Premature ejaculation can feel like an isolating, embarrassing problem. While it has become a punchline in our culture, people who suffer from premature ejaculation are not just suffering from a dissatisfying sex life. Premature ejaculation, or PE, can affect multiple aspects of health, including psychological and emotional health, as well as interpersonal relationships with partners and/or spouses.

Although PE is one of the most prevalent sexual dysfunctions, it lacked an evidence-based, united definition until 2007, when the International Society for Sexual Medicine formed an Ad Hod Committee for the Definition of Premature Ejaculation.

Their definition of PE includes three prongs:

1. Ejaculation which always or nearly always occurs prior to or within about one minute of vaginal penetration from the first sexual experience (lifelong), or, a clinically significant reduction in latency time, often to about 3 min or less (acquired).
2. The inability to delay ejaculation on all or nearly all vaginal penetrations.
3. Negative personal consequences such as bother, distress, frustration, and/or the avoidance of sexual intimacy.

The third prong is responsible for PE transforming from a minor occasional embarrassment into a mortifying issue that should be taken seriously by the one who suffers from it, and the medical professionals treating him.

Premature ejaculation is a generally neglected area of men’s sexual health, which is why we want to help men understand the problem and how they can fix premature ejaculation through a holistic approach to their sexual health.

How Common is Premature Ejaculation?

First of all, it’s important to understand that if you are suffering from premature ejaculation, you are far from the only one. 

PE is considered to be the most common sexual disorder in the male population. There are poor rates of men seeking treatment due to shame or embarrassment. Because PE is understudied, there can also be clinical confusion around the diagnosis and management of premature ejaculation.

That being said, recent studies suggest that about 30% of men are affected, but that number may be up to 70% in some reviews.

ED is more prominent in older age groups and associated with other medical conditions like diabetes.

How Does Ejaculation Normally Work?

Premature ejaculation should be understood in the context of what is considered to be normal ejaculation, in order to diagnose and treat it properly. Ejaculation is not just one orgasmic moment; it’s actually multiple steps through the sexual experience that occur one after another.

The Steps to Ejaculation

Normal male sexual response can be thought of as a four step sequential process

The first step is excitement. This is when sexual interest and/or stimulation leads to penile tumescence and subsequent erection. That’s science-speak for getting an erection due to sexual stimuli.

The second step is a plateau period in which ejaculation is delayed and where sexual intercourse can occur. This is when an erection is maintained prior to ejaculation.

The third step is ejaculation and orgasm.

The fourth step is postejaculatory detumescence and resolution

In patients with PE, the process becomes compressed. A steep excitement period is followed by reduced ejaculatory control during the plateau phase and subsequently, rapid ejaculation.

How to Control Ejaculation

Ejaculation control is not just a matter of “controlling yourself” mentally. Ejaculation is a highly coordinated process that occurs at key spinal centers. A complex ejaculatory network contributes to the ultimate physical response. 

Several groups of interconnected neurons at various levels of the brain play different roles in the ejaculatory response. These roles include

• sensory/integrative– responsible for processing sexual stimuli
• excitatory– projections sent from neurons to autonomic neurons contained in the spine
• inhibitory actions– nuclei of the ventral medulla, identified as source of inhibitory control

Because these processes are complex and involve the brain, spine, nerves, and muscles, there is no one “easy way” to control ejaculation.

How Do I Know if I’m Ejaculating Too Early?

There’s always going to be a guy who says that he lasts a very long time in bed, but the truth is, the median time for penetrative sex might be shorter than you think. A 2005 multinational study measured Intervaginal Ejaculation Latency Time (IELT), which is the time a man maintains an erection during penetrative sex prior to ejaculation. They found that the median time for sex was 5.4 minutes as measured by, not even close to the marathon sessions that some Lotharios brag about.

There wasn’t a significant difference in how long a man lasted during sex across race, ethnicity, or nation of participants, but there was one factor that crossed the other boundaries: age. The median time for sex dropped significantly with age, with the age 18-30 age group lasting about 6.5 minutes, and the 51+ age group lasting 4.3 minutes. 

This means that despite what people may find out word-of-mouth or anecdotally, the normal range for how long a man should last during sex isn’t very long.

The Connection Between PE and Female Orgasmic Disorder 

It takes a woman about 13.46 minutes to orgasm, which seems like a sexual mismatch with a man’s Intervaginal Ejaculation Latency Time (IELT), the unit measured in surveys of how long sex should last. However, sexual activity between a man and a woman often begins with foreplay that contributes to a woman’s orgasmic response.

