Most men will experience sexual challenges such as premature ejaculation or erectile dysfunction at one point or another, even if only in passing. Premature ejaculation occurs when a man has an orgasm very quickly or without control; there's often little warning before the orgasm, which makes it difficult to delay or control.
Over time, premature ejaculation (PE) can lead to lower sexual satisfaction for both the person experiencing it and their partner. It’s difficult to know exactly how many men experience premature ejaculation, but some estimates have put the rate between 4% and 39% - quite a range in-part because self-reporting is notoriously unreliable.
Part of the reason that so many men experience PE is because of its complexity, involving both mental and physical factors. While some medical treatments for premature ejaculation exist, there is no single permanent cure.
But there are ways men can learn how to control their ejaculation and ultimately experience improved sexual satisfaction.
What is Premature Ejaculation?
In the simplest terms, premature ejaculation occurs when a man does not have full control over his ejaculation, happening when he or his partner did not intend, during the early stages of sexual excitement or soon after penetration. It’s possible for premature ejaculation to occur in as little as 30 seconds and can even happen before penetration.
Despite what pornography and pop culture might suggest, the average time that it takes before a man will ejaculate during intercourse is four to five minutes, on average. One study looked at 500 couples from five different countries and found that the average time to ejaculate during intercourse was five and a half minutes.
What Causes Premature Ejaculation?
While the exact cause of premature ejaculation is still unknown, it's often rooted in physical, phycological, or emotional issues. The most commonly assumed cause is brain chemistry and psychological factors. For example, men with low levels of the chemical serotonin may take a shorter time to ejaculate when compared to men with normal levels.
Some of the issues that most commonly contribute to premature ejaculation include:
- Anxiety
- Concerns about sexual performance
- Depression
- Guilt
- Inflammation or infection in the prostate or urethra
- Inherited genetic traits
- Irregular neurotransmitter levels
- Lack of confidence or self esteem
- Negative feelings surrounding sex or sexual repression
- Poor body image
- Relationship issues
- Stress
- Unusual hormone levels or chemical imbalances
In some cases, men may experience premature ejaculation as the result of erectile dysfunction. When the penis doesn’t remain firm long enough for sex, a man may start to develop a pattern of rushing to ejaculate before they lose their erection. This can be a difficult cycle to break.
7 Treatments For Premature Ejaculation
The most common treatment options for premature ejaculation include behavioral techniques, topical anesthetics, medication, and counseling.
It may take some time to find the best treatment or combination of treatments that will be effective for your PE. Behavioral therapy coupled with drug therapy seems to be the most effective course of treatment.
Analgesics
Tramadol (Ultram) is an analgesic that is commonly used to treat pain, but it also has side effects that can delay ejaculation. Other side effects, however, may include nausea, headache, sleepiness, and dizziness. An analgesic may be prescribed when SSRIs haven’t been effective, but Tramadol cannot be used in combination with an SSRI.
Antidepressants
One of the side effects of certain antidepressants is a delayed orgasm. For this reason, selective serotonin reuptake inhibitors (SSRIs) such as escitalopram (Lexapro), sertraline (Zoloft), paroxetine (Paxil), or fluoxetine (Prozac, Sarafem), are sometimes used to help delay ejaculation.
Of those that are approved for use in the United States, paroxetine appears to be the most effective. These medications usually take about five to ten days before they start working, but it may take two to three weeks of treatment before reaching the full effect. Side effects of antidepressants may include nausea, perspiration, drowsiness, and decreased libido.
Condoms
One popular complaint about condoms in general is that they decrease the overall sensation of sex, making it harder to climax. This makes them a perfect solution for anyone experiencing premature ejaculation.
Several condom manufacturers now offer products containing numbing agents such as benzocaine or lidocaine in order to delay ejaculation. Additionally, thicker condoms can also have this effect.
Counseling
Talking with a mental health provider about your relationships and sexual experiences may help to reduce your performance anxiety and find better ways of coping with stressful situations.
Counseling is most effective when coupled with drug therapy. With premature ejaculation, it’s possible that you may start feeling as though you're losing some of the closeness that you previously shared with a sexual partner. In addition, your partner may also begin to feel upset with the changes in sexual intimacy. Talking about the problem together may be an important step to relief, and undergoing relationship counseling or sex therapy can be beneficial.
Pelvic Floor Exercises
Having weak pelvic floor muscles can impair your ability to delay ejaculation. Pelvic floor exercises, also known as Kegel exercises, can help to strengthen these muscles.
In order to perform these exercises, follow these steps:
- The first step is to locate the correct muscles. The next time that you urinate, try to cut off the flow midstream. The muscles that you're using to perform this task are the ones that you need to focus on for this exercise.
- Start by performing this exercise laying flat on your back. Eventually you can do them while sitting, standing, and even walking.
- Squeeze the muscles that you located in step one, holding them for a count of five.
- Release them and relax for a count of five.
- Repeat this process 10 to 20 times each session and perform two to three sets daily.
PDE5 Inhibitors
Phosphodiesterase-5 (PDE5) inhibitors are typically used to treat erectile dysfunction, but may also help with premature ejaculation as well. Medications such as sildenafil (Viagra®), tadalafil (Cialis®), or vardenafil (Levitra®) are the most commonly prescribed. Some potential side effects may include headache, facial flushing, and indigestion. These medications may be more effective when used in combination with an SSRI.
Topical Anesthetics
There are some anesthetic creams and sprays available that contain numbing agents such as benzocaine, lidocaine, or prilocaine. These products are applied to the penis 10 to 15 minutes before sex in order to reduce sensation and help delay premature ejaculation.
While a lidocaine-prilocaine cream for premature ejaculation is available by prescription only, there are lidocaine sprays available over the counter. Although topical anesthetic agents are generally effective and well-tolerated, there are potential side effects such as a temporary loss of sensitivity and decreased sexual pleasure.
The Takeaway: Premature ejaculation is a fairly common occurrence in men and may be the result of several different factors. Depending on the root cause, there are many available treatments such as exercises, medications, and counseling.
The best treatment for PE involves talking with your doctor about your experiences. With the help of a medical professional you may be able to identify the root cause of your premature ejaculation, and a physician can help to plot out the best plan of action.
