Everything You Should Know About Premature Ejaculation: Symptoms, Causes & Treatments

What is Male Ejaculation, and How Does it Occur?

When a man reaches orgasm or climax during sexual activity, he ejaculates semen from his penis. It is a reflex action controlled by nerve impulses and hormone releases, which cause rhythmic contractions of the pelvic muscles, leading to the release of semen.

What is Premature Ejaculation (PE)?

While having sexual intercourse, if you orgasm and ejaculate sooner than your partner prefers, you may have premature ejaculation (PE). It is a common male sexual disorder. You may ejaculate right before or shortly after penetration. Premature ejaculation is also referred to as premature climax, rapid ejaculation, or early ejaculation.

Although there is no set figure for how long sex should last, doctors consider it premature if you reach a climax within one minute of penetration. After ejaculating, you lose erections and cannot continue with sex, leading to an unsatisfactory sexual experience.

Sometimes, premature ejaculation occurs along with erectile dysfunction, another common male sexual dysfunction that creates difficulty in achieving and maintaining an erection for sexual intercourse. Early ejaculation is mostly not due to any underlying conditions and is rarely a cause of worry. However, repeated occurrences of premature ejaculation while engaging in sexual activity can create psychological distress for both partners.

You may develop embarrassment, anger, low self-esteem, anxiety, and depression, while your partner may feel frustrated, dissatisfied, and undesired. Your sexual desire will also significantly reduce, and you may start avoiding sex to escape the difficult situation and feelings. Over time, premature ejaculation can cause difficulties, not just with intimacy but your overall relationship.

However, it is essential to remember that treatments for PE are available, and you do not have to live with it all your life. Discuss with your healthcare provider if you are unsatisfied with your ejaculatory time. They will diagnose the root cause of your PE and provide you the best treatment for premature ejaculation.

Also Read: Erectile Dysfunction: Symptoms, Causes and Treatments and FAQs

What are the Different Types of Premature Ejaculation?

There are two main types of premature ejaculation—primary premature ejaculation and secondary premature ejaculation.

• Primary Premature Ejaculation (Lifelong): When a man has always had problems with premature ejaculation and has never been able to control it for a longer duration, he has primary or lifelong PE. Psychological factors are the leading cause of primary PE.  
• Secondary Premature Ejaculation (Acquired): When a man previously had control over his ejaculation but has recently developed premature ejaculation, he has secondary or acquired PE. Psychological as well as physical factors can cause secondary PE.

What are the Symptoms of Premature Ejaculation?

Premature ejaculation may occasionally occur due to stress, fatigue, alcohol or drug use, or a new sexual partner. In such cases, it may not be a cause for concern. However, if it occurs repeatedly and it is causing difficulties in your sex life, you may need to seek help. Premature ejaculation is usually self-diagnosable, and you are probably experiencing it if:

• You ejaculate earlier than desired: You and your partner can together define the parameters of sexual satisfaction. If you both feel your ejaculation time is too short to enjoy sex, it may signify premature ejaculation. By definition, PE is characterised by ejaculating before or within one minute of vaginal penetration.
• You do not have control over your ejaculation: Men with premature ejaculation also experience a lack of control over ejaculation. So, you may be trying to delay ejaculation, but you are still not able to control it from happening.
• You and your partner's sexual satisfaction has decreased: Sex is an essential aspect of a relationship and overall well-being. It elevates happiness, self-confidence, love and intimacy with your partner. But premature ejaculation causes you to lose erection earlier than desired and interrupts your ability to have longer and satisfactory sex.
• You are experiencing psychological distress: Premature ejaculation can take a toll on your mental health. You may feel angry, stressed, helpless, and embarrassed about your condition. Your inability to satisfy your partner may also lower your self-esteem and self-confidence. Combined, this can lead to more complex mental health conditions such as anxiety disorder and depression.
• You are avoiding sex: Sexual satisfaction and sexual desire are interconnected. If you are experiencing an unsatisfactory sex life due to ejaculation problems, you may develop sexual performance anxiety. As a result, you may start avoiding sex.
• You are experiencing erectile dysfunction: Sometimes, erectile dysfunction and premature ejaculation occur together. While PE is not alarming on its own, it can be a more significant cause of concern when accompanied by ED.

What are the Causes of Premature Ejaculation?

A combination of various factors may cause premature ejaculation. Most cases of PE are related to psychological reasons, while some may experience it due to physical or neurological conditions. In some cases, the exact cause of premature ejaculation is not known.

