Premature ejaculation (PE) is a distressing condition in which a man ejaculates before he intends to. Men may feel that they have little or no control over when they ejaculate.
To diagnose PE, doctors usually start by asking questions like the following:
- How long has PE been a problem? When did it start?
- What is the length of time between partner penetration and ejaculation?
- How much control does the man think he has over ejaculation?
- How distressed does he feel about the situation?
- How distressed does his partner feel?
- Are there any psychological, emotional, or relationship issues of concern?
Sometimes, men complete a questionnaire like the Premature Ejaculation Diagnostic Tool (PEDT) during their office visit.
Doctors also consider a man’s medical history and conduct a physical exam to see if other health conditions might be contributing to PE. For example, some men develop PE in connection with prostatitis (inflammation of the prostate gland), anxiety, or erectile dysfunction (ED).
Once a diagnosis is made, PE is usually treated with sex therapy, medications, or a combination of these two approaches.
A sex therapist can educate men and their partners about ejaculatory function and why PE might be happening. They can also provide some context and reassurance, as men who feel they are ejaculating too soon may be closer to “normal” than they think. (The average time between penetration and ejaculation is between 5 and 7 minutes.)
In addition, men may learn practical techniques to try the next time they have intercourse. One such technique is called the stop-start method. When a man thinks he is about to ejaculate, stimulation stops for thirty seconds. Then, stimulation continues and stops again. The process is repeated until the man feels ready to ejaculate.
Sex therapists can also help men and their partners work on psychological, emotional, and relationships issues, which might have been present for a long time or might be more recent, stemming from PE distress.
Medications
Two types of medications are commonly prescribed to treat PE:
- Topical anesthetics (such as lidocaine) are applied directly to the penis before sexual activity. These drugs work by reducing the sensitivity of the penis enough so that a man doesn’t ejaculate too quickly but doesn’t miss out on sexual pleasure either.
- Oral serotonergic drugs work on nerve signaling in the brain and nervous system to delay ejaculation.
Men should always take PE medications with the guidance of a healthcare professional.
Some men also find these strategies helpful in managing PE:
- Masturbating before intercourse. Many men find they have better control if they ejaculate shortly before starting sexual activity.
- Using condoms. For some men, a condom makes the penis less sensitive.
- Distraction. Some men think about non-sexual topics during sex.
- Squeeze method. The penis tip is gently squeezed by a partner when a man is about to ejaculate. Stimulation stops for 30 seconds, then starts again.
Before trying any treatment strategy, men should consult their physician.
Resources
International Society for Sexual Medicine
“How is PE diagnosed?”
https://www.issm.info/sexual-health-qa/how-is-premature-ejaculation-diagnosed/
“How is PE treated?”
https://www.issm.info/sexual-health-qa/how-is-premature-ejaculation-diagnosed-and-treated/?ref_condition=premature-ejaculation/
“ISSM Patient Information Sheet on Premature Ejaculation”
(August 2014)
https://www.issm.info/images/uploads/ISSM_Patient_Information_Sheet_on_PE_-_website.pdf
“ISSM Patient Information Sheet on Premature Ejaculation”
(January 2015)
https://www.issm.info/images/uploads/ISSM_Patient_Information_Sheet_on_PE_-_website_JAN_2015.pdf
“ISSM Quick Reference Guide to PE”
(January 2015)
https://www.issm.info/images/uploads/ISSM_Quick_Reference_Guide_to_PE_-_website_JAN_2015.pdf