Premature ejaculation: causes and treatment
Most men will experience premature ejaculation (PE) at some point in their lives, but what the term really means can be confusing. We understand that many men might feel uncomfortable discussing sexual problems with their GP, or even with a friend or partner, so we’ve provided a short overview of what exactly PE is and what you can do if you think you have it.
What is premature ejaculation?
Premature ejaculation (PE) is a very common sexual disorder, affecting around 20-30% of men. It really just means ejaculating/coming or finishing too early - before you and your partner are satisfied.
Generally men who have PE will experience all of the following:
- Ejaculation occurs within less than one minute of penetrative sex
- This happens 75% of the time
- It occurs for a period of at least six months
- It causes distress
During sex, many men and their partners find that ejaculation sometimes occurs sooner than they would like it to.
Types of premature ejaculation
Primary PE
Primary PE starts when first becoming sexually active and is often psychological, this is sometimes called 'life-long PE'.
Secondary PE
Secondary PE tends to occur later on in life and can be caused by both psychological and physical factors. This is sometimes called 'acquired PE'.
Generalised PE
PE might be ‘Generalised’, where it is a problem in every sexual context, e.g. during masturbation, foreplay with a partner and penetrative intercourse.
Situational PE
‘Situational’ PE is when it only occurs in certain situations, e.g. during partnered sex, rather than solo masturbation. Controlling sexual excitement and ejaculation might be absolutely fine during foreplay, but rapid ejaculation might always occur when penetrative sex begins. This might indicate that the causes are more psychological, rather than physical.
Types of situational and generalised PE depend on the individual and their preferences when it comes to sex. For instance, some men might orgasm within two minutes of penetrative sex but, if they and their partner found the experience sexually satisfying, they might not consider it to be a problem.
Symptoms of premature ejaculation
How long should it take to ejaculate?
Ejaculation which occurs always or nearly always within two minutes of penetration with little sexual stimulation would be classed as premature ejaculation.
There is no set time for how long a man should ‘last’ in bed. So long as you and your partner are gaining pleasure from sex, it doesn’t matter how long it takes. Too much emphasis tends to get placed on reaching orgasm from long-lasting penetrative sex. Enjoying the arousal during mutual masturbation, oral sex and sensual massage can be just as good, if not more pleasurable than intercourse.
Having difficulty controlling ejaculation
If there are times when you are able to slow down and control your arousal and ejaculation during sex, then you probably wouldn’t be described as experiencing PE.
Finding sex distressing or frustrating
They key here is how bothered you or your partner are about the timing of ejaculation. This depends on the individual and their personal sexual preferences. In general, ejaculating very soon after penetration or ejaculating quickly during sex is only a problem if it makes you feel uncomfortable or embarrassed, or causes problems in your relationship.
Causes of premature ejaculation
Conditioning
Early sexual experiences can have an impact on your future sex life. A good example of this is a teenager teaching themselves to ejaculate quickly to avoid being caught, it can be difficult to break the habit.
Sexual performance anxiety
Being anxious because of inexperience when first having sex can contribute to PE. However with increasing sexual experience and age, men often learn to delay orgasm.
Early stages of a relationship
Being in the early stages of a relationship or with a new partner, particularly if it's been a long time since you last ejaculated can contribute to PE.
Traumatic sexual experience in childhood
Childhood experiences can impact PE. This could be anything from being caught masturbating to sexual abuse.
How your partner's feeling
Having a partner with a sexual problem, such as low desire or discomfort during intercourse, may cause eagerness to get sex over with quickly.
Strict upbringing or beliefs about sex
Feelings of shame and guilt associated with sex can come from your upbringing and this can impact PE.
Drugs or alcohol
A man’s ability to control his ejaculatory reflex can also be affected by alcohol, drugs and medication, as well as low testosterone or an over-sensitive penis.
Medical conditions
PE can also have biological roots, e.g. it could be due to genetics or heightened sensitivity in the nerves of the penis, as well as conditions such as multiple sclerosis, diabetes, prostate disease, high blood pressure, under or active thyroid and low testosterone.
Relationships and premature ejaculation
With PE, it is often the case that penetration is not possible, as ejaculation always occurs before. This can cause relationship distress and frustration for both partners and bring about feelings of shame and inadequacy. If a couple want to have a baby, this can become a problem in trying to conceive naturally.