Psychological Causes of Premature Ejaculation:

• Stress: Everyday stress arising due to deadlines at work, driving in traffic, managing finances, an illness, pollution, and taking care of children is relatively common. It can lead to problems with sex, including erection and ejaculation, occasionally. However, the loss of a loved one, chronic health conditions, poverty, a dysfunctional marriage, or an unsatisfactory job can put you under chronic stress. When constantly stressed, the body releases stress hormones such as cortisol, adrenaline, and norepinephrine. These force the body into a state of anxiety, leading to muscle tension, thus making it difficult for you to relax during sex. Additionally, stress can affect your desire to have sex, cause performance anxiety, and lead to relationship problems. All of this can worsen premature ejaculation.

• Anxiety: This condition is characterised by excessive fear or worry. The production of stress hormones increases during anxiety, interfering with your ability to relax and focus during sex. Thus, you may be unable to control your sexual response time and ejaculate early.
• Sexual Performance Anxiety: You may struggle with performance anxiety if you constantly worry about performing well during sexual activity. You may also feel you cannot satisfy your partner's expectations. Such a stressful state of mind will impact your sexual ability and cause premature ejaculation. Various factors can influence performance anxiety, such as body image, penis size, unrealistic expectations about sex, ideas about gender roles, relationship issues, and porn.
• Depression: When you are depressed, you may experience constant sadness and loss of interest in everyday activities, including sex. You may also be tired, restless, and have poor focus. These symptoms can negatively impact your sexual drive, desire, performance, and satisfaction, thus causing sexual dysfunction such as premature ejaculation.
• Relationship Problems: Your relationship with your partner contributes to a satisfactory sex life. If your relationship is strained, it can lead to stress and anxiety, making it difficult to have sex for longer. Additionally, relationship problems can also affect your sexual desire towards your partner, which can also contribute to your sexual dysfunction.
• Guilt or Shame: If you associate guilt and shame with sex, it may make you anxious when engaging in sexual activity. It can cause you to rush through it, and as a result, you may end up ejaculating early. These feelings may also affect your desire to have sex.
• Sexual Abuse: If you have experienced sexual trauma once or multiple times, you may develop negative feelings around sex. As a result, you may lose the desire for sexual activity and feel anxious if you ever have to participate. The anxiety, performance pressure, and associated trauma can make arousal difficult and cause premature ejaculation.
• Early Sexual Experiences: When you masturbate or have sex at an early age, you may learn to ejaculate quickly under the pressure and fear of getting caught. This pattern can continue in adulthood, and you may find it challenging to sl6ow down and enjoy sex.

Physical Causes of Premature Ejaculation:

• Hormonal imbalances: An imbalance in any of the following hormones can impact sexual function and contribute to premature ejaculation:
• Testosterone: It is the primary male sex hormone that is responsible for regulating sexual desire, arousal, and function.
• Luteinizing Hormone (LH): This hormone stimulates testosterone production in the testes.
• Follicle-Stimulating Hormone (FSH): This hormone helps regulate the production of sperm in the testes.
• Prolactin: This hormone is involved in regulating sexual function, including ejaculation.
• Thyroid-Stimulating Hormone (TSH): This hormone helps regulate thyroid function, which can impact sexual function.
• Irregular Levels of Neurotransmitters: Neurotransmitters are chemical messengers released by the brain and nervous system nerve cells. They transmit messages and signals related to movement, sensation, mood, thoughts, and other functions to different body parts. The neurotransmitters involved in sexual function include serotonin, dopamine, and norepinephrine. Serotonin helps regulate sexual arousal and increases ejaculation time by slowing the transmission of signals from the brain to the penis. When there are low serotonin levels, these signals are not slowed down and result in premature ejaculation. Similarly, low dopamine and high norepinephrine levels contribute to PE.
• Nerve Damage: Nerves are responsible for transmitting signals that control arousal, sexual function, and the muscle contractions that lead to ejaculation. If these nerves are damaged for any reason, it can result in reduced control over ejaculation, leading to premature ejaculation. There are various reasons for nerve damage causing sexual dysfunction, including:
• Surgery: Certain surgical procedures, such as prostatectomy (removal of a part or all of the prostate gland), pelvic surgery, spinal cord surgery, and radiation therapy
• Trauma: Physical injury or trauma to the pelvic region due to accidents or sports
• Diseases: Diabetes, multiple sclerosis, spinal cord injuries, and Parkinson's disease
• Erectile Dysfunction: If you have ED, you may get into the habit of ejaculating as soon as you get an erection because you will lose it quickly. Hence, erectile dysfunction and premature ejaculation often occur together.
• Penile Sensitivity: The penis contains thousands of nerve endings, making it sensitive to stimulation. Injuries, inflammation, or nerve damage due to conditions such as diabetes or multiple sclerosis can increase penile sensitivity. If your penis is overly sensitive, you may experience rapid stimulation, leading to premature ejaculation.
• Inflammation in the Genital Area: Inflammation in the genitals resulting from an injury, infection, or autoimmune disorders can damage the nerve endings and surrounding tissue. It can reduce penis sensitivity and the ability to control ejaculation.
• Medications: Premature ejaculation can be a side-effect of certain medicines, such as:
• Antihistamines (drugs used to treat allergies)
• Alpha-blockers (drugs used to treat high blood pressure and enlarged prostate)

