Premature Ejaculation: Symptoms, Causes, Treatment

You may initially think that premature ejaculation and erectile dysfunction are on opposite sides of the ring. One is about not having an erection. The other features very rapid ejaculation. However, the truth is that both erectile dysfunction and premature ejaculation share a few aspects. 

They both cause male sexual dysfunction and significant problems. In most cases, they have strong psychological factors. And recent studies show that they are comorbid problems. In other words, many patients complain of experiencing both problems interchangeably (1).

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What is premature ejaculation?

We call ejaculation the release of sperm, which happens the moment a man reaches an orgasm. Premature ejaculation is a very rapid ejaculation shortly after penetration. Sometimes it happens before actually achieving penetration. 

In premature ejaculation, the time it takes to release sperm is not enough to enjoy sex, and both partners end up dissatisfied with the experience. Sometimes you and your partner agree on having a rapid relief, and that is fine. That is not premature ejaculation. 

But if you want to enjoy for a more extended period and uncontrolled ejaculation occurs, ask yourself how frequently that happens. This problem is much more common than expected. According to statistics, up to 70% of men in the United States have had at least an episode (2). Luckily, most people only have isolated episodes, and it is not usually a problem.

Is premature ejaculation a type of sexual dysfunction?

Yes, premature ejaculation is one of many types of sexual dysfunction. It is included in the list of problems that restrain couples from enjoying their sexual life. As noted above, it is basically reaching an orgasm and ejaculating too fast.

We also mentioned erectile dysfunction, which is the inability to reach an erection or maintain it. They are sometimes weak or partial erections that won’t be enough for penetration. However, many patients experience both sexual dysfunction problems at the same time. 

Of course, not at the same moment. You could have an episode of erectile dysfunction today, and finally, when you achieve an erection tomorrow, premature ejaculation leaves you dissatisfied (3).

Symptoms

Should you worry about premature ejaculation if you had a recent episode? Not really. If you have this unexpected issue occasionally, there’s probably nothing to worry about. But if that happens frequently or repeatedly for an extended period, it is a good idea to talk to your doctor about it.

This is what people with premature ejaculation usually feel:

  • Very rapid ejaculations after penetration, sometimes no longer than one minute.

  • Inability to delay ejaculation for a few minutes during sexual intercourse.

  • Personal and relational problems with the patient’s partner as a result of a recurrent sexual dysfunction.

  • Sometimes patients alternate between premature ejaculation and erectile dysfunction problems.

It is also useful to detect if you’ve always had a premature ejaculation problem or it developed recently. If your problem started recently, try to find the cause (changing sexual partners, anxiety, and stress, among others). Your doctor will probably ask you several questions about it based on the International Society of Sexual Medicine (4). Thus, it is a good idea to reflect on what you feel ahead of time.

Causes & Risk Factors

Depending on the type of premature ejaculation you have, we can consider several causes and risk factors (5):

Lifelong premature ejaculation

These patients have had premature ejaculation since they started having sexual intercourse. The causes and risk factors often include:

Traumatic sexual experiences

For instance, sexual assault, being discovered by their parents during masturbation, or guilty thoughts around the sexual act.

Unhealthy peer relationships

This includes feeling inferior or frailer among male patients, being bullied, or constantly rejected in the past.

Unhealthy attitudes toward sex

These patients see sex as something unholy or dirty. They can be ashamed of their thoughts and fantasies or always scared of being caught.

Recent marriage

After starting marital sex, patients with no previous sexual experience could begin having episodes of premature ejaculation.

Sexual partner issues

Blaming partners or those constantly struggling for power in the relationship are more likely to suffer from these problems.

Acquired premature ejaculation (secondary premature ejaculation)

In these cases, there was a trigger after which a man started experiencing frequent episodes of premature ejaculation. 

They can be:

Current relationship issues

The cause of an acquired problem could be related to a conflict of power in the relationship that started not long ago. Constantly feeling blamed for the problem could also contribute to the symptoms.