Sadly, many men suffering with PE might avoid relationships altogether for fear of humiliation and disappointment leading them to withdraw socially, adding to the emotional strain.
Premature ejaculation treatments
Medical treatments
There are several medical treatments available to help alleviate PE in the short term.
EMLA cream for premature ejaculation
EMLA is a topical numbing cream that can be applied to the penis. A condom would need to be worn during sex with a partner, to prevent the cream affecting them. As with all medication, there may be side effects and it may take a few attempts to notice the benefits.
Priligy for premature ejaculation
Priligy is an oral treatment. It's a low-dose anti-depressant that has been developed especially for PE.
Exercises for premature ejaculation
There are exercises that you can practice until you have gained more control over your ejaculation:
Pelvic floor exercises
Situated between your legs is a layer of supportive muscles, known as the pelvic floor or PC muscles. Strengthening them can enable you to have more control over your ejaculation.
Directions:
- Three times a day (perhaps at meal times), squeeze and lift the muscles in that area, then relax them fully.
- Hold the squeeze for ten seconds, then rest for four seconds; do this ten times.
- Then do ten quick flicks.
This should only take a few minutes and you can do it whilst sitting or standing. When you squeeze the PC muscles, it should feel as though you are holding in wind or urine. Make sure you are not holding your breath and don’t squeeze your buttocks, thighs or tummy muscles.
The stop-start technique
The stop-start technique is a widely used exercise that can help to control sexual excitement in men. When practiced this exercise can help you hold off from ejaculating for longer periods of time during sex.
Directions:
- Three times a week, stimulate your penis and notice your arousal increasing.
- Imagine a scale marking your sexual excitement as it builds from one to ten.
- Imagine a scale marking your sexual excitement as it builds from one to ten (ten would be orgasm and ejaculation).
If number eight on the scale is the point of ‘ejaculatory inevitability’ (the part when you can’t stop yourself from coming), then you need to learn to recognise all the points on that scale from one to seven and let your arousal travel up and down a few times before you ejaculate. It may take many attempts, so don’t give up. When you are happy with the time it takes you to ejaculate during this exercise, make it more challenging by adding in lubrication to stimulate yourself with, and then ask your partner to take part in the exercise.
You may find that your partner’s involvement makes you come more quickly, but with patience and perseverance from both of you, it may improve with practice. Doing this exercise regularly can help you to become an expert in recognising the stages of your arousal process and to know which point to stop stimulation for a while to slow things down.
De-sensitisation exercises
Some men have a highly sensitive ‘Glans Penis’ (the head of the penis), which can cause PE. Practicing a de-sensitising exercise regularly can be helpful.
Directions: Ten minutes twice a day, pull back your foreskin (if you have one), apply some lubrication, then walk around so that your underpants are touching the sensitive area of your penis to get used to this sensation.
Practice being present
When you worry about PE occurring, you can often become pre-occupied with this worry during sex, so you aren’t really present, enjoying what is happening. You might find yourself trying to think about unsexy things to slow your arousal, but then sex becomes about performance, rather than about your pleasure.
Directions: To become more present and less preoccupied, focus on the physical sensations you are experiencing in your entire body when you and your partner touch each other.
Ask yourself, what temperature, textures and pressures can you notice?
Explore what you can smell, taste, see and hear. Stay with the physical sensations when your mind starts to wander. When your arousal builds, place your hand over your partner’s hand and move it to somewhere you are curious about being touched, away from areas like your genitals that might be highly sensitive.
Focus on touching and stimulating your partner, asking them what they enjoy and allowing them to guide your hand around their body.
The squeeze technique
If you have not benefited from the other exercises, you might like to try the squeeze technique.
Directions: Indicate to your partner when your arousal is high, then your partner should apply a very firm squeeze to the head of the penis for 15-20 seconds.
The thumb should be placed under the ‘Frenulum’ and the two forefingers need to wrap around the penis under the ‘Glans’ (the head) where it meets the shaft.
This will inhibit the ejaculatory reflex and you may lose your erection somewhat for a little while. You can repeat this every time your arousal builds, until you wish to ejaculate.
Counselling
If you find that you still need further help with PE or any other sexual difficulties, you may wish to seek specialist help from a qualified, accredited Psychosexual Therapist.
References
https://www.baus.org.uk/patients/conditions/8/premature_ejaculation/
https://www.nhs.uk/conditions/ejaculation-problems/