Lifestyle Causes of Premature Ejaculation:

• Alcohol: Long-term use of alcohol, especially in heavy amounts, can affect your nervous system and the signals between the brain and the genitals. It relaxes your muscles and nerves, making it difficult to feel sexual stimulation, achieve an orgasm, and control ejaculation.
• Drugs: Regular use of drugs like marijuana and cocaine can affect the functioning of the brain and nervous system. It can lead to changes in sexual function and potentially premature ejaculation.
• Lack of Physical Activity: A sedentary lifestyle can lead to physical and mental health conditions such as obesity, hypertension, cardiovascular disease, diabetes, and depression. These conditions can, in turn, impact sexual function and contribute to premature ejaculation.
• Poor Nutrition: While an unhealthy diet may not directly cause premature ejaculation, it can lead to problems that may ultimately contribute to PE. For instance, a diet lacking essential nutrients can lead to various health problems, including decreased energy levels, reduced circulation, and decreased hormonal levels, which may affect your sexual function.
• Sleep Deprivation: Lack of good quality sleep can lead to decreased testosterone levels, stress, anxiety, exhaustion, and poor stamina. These factors affect your sexual performance and cause problems with ejaculation.
• Smoking: Smoking impacts all the functions involved in sexual function—it narrows your blood vessels, decreases blood circulation, and increases oxidative stress, which can damage the nerves and blood vessels.

How is Premature Ejaculation Diagnosed?

Your primary care provider will be your first point of contact for getting help with premature ejaculation. If they suspect the need for specialist intervention, they will likely refer you to a urologist, an expert on male sexual function. The urologist will diagnose your condition using the information you provide and a physical exam. You can expect them to ask questions about your symptoms, medical conditions, medications, and lifestyle habits to understand what may be causing premature ejaculation. Some of the common assessment questions may include:

• How long have you been sexually active?
• When did you first experience premature ejaculation?
• How often does PE occur?
• Do you always ejaculate early or only at certain times?
• How long can you hold your ejaculation during sex and masturbation?
• How much stimulation causes ejaculation?
• What type of sexual activity (foreplay, masturbation, intercourse) do you engage in and how often?
• Does PE happen with all partners?
• How has PE affected your sexual activity?
• How is your relationship with your partner? Has PE affected it?
• Does PE affect your quality of life?
• Do you have erection problems?
• Do you have any health conditions?
• Did you recently undergo surgery or sustain an injury in your pelvic area?
• Do you take any medications?
• Do you smoke, drink alcohol, or take any drugs?
• Do you have sleep issues?
• What kind of diet do you eat every day?

After conversing about your condition, they will check your genital area to rule out abnormalities. Sometimes, they may ask for a semen sample for analysis. They may order specific diagnostic tests if they suspect any underlying conditions contributing to PE.  

What is the Medical Treatment for Premature Ejaculation?

The treatment options for premature ejaculation (PE) will depend on the underlying cause and the severity of the condition. Your doctor may suggest you a combination of the following treatments:

Behavioural Therapy

It involves using techniques that help in building control over your ejaculation. You will have to perform them for a few weeks, either on your own or with your partner, to see significant results. The most common behavioural therapy strategies include:

• Start-and-stop Method: You or your partner need to stimulate your penis until just before orgasm and ejaculation. Then, you pause for a few seconds till you feel you are in control again and restart the stimulation. You can do this 2-3 times. The fourth time, you can allow yourself to ejaculate. You can practise the start-and-stop method thrice a week.
• Squeeze Method: The steps for the squeeze method are similar to the start-and-stop method. In this, too, you need to stimulate your penis until you are close to ejaculating, but instead of stopping stimulation, you need to squeeze your penis to weaken your erection firmly. It will help you become aware of the feelings right before the climax and delay ejaculation. You can rest for around 30 seconds after one cycle of the squeeze method and repeat it a few times before finally ejaculating.
• Distracted Thinking: To build more tolerance to stimulation, you can try diverting your attention to non-sexual things during sexual activity. It can help you decrease the level of physical arousal, slow down the stimulation rate and delay ejaculation to last longer during sex.