Impotence

Erectile dysfunction can be a risk factor, and both problems can start simultaneously.

Mental health issues

This includes depression, poor self-esteem, and situational problems that affect their sexual life.

Performance anxiety

Patients who worry too much about pleasing their partner and not ejaculating early might be the ones with a more severe problem.

Stress

Feeling stressed or sexually loaded could also lead to frequent episodes of premature ejaculation.

Complications

Premature ejaculation is not a threatening condition. Thus, there are no physical complications of premature ejaculation. They are psychological complications, instead.

Patients could further reduce their self-esteem and give up on trying to find satisfying sexual intercourse. The problem can affect their relationship with their partner, especially if they do not use an alternative method to make it last longer. This could also lead to depression, performance anxiety and ultimately trigger erectile dysfunction (6).

When to see a doctor

As noted, premature ejaculation is not life-threatening and won’t cause many physical problems. However, it is essential to look for medical help to counter the psychological and relational consequences.

Talk to your doctor as soon as possible if you have the following problems:

  • If premature ejaculation is very frequent or causes issues with your partner

  • When premature ejaculation triggers depressive feelings and low self-esteem

  • If you’re constantly afraid of intimate relationships because of premature ejaculation

The specialist you want to look for is a urologist, and you want to be prepared to ask a few questions about your sexual life. Give the most accurate data you can give, answering truthfully to any question.

Diagnosis

The diagnosis of premature ejaculation is clinical. In other words, there are no blood tests or CT scans to diagnose premature ejaculation. Instead, it has to go through a private interview with the patient to describe his symptoms as accurately as possible.

The International Society of Sexual Medicine recommends using these basic questions:

  • What is the usual time between achieving penetration and experiencing ejaculation?

  • Do you succeed when you try to delay ejaculation voluntarily?

  • Are you feeling frustrated, bothered, or annoyed by your ejaculatory problem?

After evaluating the patient and the extent of the problem, the doctor will investigate whether this is a lifelong problem or an acquired condition. They might also need to screen for additional medical conditions that precipitate premature ejaculation. 

For example, angina pectoris or a previous myocardial infarction. These patients could feel worried about their heart condition during intercourse, which triggers premature ejaculation (4).

Treatment

Is there any medical treatment for early ejaculation? It depends on the underlying cause. The first thing a doctor would do is deal with any underlying condition, especially heart disease. If the patient is apparently healthy, they may use a combination of pharmacological treatment and counseling (4):

Pharmacologic therapy

There is no specific drug branded and approved by the FDA for premature ejaculation. However, we can use the effects of certain medications to our advantage. Desensitizing creams are becoming popular for those whose main problem is a very sensitive penis. 

They may contain lidocaine or a combination of herbal ingredients. Urologists may also recommend therapy with selective serotonin reuptake inhibitors (SSRI). It is an antidepressant medication, but it also causes delayed ejaculation as a side effect. 

Another option is using PDE5 inhibitors (Viagra and similar drugs). Patients using this oral medication not only maintain the erection for longer, but most of them also inhibit ejaculation for a while longer.

Counseling (psychological therapy) 

Premature ejaculation is often rooted in a deep psychological cause. It works to relieve performance pressure, wrong beliefs around sex, stress, and anxiety. In some cases, bringing your partner with you may help, especially if you have relationship problems. Behavioral therapy can also make a difference if you can benefit from changes in your sexual practice.

Home remedies

Most men experience transient episodes of early ejaculation, and they improve by making a few changes in their lifestyle and sex-related routine.

You could try one of these methods or a combination:

  • Masturbating one hour before intercourse could help you extend sex for a little longer when you’re with your partner.

  • Focusing more on your partner’s sensation instead of your own.

