What is premature ejaculation?

Premature ejaculation is when you have trouble controlling when you orgasm, and you ejaculate at a time that you or your partner feel is too fast. Premature ejaculation is very common. Many men ejaculate prematurely, or “come too early”, at some time in their lives.

There is no fixed time that a man should ejaculate. Premature ejaculation is normally considered when you ejaculate within one minute of your penis entering your partner. Premature ejaculation may also mean some men may ejaculate during foreplay, or when trying to insert their penis during sex. If premature ejaculation happens occasionally, that is usually not a worry. But if you regularly come earlier than you or your partner would like, then it is an issue to think about.

How common is premature ejaculation?

Premature ejaculation is the most common sexual problem to affect men. It is more common in younger men, as ejaculation tends to take longer as men get older, but premature ejaculation can happen at any age.

What causes premature ejaculation?

Sometimes premature ejaculation is a lifelong problem that starts the first time a man has sex. This may be due to a chemical imbalance in the brain that causes a lower threshold for ejaculation, or it could be due to psychological factors such as performance anxiety.

Acquired premature ejaculation can develop after a period of normal ejaculation. It is usually due to another problem such as performance anxiety, generalised anxiety, stress, erectile dysfunction or relationship problems. Alcohol and recreational drugs can make premature ejaculation worse.

Some men may have physical problems tied in with premature ejaculation, such as impotence or high blood pressure. Some medicines can make it worse too.

When should I see my doctor?

You should talk to your doctor if you are experiencing premature ejaculation because they can provide reassurance, assess to identify the cause and offer management options. It can also help to talk to your partner and include your partner when you talk to a health professional.

Most men with premature ejaculation can be helped, which can help with developing and maintaining intimate relationship.

It is important to remember that ejaculation problems are common and nothing to be embarrassed or shy about.

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How is premature ejaculation diagnosed?

There is no test to diagnose premature ejaculation. Your doctor will ask questions about your sexual history and details about the premature ejaculation.

How is premature ejaculation treated?

There are some things you may wish to try before seeking medical help. These include:

• masturbating an hour or 2 before you have sex
• using a condom to help decrease sensation
• taking a deep breath in to briefly shut down the ejaculatory reflex (an automatic reflex of the body during which ejaculation occurs)
• having sex with your partner on top, so they can pull away when you’re close to ejaculating
• trying different positions that you may find less arousing
• taking a break and thinking of something other than sex

Your doctor can offer and help arrange different treatment options.

Counselling

There are sex therapists and other specialists, like psychologists, that can help with premature ejaculation and other sexual problems. You may benefit from seeing one of these professionals. Counselling may help identify any underlying psychological, sexual or relationship issues and can also help improve other problems related to premature ejaculation, such as anxiety.

If you are in a long-term relationship, you may benefit from couples therapy.

Behavioural techniques

There are techniques that can help someone 'unlearn' the habit of premature ejaculation. Sex therapists can advise on techniques available to do this, and include’ “stop-start” technique and the “squeeze” technique.

Medicines

Another treatment option is a local anaesthetic spray that can be bought over-the-counter at your pharmacy without prescription. You spray it on the head of your penis 10 minutes before having sex. It is important that you follow the instructions. Also, you should be aware that the spray may also be transferred from your penis to your partner, for example within the vagina, causing a short term reduction in sensation.

Also, antidepressants have been used successfully to treat premature ejaculation.

Using medicines to treat erectile dysfunction if this is also present, can help bring back the normal control over ejaculation.

Exercises

Kegel exercises, which are exercises to strengthen the pelvic floor muscles, can also help to improve control over ejaculation.