Pelvic Floor Exercises

Sometimes, weak pelvic floor muscles can cause difficulty in controlling ejaculation. These muscles support the pelvic organs, regulate urinary and faecal continence, and help with sexual arousal and ejaculation. In men, the pelvic floor muscles surround the base of the penis and the rectum. If you contract these muscles, you can delay ejaculation. Various exercises (Kegels) can help strengthen the pelvic floor muscles. Use the following step-by-step guide to do these exercises:

• Find Your Pelvic Floor Muscles: To do Kegel exercises correctly, you will need to find your pelvic floor muscles. You can identify your pelvic floor muscles by stopping your urine stream midway while urinating. You can also prevent yourself from passing gas. The muscles helping you in these functions are your pelvic floor muscles.
• Perform Kegel Exercises: Start by lying down and contracting the pelvic floor muscles. Hold it for 3-5 seconds, then release and relax for 3-5 seconds. Repeat this for 10 to 20 repetitions, 3 to 4 times daily. You can even try doing these exercises while sitting, standing or walking once your pelvic floor muscles are stronger. However, remember not to strain your abdomen, thighs or buttocks muscles while doing the Kegel exercises.

Condoms

Condoms make the penis less sensitive to stimulation which can help control premature ejaculation. You can also opt for climax control condoms that contain numbing agents such as benzocaine or lidocaine to delay ejaculation. They may also be designed of thicker latex.

Oral Medications

Your doctor may prescribe oral tablets for long lasting ejaculation, including antidepressants, pain relievers and erectile dysfunction drugs. They may prescribe these along with other treatments.

• Antidepressants: These drugs are used to treat the major depressive disorder, anxiety disorders, chronic pain, and addiction. However, they can be good sexual performance boosters. They are prescribed for PE as they delay orgasm and ejaculation. Your doctor may prescribe selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa®), escitalopram (Lexapro®), or the tricyclic antidepressant clomipramine (Anafranil®). SSRIs are commonly used off-label to treat PE by delaying ejaculation. It usually takes 5-10 for these medications to start working, but it might take 2-3 weeks to experience their full effect. While these medications can be effective in delaying ejaculation, they can also have side effects such as drowsiness, nausea, decreased sex drive and erectile dysfunction. It would be best if you discussed the benefits and risks in depth with your doctor before using SSRIs to treat premature ejaculation.
• Pain Relievers: Tramadol (Ultram, Conzip, Qdolo) is an opioid pain medication that has been shown to improve PE symptoms in some men. Your doctor may prescribe you this medication if SSRIs do not prove effective. However, it would be best not to take them along with SSRIs. Tramadol can be addictive if taken for a long time and even lead to side effects such as nausea, headache, sleepiness and dizziness.
• Phosphodiesterase-5 inhibitors (PDE5 inhibitors): PDE5 inhibitors such as sildenafil (Viagra), tadalafil (Cialis, Adcirca), vardenafil (Levitra, Staxyn) and avanafil (Stendra) are used to treat erectile dysfunction. But they may also help with PE problems, although their efficacy is unclear. The potential side effects of PDE5 inhibitors include headache, facial flushing and indigestion. These medications may work better in combination with an SSRI.

Topical Numbing Agents

Topical creams, lubricant gels, or sprays containing numbing agents such as benzocaine, lidocaine or prilocaine can be applied to the penis 10-15 minutes before sex to reduce sensitivity and help delay ejaculation. Although these are available over the counter, you must always consult your doctor before using them. However, due to the numbing effect, your and your partner's sexual pleasure may decrease.

Counselling

If the underlying cause of your premature ejaculation is psychological, such as stress, performance anxiety, or depression, your doctor will refer you to a mental health provider. A therapist can help you learn ways to cope with your mental health condition through talk therapy sessions. It may help to take couples therapy if PE is happening due to relationship stress.

Sexual Routine Changes

Your doctor may suggest some changes in your sexual routine to help delay ejaculation, including:

• Avoid Penetrative Sex: You may try taking a break from sexual intercourse for a while and try engaging in other types of sexual activity with your partner. It may include oral sex, massage, manual stimulation, and using sex toys. It can help you find relief from the pressure of performance anxiety during intercourse.
• Masturbate Before Sex: Masturbating an hour or two before sexual intercourse can help reduce your excitement level and delay ejaculation.
• Do Slow, Shallow Thrusting: Deep and fast thrusting during intercourse can cause you to orgasm sooner. Instead, try slow and shallow thrusting to have longer sex and delay ejaculation.
• Interrupt Intercourse: If you feel close to ejaculating, you can stop and change positions or interrupt intercourse for a few moments to regain control.

