Premature Ejaculation

What is premature ejaculation?

Many men sometimes ejaculate sooner than they or their partner would like. If it just happens occasionally, it's probably not something to worry about. However, if you regularly ejaculate sooner than you and your partner would like, such as before intercourse begins or soon afterward, you may have a condition known as premature ejaculation. Although the issue is often phrased in terms of time (i.e., I’m ejaculating within thirty seconds after starting intercourse), the issue is really about voluntary control of the ejaculatory process.

What is the average time until ejaculation?

In assessing whether you have premature ejaculation, it can be important to ask whether your own or your partner’s stamina expectation is realistic. Keep in mind that the average time from insertion to ejaculation is less than three minutes.

If your partner is a woman, remember that female orgasm doesn’t occur automatically as a result of prolonged intercourse. Surveys tell us that only about one fourth to one half of women regularly orgasm during intercourse. Most women find it is easier to be orgasmic with manual or oral stimulation than through intercourse.

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How common is it?

Premature ejaculation affects about one out of three men. It is the most common male sexual problem, particularly among younger men.

What are the causes?

Premature ejaculation can have both psychological and biological causes.

Psychological causes

  • Early sexual experiences may establish a pattern which is difficult to change. First experiences of sexual intercourse often involve excitement mixed with anxiety and a demand to perform quickly in order to avoid being discovered. Your focus might be on your performance rather than on the pleasurable and erotic aspects of the experience. Most males reach orgasm very quickly the first time they have intercourse. Although most men also learn to slow down, to enjoy their own and their partner’s pleasure, and become comfortable and confident with sexual intercourse, early ejaculation continues to be a problem for about 30 percent of men.
  • Many men with premature ejaculation also have problems with anxiety — either specifically about sexual performance, or anxiety caused by other issues. In general, linking sex and performance, rather than sex and pleasure, can be problematic. In developing ejaculatory control, you might find that it is best to focus on what would bring pleasure to you and to your partner. It can also help to think of ejaculatory control as a skill that you and your partner develop together to enhance mutual satisfaction.
  • Premature ejaculation can also be related to erectile dysfunction. Men who are anxious about obtaining or maintaining their erection during sexual intercourse may form a pattern of rushing to ejaculate and have difficulty changing that pattern.

Biological causes

A number of biological factors may contribute to premature ejaculation, including:

  • Abnormal hormone levels
  • Insufficient concentration of the neurotransmitter serotonin
  • Abnormal reflex activity of the ejaculatory system
  • Certain thyroid problems
  • Inflammation and infection of the prostate or urethra
  • Inherited traits

Rarely, premature ejaculation is caused by:

  • Nervous system damage resulting from surgery or trauma
  • Withdrawal from narcotics or a drug called trifluoperazine (Stelazine), used to treat anxiety and other mental health problems

Whether the cause is psychological or biological, treatments including medications, counseling and learning sexual techniques to delay ejaculation can improve sex for you and your partner(s).

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What are the treatment options?

Treatment for premature ejaculation can include behavioral therapy (including learning specific sexual techniques), certain medications and counseling or psychotherapy. Often, a combination approach works best. 80-90% of men are able to learn better control through treatment.

In some cases, behavioral therapy may involve simple steps such as masturbating an hour or two before intercourse to help you delay ejaculation during sex or stimulating your partner to a state of high arousal before you have your genitals touched, so that your orgasms can be achieved closer to the same time.

Another approach that may help is to avoid intercourse for a period of time and instead focus on other types of sexual play so that pressure is removed from your sexual encounters. Connecting in this way can help you re-establish a satisfying physical bond with your partner(s).

In addition to the approaches above, there are two specific behavioral methods which can help you develop ejaculatory control:

  • The stop and start method helps you learn to recognize when climax is imminent and to slow down or reduce stimulation in order to extend the time until ejaculation. If you find yourself nearing climax, withdraw your penis from your partner or otherwise reduce stimulation and allow yourself to relax enough to prevent ejaculation. By starting and stopping sexual stimulation and learning to notice when climax is imminent, you can learn to prolong the sex act.
  • A second method known as the squeeze technique also helps you gain control over the timing of your ejaculation. To use the squeeze technique, you begin sexual activity as usual, including stimulation of the penis, until you feel almost ready to ejaculate. Have your partner squeeze the end of your penis, at the point where the head joins the shaft, and maintain the squeeze for several seconds, until the urge to ejaculate passes. After the squeeze is released, wait for about 30 seconds, then go back to sex play. (You may notice that squeezing the penis causes it to become less erect, but when sexual stimulation is resumed, the full erection returns.) If you again feel you're about to ejaculate, have your partner repeat the squeeze process. By repeating this as many times as necessary, you can reach the point of entering your partner without ejaculating. You can also use this technique without a partner by masturbating and then applying the squeeze yourself as described above. After a few practice sessions, the feeling of knowing how to delay ejaculation may become a habit that no longer requires the squeeze technique.

