What is it?
Many men occasionally ejaculate sooner during sexual intercourse than they or their partner would like. As long as it happens infrequently, it's not cause for concern. However, if you regularly ejaculate sooner than you and your partner wish — such as before intercourse begins or shortly afterward — you may have a condition known as premature ejaculation.
Premature ejaculation is a common sexual complaint. Estimates vary, but as many as one out of three men may be affected by this problem at some time.
Both psychological and biological factors can play a role in premature ejaculation. Although many men feel embarrassed to talk about it, premature ejaculation is a common and treatable condition.
Medications, psychological counseling and sexual techniques that delay ejaculation can improve sex for you and your partner. For many men, a combination of treatments works best.
The primary sign of premature ejaculation is ejaculation that occurs before both partners wish, causing concern or distress. However, the problem may occur in all sexual situations, even including during masturbation.
Doctors generally classify premature ejaculation as either lifelong (primary) or acquired (secondary).
According to the International Society for Sexual Medicine, lifelong premature ejaculation is characterized by:
- Ejaculation that always or nearly always occurs within one minute or less of vaginal penetration
- The inability to delay ejaculation on all or nearly all vaginal penetrations
- Negative personal consequences, such as distress, frustration or the avoidance of sexual intimacy
The International Society for Sexual Medicine has concluded that there aren't yet enough published data about acquired (secondary) premature ejaculation to publish an evidence-based definition of this condition.
According to the definition in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, secondary premature ejaculation:
- Is marked by persistent or recurrent ejaculation with minimal stimulation before, on, or shortly after penetration, and before you wish it
- Causes personal distress or relationship problems
- Develops after you've had previous, satisfying sexual relationships without ejaculatory problems
The exact cause of premature ejaculation isn't known. While it was once thought to be only psychological, we now know premature ejaculation is more complicated and involves a complex interaction of both psychological and biological factors.
Some 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
Other factors that can play a role in causing premature ejaculation include:
- Erectile dysfunction. Men who are anxious about obtaining or maintaining their 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 caused by other issues.
- Relationship problems. If you have previously had satisfying sexual relationships in which premature ejaculation happened infrequently or not at all, it's likely that interpersonal issues between you and your current partner are contributing to the problem.
A 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
Rarely, premature ejaculation is caused by:
- Nervous system damage resulting from surgery or trauma
- Withdrawal from narcotics or a drug called trifluoperazine (Stelazine) that is used to treat anxiety and other mental health problems
Although both biological and psychological factors likely play a role in most cases of premature ejaculation, experts think a primarily biological cause is more likely if it has been a lifelong problem (primary premature ejaculation).
Various factors can increase your risk of premature ejaculation, including:
- 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 unconsciously hurry through sexual encounters.
- Health problems. A medical concern that causes you to feel anxious during sex, such as a heart problem, may cause you to 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.
- Certain medications. Rarely, drugs that influence the action of chemical messengers in the brain (psychotropics) may cause premature ejaculation.
While premature ejaculation doesn't increase your risk of serious health problems, it can cause problems in your personal life, including:
- Relationship strains. The most common complication of premature ejaculation is relationship stress. If premature ejaculation is straining your relationship, ask your doctor about including couple's therapy in your treatment program.
- Fertility problems. Premature ejaculation can occasionally make fertilization difficult or impossible for couples who are trying to become pregnant. If premature ejaculation isn't effectively treated, you and your partner may need to consider infertility treatment.
In addition to a detailed interview about your sex life, your doctor will want to know about your health history and may perform a general physical exam. He or she may refer you to a urologist who specializes in sexual dysfunction or to a mental health professional to help make the diagnosis.
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.