex.2These pills are commonly referred to as “anti-depressants” because one of the things they can be used for is depression. If your doctor offers you one, it doesn’t mean he or she thinks you’re depressed. It’s just that these pills have many effects and some men find they help with premature ejaculation.

Other Therapies

There are a few other medical therapy options that have been tried but none seem to work better than the options listed.2 Other options, such as surgery, can do damage and aren’t recommended.2

Conclusion

Premature ejaculation is a common problem and there are several options for treatment. These include behavioural modifications, topical creams and medications. If you think you might be having trouble with premature ejaculation, talk to your doctor to ensure that you have the problem and, if so, what kind. Your physician should be able to help you.

References

1. Castiglione, F. et al. Current Pharmacological Management of Premature Ejaculation: A Systematic Review and Meta-analysis. Eur. Urol. 69, 904–916 (2016).

2. McMahon, C. G. Book Chapter: Disorders of Male Orgasm and Ejaculation, Campbell Walsh Urology 29, 692–708.e5

3. Georgiadis, J. R. & Kringelbach, M. L. The human sexual response cycle: Brain imaging evidence linking sex to other pleasures. Prog. Neurobiol. 98, 49–81 (2012).

4. Serefoglu, E. C. et al. An evidence-based unified definition of lifelong and acquired premature ejaculation: report of the second International Society for Sexual Medicine Ad Hoc Committee for the Definition of Premature Ejaculation. J. Sex. Med. 11, 1423–1441 (2014).

5. Gur, S., Kadowitz, P. J. & Sikka, S. C. Current therapies for premature ejaculation. Drug Discov. Today 21, 1147–1154 (2016).

6. Waldinger, M. D. & Schweitzer, D. H. Changing Paradigms from a Historical DSM-III and DSM-IV View Toward an Evidence-Based Definition of Premature Ejaculation. Part II—Proposals for DSM-V and ICD-11. J. Sex. Med. 3, 693–705 (2006).

7. Cooper, K. et al. Behavioral Therapies for Management of Premature Ejaculation: A Systematic Review. Sex. Med. 3, 174–188 (2015).