Premature ejaculation: symptoms, causes, & treatment

Premature ejaculation, also called rapid ejaculation, describes a recurrent pattern of ejaculating quickly during partnered sexual activity. Usually, clinicians define rapid ejaculation as occurring within a minute of penetration. 

PE is one of the most common forms of sexual dysfunction in men, and it’s believed to impact about 30% of men worldwide. Although there’s a tendency to associate this issue with young men, the condition is equally prevalent in men ranging from 18 to 59 years old.

What causes premature ejaculation?

The underlying causes of PE can be psychological, physiological, or some combination of the two. 

Regardless of the cause, if you’ve had an experience involving premature ejaculation, you may be worried that it will happen again. While these concerns make sense, they aren’t helpful. Unfortunately, this preoccupation and worry about sex can increase the likelihood you’ll experience PE in the future.

Risk factors

In the past, researchers believed that premature ejaculation causes were primarily psychological, but recent research has drawn attention to potential physiological causes.

Psychological risk factors

Anxiety

Any form of stress or anxiety can inhibit your ability to relax during sex. Common issues related to sex include specific phobias and performance anxiety.

History of sexual trauma

The National Health and Social Life Survey (NHSLS) found that PE was more common in survey respondents who reported specific sexual experiences, such as being sexually harassed or abused. 

Relationship issues

Your relationship with your partner may play a role in sexual dysfunction, especially if you’ve never experienced the symptoms with other partners. 

Body image or self-esteem issues

If you have a hard time with negative body image or experience confidence concerns, you may feel uncomfortable being physically intimate with a partner. 

Physiological risk factors

Erectile dysfunction

Premature ejaculation and erectile dysfunction are often comorbid conditions, which means that they commonly co-occur in the same patient. Learn more about how to deal with ED in a relationship.

Urological and prostate conditions

Certain medical conditions, such as chronic bacterial prostatitis and urinary tract infections, make you more likely to develop the condition. 

Low serotonin levels

Serotonin has an inhibitory role in ejaculation, so problems processing serotonin or low levels of serotonin may contribute to premature ejaculation. Learn how to increase serotonin levels here.

Genetic predisposition

Research suggests that certain genetic factors may increase your likelihood of developing PE. 

Hormonal imbalances

Disruptions of the endocrine system, including thyroid problems and other hormonal issues, may lead to rapid ejaculation.

Complications

Although PE doesn’t cause any significant medical complications, it may cause difficulty in your relationships. 

In addition, premature ejaculation has been linked to ED, hypogonadism, and other conditions that could interfere with family planning goals. 

Premature ejaculation symptoms

To be diagnosed with PE, you must have symptoms that last for at least 6 months.

PE is usually divided into two categories, lifelong and acquired. 

The symptoms of lifelong, or primary, premature ejaculation are:

• Ejaculation that occurs prior to or within about 1 min of penetration
• No ability to delay ejaculation during in all or nearly all penetrations
• The symptoms cause significant distress

With acquired, or secondary, PE, the issues emerge later in life. The acquired condition is defined by abnormally rapid ejaculation in comparison to prior sexual encounters. The symptoms of acquired PE can come on suddenly or gradually. 

Interestingly, the diagnostic criteria used by most doctors in the United States define PE only in terms of vaginal penetration. Despite this narrow medical definition, rapid ejaculation is possible during any type of sexual experience.

Testing & diagnosis

A clinician can help you determine whether you have PE. 

To begin, you will need to answer questions about your health history. The clinician may use a Premature Ejaculation Diagnostic Tool (PEDT). This evaluation is designed to understand your symptoms better. 

Also, a healthcare professional will probably perform a physical exam. If your clinician suspects you may be experiencing another medical condition, they may order additional blood tests or scans. 

After your initial appointment, you may receive a referral to see a specialist, such as a urologist or a mental health provider, for further treatment.

Premature ejaculation treatments

Several different treatments address the symptoms of PE. These may include medications, exercises, and counseling. 

Medication

The Food and Drug Administration (FDA) has not approved any medications for the treatment of PE, but certain drugs are frequently prescribed “off-label” for this condition. 

Antidepressants

When your body’s serotonin levels are high, they can help delay ejaculation. As a result, clinicians often prescribe selective serotonin reuptake inhibitors (SSRIs), including Lexapro, Zoloft, Paxil, and Prozac, to treat this condition. 

Analgesics

Some pain medications delay ejaculation as a side effect. 

Erectile dysfunction medications

Drugs used to treat erectile dysfunction, such as Cialis and Viagra, can also help with premature ejaculation. In some cases, they may be prescribed alongside SSRIs to reduce symptoms. Get an online medical consultation with Lemonaid to see if ED meds are right for you.

Topical anesthetics

Over-the-counter premature ejaculation medicine, such as numbing sprays and creams, work by decreasing penile sensitivity during sex. They can sometimes help you last longer before ejaculating.

Exercises and techniques

A healthcare provider may recommend exercises that can give you more control over orgasm during sexual stimulation.

Kegel exercises

By exercising your pelvic floor muscles, you may be able to increase your ability to delay ejaculation. 

Pause-squeeze

Manually squeezing the end of your penis (where the glans meets the shaft) can help you prevent ejaculation during sex. 

Condoms

Wearing condoms can reduce your sensitivity during sex, which can delay ejaculation. In fact, some condoms come with numbing creams and extra-thick rubber to help you last longer during sex. 

Therapy

If the causes of PE are psychological, you may benefit from talk therapy. With the help of a therapist, you can address anxiety, relationship issues, or other issues affecting your sexual health. Plus, talk therapy may help you identify and work through any past trauma that could be inhibiting a healthy and fulfilling sex life. 

Outlook

Hundreds of millions of men experience the symptoms of PE. It’s the most prevalent sexual disorder worldwide. To address it, you will need to discuss your symptoms with a doctor. 

The outlook for PE depends on the underlying cause. When another medical condition causes PE, it’s essential to address that condition directly. Although it can be uncomfortable to talk about sex with a health care provider, premature ejaculation symptoms may indicate that you have an infection or hormonal imbalance that needs immediate treatment. 

For most people living with PE, it’s possible to maintain a healthy and functional sex life. You can reduce your symptoms with medication, behavioral strategies, or counseling. Most men find success with a combination of treatments, and some can eliminate the symptoms entirely.