Premature Ejaculation
Overview
Men sometimes ejaculate (release semen) sooner than they'd like during sex. This is a common problem, affecting about one in three people at some point.
It's not a major issue if it happens occasionally. However, if you consistently ejaculate within a minute or two of starting sex, or if you can't control when you ejaculate most of the time, and this causes you stress, frustration, or makes you avoid sex, you might have premature ejaculation.
Key signs include:
- Ejaculating within a minute or two of sexual penetration, nearly every time.
- Being unable to control your ejaculation during sex, most of the time.
- Feeling anxious or upset about it, and avoiding sex as a result.
Premature ejaculation is treatable. There are different ways to help. These might include medications, talking to a therapist or counselor, and learning specific techniques to help control ejaculation. These approaches can improve both your sex life and the relationship with your partner.
Symptoms
Men often experience ejaculation sooner than they'd like during sex. This is called premature ejaculation. A key sign is not being able to delay ejaculation for more than about three minutes after sexual penetration. It can happen during sex or even masturbation.
There are two main types:
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Lifelong premature ejaculation: This means a man has had trouble controlling ejaculation from the very start of his sexual experiences.
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Acquired premature ejaculation: This develops later in life, after a period of normal sexual function.
Many men think they have premature ejaculation, but their experiences might not quite fit the medical definition. It's normal to sometimes ejaculate sooner than desired. If you find you're frequently ejaculating earlier than you'd like during sex, it's important to talk to your doctor.
It's completely understandable to feel embarrassed about discussing sexual health. But talking to your doctor can help. They can reassure you that premature ejaculation is common and treatable. They can also help you understand what's considered a normal timeframe for ejaculation—about five minutes on average. This information can ease your concerns and help you develop strategies for managing the issue.
When to see a doctor
If you find you're ejaculating sooner than you'd like during sex most of the time, talk to your doctor. It's completely normal to feel uncomfortable discussing sexual health, but don't let that stop you. Premature ejaculation is a common issue, and there are ways to treat it.
Talking to your doctor can help ease your worries. For example, it might be helpful to hear that experiencing premature ejaculation occasionally is quite typical. It can also be reassuring to know that the average time from the start of sexual intercourse until ejaculation is about five minutes. This gives you a good point of reference and helps you understand if your experience is within the typical range. If it's causing you distress, your doctor can help you explore options to address it.
Causes
Doctors don't fully understand why some people experience premature ejaculation. While it was once believed to be only a mental health issue, we now know it's often a mix of mental and physical reasons.
Mental factors can certainly play a part:
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Past experiences: Early sexual experiences, including sexual abuse, can significantly impact how someone approaches sex later on. A negative body image or feeling anxious can also make the experience more stressful and lead to rushing. Sometimes, guilt about sex can cause a person to want to finish quickly.
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Anxiety and stress: Premature ejaculation and anxiety often go hand-in-hand. This anxiety might be about performing sexually or stem from other worries in life.
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Relationship problems: Trouble in a relationship can contribute to premature ejaculation, particularly if it's a new issue. If it's not a consistent problem in other relationships, it might be tied to stress and anxiety within the current relationship.
Physical factors can also be involved:
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Other health issues: Erectile dysfunction (ED) can create a cycle of anxiety. The worry about getting or maintaining an erection might lead to a pattern of trying to finish quickly. This pattern can be hard to break.
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Hormonal imbalances: Imbalances in hormone levels can sometimes be a contributing factor.
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Brain chemicals: Problems with certain brain chemicals could also affect the experience.
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Physical conditions: In some cases, swelling or infection in the prostate or urethra might be related to premature ejaculation.
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Genetics: A person's genes can sometimes play a role.
It's important to remember that premature ejaculation is rarely caused by a single factor. It's usually a combination of mental and physical factors, and addressing these factors often requires professional guidance to find the best solutions.
Risk factors
Several things can make premature ejaculation more likely. Here are a couple:
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Problems with getting an erection (Erectile Dysfunction): If you have trouble getting or keeping an erection, you might be more prone to premature ejaculation. The fear of losing your erection can make you rush through sex, sometimes without even realizing it. This is because you're focused on maintaining the erection rather than enjoying the experience.
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Stress: Feeling stressed out, whether about work, relationships, or other things, can contribute to premature ejaculation. Stress makes it harder to relax and focus during sex, which can lead to a shorter experience. It can also affect how much control you have over your body's responses during intimacy.