If a man’s female partner has sexual dysfunction of her own, it could mistakenly make a man believe he has premature ejaculation problems. Female organismic disorder could be misdiagnosed as the male partner’s PE. This is why the concept of treating sexual partners as a unit for evaluation and treatment is increasingly prominent.

What Causes Premature Ejaculation?

Premature ejaculation usually isn’t caused by one thing. While it is often concomitant with erectile dysfunction (ED), the different types of clinically diagnosed premature ejaculation have different causes.

In order to find the root cause of a patient’s premature ejaculation, it’s important to suss out the type of PE they have, how long they’ve been suffering from it, and in what types of situations it occurs.

The Types of Premature Ejaculation

Premature ejaculation is often secondary to erectile dysfunction. As such, medical professionals will often treat ED first, in the hopes that improvement in erectile dysfunction will also show improvement in PE.

As with any dysfunction, it’s important to find and treat the root cause for whichever type of premature ejaculation it is. There are two primary categories, which can be further subdivided.

Lifelong Premature Ejaculation (aka Primary Premature Ejaculation)

Lifelong PE, also referred to as Primary PE, is characterized by a low IELT from the person’s first sexual experience and on most, if not all subsequent encounters. A low IELT is considered to be less than one minute. 

Lifelong PE can be indicative of a functional disturbance in the timing of an erection, arousal, and detumescence. It can present with several other sexual dysfunctions, including  hypererotic state, early erections, early ejaculations, and early detumescence. Primary PE has been linked to familial occurrence, as well as possible genetic polymorphisms.

Acquired Premature Ejaculation (aka Secondary Premature Ejaculation)

Acquired PE is also referred to as secondary PE because it is often the result of some other dysfunction. Unlike primary PE, acquired PE is characterized by reduced ejaculatory latency that develops at some point in the patient’s life. Acquired PE is often comorbid with erectile dysfunction.

This means that patients have experienced normal ejaculations in the past, and the dysfunction is usually due to an identifiable medical, psychological, or interpersonal underlying cause. Risk factors for secondary premature ejaculation include psycho-relational, endocrine, and urologic dysfunction. Other causes could include prostatitis and hyperthyroidism.

Variable Premature Ejaculation

A way to further break down the categories of PE, variable PE refers to early ejaculation that occurs inconsistently, or irregularly in a man’s sexual life. 

There is some normal variation in ejaculatory time across time and circumstances in a man’s life. But when inconsistent and short ejaculatory times begin to fit the criteria of the third part of the definition of PE, and the premature ejaculation is consistently causing negative consequences for the patient, then variable PE could be the culprit.

Variable premature ejaculation can be further broken down as generalized, which means that the inconsistency doesn’t seem to have an external cause, or situational, when the premature ejaculation is linked to certain partners, stimulations, or situations.

Perceived Premature Ejaculation 

The final kind of premature ejaculation is the one that we mentioned above. Perceived PE, just as it sounds, refers to patients perceiving and describing themselves as having PE despite normal IELTs. This can be due to inaccurate partner feedback, a partner’s sexual dysfunction, or the patients own low self-assessment.

How to Treat Premature Ejaculation

Because there are a variety of confounding factors in diagnosing premature ejaculation and its root problems, it may not be surprising to hear that there are a variety of treatments.

Treating Primary Premature Ejaculation

One possibility is SSRIs for premature ejaculation. This is an example of using what could otherwise be a negative pharmaceutical side effect and turning it into a positive.

SSRIs are selective serotonin reuptake inhibitors, and are commonly indicated for depression. But serotonin is more than a “happy” neurotransmitter– it’s also the primary neurotransmitter involved in cerebral control of ejaculation. SSRIs can increase synaptic levels of serotonin, leading to post-synaptic nerve transmission. This leads to a well-documented side effect of sexual dysfunction, including delayed ejaculation

SSRIs are primarily indicated for patients with lifelong PE, since people suffering from primary PE are probably less likely to find relief from traditional ED treatments.

Best ED Drugs for Premature Ejaculation (Acquired/Secondary)

PDE-5 inhibitors, famous for helping men achieve and maintain an erection, can also play a role in reducing premature ejaculation by helping increase sexual confidence and ejaculatory control.

We offer a variety of PDE-5 inhibitors, to help you find the one that best fits your needs.

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