  • There’s a strategy that requires your partner’s participation. It is called the squeeze method. When you’re close to ejaculation, tell your partner to stop stimulating you and squeeze the penis just below the glans for a few seconds. The squeeze should be firm and can be uncomfortable but not painful. After the urge to ejaculate is gone, you can resume intercourse.

  • Another easy strategy would be the start-and-stop method. It’s basically the same, but this time you’re in control. When ejaculation is very close, change positions or stimulate your partner with minimal sexual stimulation in your penis. Resume intercourse when the sensation of imminent ejaculation is completely gone.

  • Men will also benefit from Kegel exercises to locate and learn how to use their pelvic floor muscles. When you’re urinating at home, concentrate on cutting the stream midway and find the muscles you used for this. Practice stimulating the same muscles while you’re sitting, standing, or doing anything at home. When you’re about to ejaculate in the middle of the sexual activity, use Kegels once again to try to hold it back.

Talking to your partner

Even if you’re not into counseling, talking to your partner is important to overcome premature ejaculation. 

Here’s why:

  • Sometimes you can have an incorrect belief about sex. Maybe it is your partner who has a bad opinion about sexual behavior.

  • New sexual partners or not having frequent sex and suddenly being with someone could trigger this problem temporarily.

  • Maybe you’re too worried about your sexual performance

  • Your partner should know why you stop intercourse to change positions or stimulate them differently

  • Communication is vital to dispel the belief that there’s a big problem you can’t solve 

Conclusion

Premature ejaculation is one of the most common types of ejaculatory dysfunction. It can ruin the sexual experience and reduce sexual satisfaction in couples. This happens when men can’t have ejaculatory control once they reach their ejaculatory threshold (when it is impossible to hold back ejaculation).

Luckily, there are many methods to counter this problem, including pelvic floor exercises, changes in your sexual intimacy, talking to your partner, and talking to a sex therapist. Your urologist may also recommend pharmacological treatment to help you extend intercourse and please your partner.

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Sources

  1. Brody, S., & Weiss, P. (2015). Erectile dysfunction and premature ejaculation: interrelationships and psychosexual factors. The journal of sexual medicine, 12(2), 398-404. https://onlinelibrary.wiley.com/doi/abs/10.1111/jsm.12738
  2. Raveendran, A. V., & Agarwal, A. (2021). Premature ejaculation-current concepts in the management: A narrative review. International Journal of Reproductive BioMedicine, 19(1), 5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7851481/
  3. Hatzimouratidis, K., Amar, E., Eardley, I., Giuliano, F., Hatzichristou, D., Montorsi, F., … & Wespes, E. (2010). Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation. European urology, 57(5), 804-814. https://pubmed.ncbi.nlm.nih.gov/20189712/
  4. Althof, S. E., McMahon, C. G., Waldinger, M. D., Serefoglu, E. C., Shindel, A. W., Adaikan, P. G., … & Torres, L. O. (2014). An update of the International Society of Sexual Medicine’s guidelines for the diagnosis and treatment of premature ejaculation (PE). The journal of sexual medicine, 11(6), 1392-1422. https://pubmed.ncbi.nlm.nih.gov/24848686/
  5. Jannini, E. A., Maggi, M., & Lenzi, A. (2011). Evaluation of premature ejaculation. The journal of sexual medicine, 8, 328-334. https://pubmed.ncbi.nlm.nih.gov/21554554/
  6. Rosen, R. C., & Althof, S. (2008). Impact of premature ejaculation: the psychological, quality of life, and sexual relationship consequences. The journal of sexual medicine, 5(6), 1296-1307. https://psycnet.apa.org/record/2008-07455-004
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Dr Alberto Parra

Dr. Alberto Parra is a Medical Doctor and clinical researcher with extensive experience in diagnostic imaging and sports medicine. He's also interested in nutrition, fitness and family medicine, with expertise and continuing education on preventive healthcare and evidence-based medicine. He provides consultancy services to a number of individuals and entities who require medical validation of their protocols, products, supplements, and medical contents.

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