Complications
Early ejaculation can affect your personal life in several ways.
Relationship problems: A frequent issue is stress in relationships. Early ejaculation can make partners feel frustrated or inadequate, leading to arguments and tension. This can impact intimacy and overall happiness in the partnership.
Fertility concerns: Sometimes, early ejaculation can make it difficult for a woman to get pregnant. If the semen isn't deposited inside the vagina, it's less likely that fertilization will occur. This is because the sperm need to reach the egg. This doesn't mean you won't be able to have children; however, it can be a factor to consider and discuss with a healthcare professional.
Diagnosis
Your doctor needs information about your sex life and health history to help you. They might also do a physical check-up. If you're having trouble with both early ejaculation and getting or keeping an erection, your doctor might want to run some blood tests. These tests can look at your hormone levels. Hormones are chemical messengers in your body that affect many functions, including sexual health.
Sometimes, your doctor might recommend seeing a urologist (a doctor specializing in the urinary system and male reproductive organs) or a therapist who specializes in sexual health problems. This could provide further help and support.
Treatment
Managing Premature Ejaculation: Options and Strategies
Premature ejaculation (PE) is a common problem where a man ejaculates sooner than he or his partner would like during sex. Fortunately, several effective treatments exist, often involving a combination of approaches.
Treatment Approaches:
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Behavioral Techniques: These are often the first line of treatment and can be very helpful on their own or combined with other methods. They can include:
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Kegel Exercises: Strengthening the pelvic floor muscles can improve control over ejaculation. These muscles support the bladder and bowel, and their strength directly impacts sexual function. To find these muscles, try stopping your urine mid-stream or tightening the muscles used to control passing gas. Once located, practice tightening them for 3 seconds, relaxing for 3 seconds, repeating this for several sets. Start by doing these lying down and gradually incorporate them into sitting, standing, and walking positions. Focus only on the pelvic floor muscles and breathe normally throughout the exercise. Aim for at least 3 sets of 10 repetitions daily.
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Pause-Squeeze Technique: This involves pausing sexual stimulation just before ejaculation, then resuming once arousal subsides. Repeat this process until you reach the desired point of penetration without ejaculating. With practice, this technique may become automatic. If this causes discomfort, try the stop-start technique. The stop-start technique is similar but involves stopping, waiting, and starting again at intervals during sexual activity.
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Using Condoms: Using condoms, particularly those designed to reduce penis sensitivity, such as "climax control" condoms containing numbing agents (like benzocaine or lidocaine), can help delay ejaculation. These are available over-the-counter.
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Topical Anesthetics: Creams, gels, or sprays containing numbing agents like benzocaine, lidocaine, or prilocaine can desensitize the penis. Apply 10-15 minutes before sex to reduce sensation and delay ejaculation. These are also typically available over-the-counter. While effective, these topical anesthetics can reduce sensation for both partners, potentially affecting sexual pleasure.
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Medications: Doctors may prescribe medications for on-demand or daily use, possibly in combination with other treatments.
- Selective Serotonin Reuptake Inhibitors (SSRIs): These are often prescribed as a first-line treatment for PE. Paroxetine is a commonly prescribed SSRI. It often takes several weeks for the full effect to be seen. Note that dapoxetine is used for PE in some countries, but it is not currently available in the United States.
- Pain Relievers: Tramadol can sometimes be helpful, but it is not recommended to be used with an SSRI.
- Phosphodiesterase-5 Inhibitors: Drugs like sildenafil (Viagra), tadalafil (Cialis), avanafil (Stendra), and vardenafil are sometimes used to treat erectile dysfunction, but may also help with PE.
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Counseling and Therapy: Addressing the emotional and relationship aspects of PE can significantly improve outcomes. Therapy can help couples manage anxiety and stress related to sexual performance. This is particularly helpful when combined with other treatments.
Additional Considerations:
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Alternative Treatments: Some alternative treatments like yoga, meditation, and acupuncture have been explored, but further research is needed to confirm their effectiveness.
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Importance of Open Communication: PE can affect both partners in a relationship. Open communication and seeking professional help are crucial for addressing the emotional and relational difficulties that may arise. Seeking professional relationship counseling or sex therapy may be beneficial to explore the impact on the relationship and develop coping strategies.
Important Note: This information is for educational purposes only and does not constitute medical advice. Always consult with a healthcare professional for diagnosis and treatment of premature ejaculation or any other health concerns.
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