Premature ejaculation

Definition

Premature ejaculation is when a man has an orgasm sooner than desired during intercourse.

Causes

Premature ejaculation is a common symptom.

It is thought to be caused by psychological factors or physical problems. The condition often improves without treatment.

Symptoms

The man ejaculates before he would like (prematurely). This may range from before penetration to a point just after penetration. It may leave the couple feeling unsatisfied.

Exams and Tests

Your health care provider will do a physical exam and talk with you about your sex life and medical history. Your provider also may do blood or urine tests to rule out any physical problems.

Treatment

Practice and relaxation can help you deal with the problem. There are helpful techniques you can try.

The "stop and start" method:

This technique involves sexually stimulating the man until he feels like he is about to reach orgasm. Stop the stimulation for about 30 seconds and then start it again. Repeat this pattern until the man wants to ejaculate. The last time, continue stimulation until the man reaches orgasm.

The "squeeze" method:

This technique involves sexually stimulating the man until he recognizes that he is about to ejaculate. At that point, the man or his partner gently squeezes the end of the penis (where the glans meets the shaft) for several seconds. Stop sexual stimulation for about 30 seconds, and then start it again. The person or couple may repeat this pattern until the man wants to ejaculate. The last time, continue stimulation until the man reaches orgasm.

Antidepressants, such as fluoxetine (Prozac) and other selective serotonin reuptake inhibitors (SSRIs), are often prescribed. These medicines can increase the time it takes to reach ejaculation.

You can apply a local anesthetic cream or spray to the penis to reduce stimulation. Decreased feeling in the penis may delay ejaculation. Condom use also may have this effect for some men.

Other medicines used for erectile dysfunction may help. Some studies show that using a combination of behavioral techniques and medicines may be most effective.

Evaluation by a sex therapist, psychologist, or psychiatrist may help some couples.

Outlook (Prognosis)

In most cases, the man can learn how to control ejaculation. Education and practicing simple techniques are often successful. Chronic premature ejaculation may be a sign of anxiety or depression. A psychiatrist or psychologist can help treat these conditions.

Possible Complications

If a man ejaculates very early, before entering the vagina, it may prevent a couple from getting pregnant.

A continued lack of control over ejaculation may cause one or both partners to feel sexually dissatisfied. It may lead to sexual tension or other problems in the relationship.

When to Contact a Medical Professional

Contact your provider if you are having a problem with premature ejaculation and it does not get better using the methods described above.

Prevention

There is no way to prevent this disorder.

References

Cooper K, Martyn-St. James M, Kaltenthaler E, et al. Behavioral therapies for management of premature ejaculation: a systematic review. Sex Med. 2015;3(3):174-188. PMID: 26468381 www.ncbi.nlm.nih.gov/pubmed/26468381/.

Matsumoto AM, Anawalt BD. Testicular disorders. In: Melmed S, Auchus, RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 19.

McMahon CG. Disorders of male orgasm and ejaculation. In: Partin AW, Domochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 71.

Shafer LC. Sexual disorders and sexual dysfunction. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 36.

Review Date: 1/1/2023
Reviewed By: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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