What are the Alternative Treatments for Premature Ejaculation?

Certain supplements may help with premature ejaculation. You can take your doctor's advice on the best supplements for your situation.

Zinc Supplements

The zinc mineral has various functions—it helps boost your immune system, supports cell growth, maintains eye health, promotes wound healing, and regulates taste, smell, metabolism, and mood.

Additionally, it is essential for maintaining male reproductive health as well. It can help produce testosterone and sperm and improve male fertility. However, the evidence for its effectiveness in treating PE is limited. Some studies suggest that zinc supplementation may improve sexual function, including ejaculatory control.

However, remember that taking more than the recommended dosage may cause side effects such as nausea, vomiting, diarrhoea, kidney and stomach damage, and a metallic taste in your mouth.

Ayurvedic Herbal Medicine

Certain Ayurvedic medicines may be good sexual performance enhancers and help treat male sexual dysfunction, including premature ejaculation. These include:

• Kaunch beej
• Kamini vidrawan ras
• Yauvanamrit vati

You can expect side effects such as stomach pain, dizziness, mild pain, and decreased libido. If you are taking other prescription drugs, you should talk to your provider before taking Ayurvedic supplements.

Chinese Herbal Medicine

Chinese herbal medicine may also treat premature ejaculation by improving sexual stamina and energy. Some of the common sexual performance supplements include:

• Yimusake tablets
• Qilin pills

Potential side effects of Chinese herbal medicine include stomach pain, dizziness, and mild pain.

What are Some Lifestyle and Diet Changes for Premature Ejaculation?

Your doctor will likely suggest particular healthy lifestyle and diet changes to support your treatment for premature ejaculation.

Dietary Changes

Eating a balanced diet with many fruits, vegetables, whole grains, and protein can help improve your physical and mental health. Talking about specific nutrients, zinc, and magnesium may improve your sexual health. Your doctor may ask you to incorporate foods rich in these minerals to resolve your early ejaculation problem. Some of these foods include:

• Dairy items (yoghourt, cheese and milk)
• Shellfish (oysters, crab, shrimp, lobster, and mussels)
• Seeds (pumpkin, flax, and sesame seeds)
• Nuts (Almonds, cashew, pine nuts, and peanuts)
• Vegetables (garlic, peas, corn, zucchini, spinach, mushrooms, and broccoli)
• Fruits (banana, strawberries, and raspberries)
• Legumes (chickpeas, beans, and lentils)
• Soybeans
• Eggs
• Meat
• Chicken
• Dark chocolate

Relaxation Techniques

Relaxation techniques such as deep breathing, meditation, massage, and yoga can help treat premature ejaculation by reducing anxiety, stress, and performance-related pressure. Regularly practising these techniques can also increase awareness of physical sensations and improve control over the pelvic muscles, which play a role in ejaculation.

Exercise

Apart from doing pelvic floor strengthening exercises, you must also incorporate a few minutes of regular exercise into your schedule. It can help improve premature ejaculation (PE) in several ways. Exercising can reduce stress and anxiety, which often contribute to PE. It can also help improve overall physical and mental health, increase stamina, improve blood circulation, and boost self-confidence, which can help to delay ejaculation during sexual activity.

Conclusion

Premature ejaculation is a common male sexual problem among men. While talking about PE with a doctor may be uncomfortable, know that they can help you resolve it. Based on your diagnosis, a combination of medications, techniques, counselling, and lifestyle changes may be part of your treatment plan. It will be a good idea to involve your partner in your treatment as their support and understanding can help you overcome PE sooner.

FAQs on Premature Ejaculation

1. Can Premature Ejaculation Be Prevented?

Ans: You can prevent premature ejaculation to some extent by making lifestyle changes and using techniques that help to delay ejaculation during sexual activity.

2. Can Premature Ejaculation Cause Infertility?

Ans: No, premature ejaculation does not impact fertility. However, it may make it difficult to get your partner pregnant. This may happen, especially if you ejaculate before vaginal penetration.

3. At What Age Does Premature Ejaculation Start?

Ans: Premature ejaculation can occur at any age, but it is more common in younger men. It can start during the teenage years or in early adulthood.

4. Is Premature Ejaculation a Sign of a Severe Health Problem?

Ans: It is not always the case, but premature ejaculation may be connected to severe underlying health conditions such as depression or nerve damage.

5. Is PE Permanent?

Ans: No, PE in men is not a permanent issue in most cases. Generally, treating the underlying cause can help you improve your control over ejaculation. Some common premature ejaculation treatment modalities include medications, topical creams, therapy, and exercise.