Medication is another option for treatment and generally most effective when used in combination with behavioral methods. Certain antidepressants and topical anesthetics can be used to treat premature ejaculation. You may need to try different medications or doses before you and your doctor find a treatment that works for you.

A side effect of certain antidepressants is delayed orgasm. Doctors sometimes suggest men who have premature ejaculation can take antidepressants to benefit from this specific side effect. You may not need to take these medications every day to prevent premature ejaculation. Taking a low dose several hours before you plan to have sexual intercourse may be enough to improve your symptoms. Other side effects of these antidepressants can include nausea, dry mouth, drowsiness and decreased libido.

Desensitizing lubricants can also be used to treat premature ejaculation. They contain a mild anesthetic (7.5 percent benzocaine) that causes a temporary numbing sensation after being applied to the skin. The purpose of this desensitization is to help men to keep their erections and to postpone ejaculation. Since the penis has less sensation, sexual pleasure could be reduced. Wearing a condom when you use these products can help so that the lube can’t rub off onto your partner's body, diminishing sensation and pleasure for him or her as well. Desensitizing lubes are water-soluble, not oil-based, and so they can be used with latex condoms. They are available over the counter. Durex Play Longer is one of the most commonly available desensitizing lubes.

If you suspect that the main cause of your premature ejaculation is anxiety, meeting with a mental health professional to address this issue can be an essential step in treating the problem. If you are a Brown student, you can make an appointment with Counseling and Psychological Services by calling 401.863-3476.

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When should I seek medical advice?

Talk with a doctor if you ejaculate sooner than you and your partner wish during most sexual encounters. Although you may feel you should be able to fix the problem on your own, you may need treatment to help you achieve and sustain a satisfying sex life. Most men will experience premature ejaculation at some point in their lives, especially when they are young, but if the problem persists then you shouldn’t hesitate to seek medical help.

Can I make an appointment at Health Services?

If you are a Brown student and you are concerned about erectile dysfunction, you can make a confidential appointment at Health Services by calling 401.863-3953.  Health Services provides a range of services including general health care, STI testing, inpatient services and emergency medical care. You can request a medical provider by gender or by name. We are located at 13 Brown Street on the corner of Brown and Charlesfield Streets.

Campus Resources

Counseling and Psychological Services 401.863-3476 
Psychological Services provides individual appointments, referrals, and groups on a variety of issues.

Health Services 401.863-3953
Health Services provides a range of services including general health care, STI testing, inpatient services and emergency medical care. You can request a male or female medical provider or you can request a specific provider by name. We are located at 13 Brown Street on the corner of Brown and Charlesfield Streets.

BWell Health Promotion 401.863-2794          
Health Promotion is available for individual appointments and group education on a variety of health issues, including premature ejaculation or other sexual health concerns. We also have safer sex supplies available. Come visit us, we are located on the 3rd floor of Health Services.

The following titles have good comprehensive discussions of premature ejaculation, including causes and treatments. Both titles are available for loan from Health Promotion:

  • The New Male Sexuality by Bernie Zilbergeld
  • Male Sexual Awareness by Barry and Emily McCarthy

Links you can use

American Urological Association
This site offers information on premature ejaculation, including treatment options, as well as information on other sexual function issues. You can also download a brochure titled The Management of Premature Ejaculation: A Patient's Guide.

American Association of Sexuality Educators Counselors and Therapists
AASECT offers a directory of certified sex therapists as well as links to sexuality resources.

Sexual Health Network
The Sexual Health Network site includes articles and Q&A sections on premature ejaculation and other sexual health topics.

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Disclaimer: BWell Health Promotion is part of Health Services at Brown University. Health Promotion maintains this site as a resource for Brown students. This site is not intended to replace consultation with your medical providers. No site can replace real conversation. Health Promotion offers no endorsement of and assumes no liability for the currency, accuracy, or availability of the information on the sites we link to or the care provided by the resources listed. Health Services staff are available to treat and give medical advice to Brown University students only. If you are not a Brown student, but are in need of medical assistance please call your own health care provider or in case of an emergency, dial 911. Please contact us if you have comments, questions or suggestions.