- Always or nearly always ejaculate within one minute of penetration
- Are unable to delay ejaculation during intercourse all or nearly all of the time
- Feel distressed and frustrated, and tend to avoid sexual intimacy as a result
SymptomsThe primary symptom of premature ejaculation is the inability to delay ejaculation for more than one minute after penetration. However, the problem may occur in all sexual situations, even during masturbation.
Premature ejaculation can be classified as lifelong (primary) or acquired (secondary). Lifelong premature ejaculation occurs all or nearly all of the time beginning with your first sexual encounters. Acquired premature ejaculation has the same symptoms but develops after you've had previous sexual experiences without ejaculatory problems.
Many men feel that they have symptoms of premature ejaculation, but the symptoms do not meet the diagnostic criteria for premature ejaculation. Instead these may have natural variable premature ejaculation, which is characterized by periods of rapid ejaculation as well as periods of normal ejaculation.
When to see a doctorTalk with your doctor if you ejaculate sooner than you wish during most sexual encounters. It's common for men to feel embarrassed about discussing sexual health concerns, but don't let that keep you from talking to your doctor. Premature ejaculation is a common and treatable problem.
For some men, a conversation with their doctor may help alleviate concerns about premature ejaculation. For example, it may be reassuring to hear that occasional premature ejaculation is normal and that the average time from the beginning of intercourse to ejaculation is about five minutes.
CausesThe exact cause of premature ejaculation isn't known. While it was once thought to be only psychological, doctors now know premature ejaculation is more complicated and involves a complex interaction of psychological and biological factors.
Psychological causesSome doctors believe that early sexual experiences may establish a pattern that can be difficult to change later in life, such as:
- Situations in which you may have hurried to reach climax in order to avoid being discovered
- Guilty feelings that increase your tendency to rush through sexual encounters
- Erectile dysfunction. Men who are anxious about obtaining or maintaining an erection during sexual intercourse may form a pattern of rushing to ejaculate, which can be difficult to change.
- Anxiety. Many men with premature ejaculation also have problems with anxiety — either specifically about sexual performance or related to other issues.
- Relationship problems. If you have had satisfying sexual relationships with other partners in which premature ejaculation happened infrequently or not at all, it's possible that interpersonal issues between you and your current partner are contributing to the problem.
Biological causesA number of biological factors may contribute to premature ejaculation, including:
- Abnormal hormone levels
- Abnormal levels of brain chemicals called neurotransmitters
- Abnormal reflex activity of the ejaculatory system
- Certain thyroid problems
- Inflammation and infection of the prostate or urethra
- Inherited traits
- Nerve damage from surgery or trauma (rare)
- Erectile dysfunction. You may be at increased risk of premature ejaculation if you occasionally or consistently have trouble getting or maintaining an erection. Fear of losing your erection may cause you to consciously or unconsciously hurry through sexual encounters.
- Health problems. If you have a serious or chronic medical condition, such as heart disease, you may feel anxious during sex and may unknowingly rush to ejaculate.
- Stress. Emotional or mental strain in any area of your life can play a role in premature ejaculation, often limiting your ability to relax and focus during sexual encounters.
- Stress and relationship problems. A common complication of premature ejaculation is relationship stress.
- Fertility problems. Premature ejaculation can occasionally make fertilization difficult or impossible for couples who are trying to have a baby.
Preparing for your appointmentIt's normal to feel embarrassed when talking about sexual problems, but you can trust that your doctor has had similar conversations with many other men. Premature ejaculation is a very common — and treatable — condition.
Being ready to talk about premature ejaculation will help you get the treatment you need to get your sex life back on track. The information below should help you prepare to make the most of your appointment.
Information to write down in advance
- Pre-appointment restrictions. At the time you make your appointment, ask if there are any restrictions you need tgo follow in the time leading up to your visit.
- Symptoms. How often do you ejaculate before you or your partner would wish? How long after you begin having intercourse do you typically ejaculate?
- Sexual history. Think back on your relationships and sexual encounters since you became sexually active. Have you had problems with premature ejaculation before? With whom, and under what circumstances?
- Medical history. Write down any other medical conditions with which you've been diagnosed, including mental health conditions. Also note the names and strengths of all medications you're currently taking or have recently taken, including prescription and over-the-counter drugs.
- Questions to ask your doctor. Write down questions in advance so that you make the most of your time with your doctor.
Basic questions to ask your doctorThe list below suggests questions to ask your doctor about premature ejaculation. Don't hesitate to ask more questions during your appointment.
- What may be causing my premature ejaculation?
- What tests do you recommend?
- What treatment approach do you recommend?
- How soon after I begin treatment can I expect improvement?
- How much improvement can I reasonably expect?
- Am I at risk of this problem recurring?
- Is there a generic alternative to the medicine you're prescribing?
- Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?
What to expect from your doctorYour doctor may ask a number of very personal questions and may also want to talk to your partner. To help your doctor determine the cause of your problem and the best course of treatment, be ready to answer questions such as:
- How often do you have premature ejaculation?
- Has this problem developed gradually or suddenly?
- Do you have premature ejaculation only with a specific partner or partners?
- Do you experience premature ejaculation when you masturbate?
- Do you have premature ejaculation every time you have sex?
- How often do you have sex?
- How much are you bothered by premature ejaculation?
- How much is your partner bothered by premature ejaculation?
- How satisfied are you with your current relationship?
- Are you also having trouble getting and maintaining an erection (erectile dysfunction)?
- Do you take prescription medications? If so, what medications have you recently started or stopped taking?
- Do you use recreational drugs?
What you can do in the meantimeDeciding to talk with your doctor is the most important step you can take. In the meantime, consider exploring other ways in which you and your partner can connect with one another. Although premature ejaculation can cause considerable strain and anxiety in a relationship, it is a treatable condition.
Tests and diagnosisIn addition to asking about your sex life, your doctor will ask about your health history and may perform a general physical exam. Your doctor may order a urine test to rule out possible infection. If you have both premature ejaculation and trouble getting or maintaining an erection, your doctor may order blood tests to check your male hormone (testosterone) levels or other tests.
In some cases, your doctor may suggest that you go to a urologist or a mental health professional who specializes in sexual dysfunction.