Men and woman laying on the bed

Premature Ejaculation – Diagnosis And Treatment

It affects one in three males—premature ejaculation is the most common form of sexual dysfunction.1

Yet, despite being so prevalent—it’s a condition that men are unlikely to discuss with their partner, medical practitioner, or even their close friends.

Silence face imageUnfortunately, this can lead many of them to suffer in silence—which can actually exacerbate the situation.

This article is the ultimate guide to premature ejaculation—what it is, its causes, and importantly, what you can do to prevent it.

What Is Premature Ejaculation?

In a medical context, practitioners diagnose premature ejaculation when a man has an IELT (intravaginal ejaculatory latency time) of one minute or less. That is, he ejaculates within 60 seconds of his penis entering a vagina.2

However, outside of this clinical arena—the term is much broader.

Premature ejaculation can be said to occur when a man reaches orgasm faster than he, or his partner(s), would prefer. Sometimes, people refer to it as early ejaculation, rapid ejaculation, or premature climax.

Stress imageWhile seemingly innocuous, this condition can place stress on relationships, cause immense embarrassment, and take the pleasure out of lovemaking.

Medically, experts separate premature ejaculation into two distinct types:

  • Primary (lifelong)—starts at the very beginning of a man’s sexual experiences and happens every time he has intercourse.
  • Secondary (acquired)—develops after a man has enjoyed previous sexual intercourse without an issue—and may not happen all the time.3

Biological, sociological, and psychological factors can promote the onset of premature ejaculation. While it’s a massive cause of concern for the sufferer—there are many techniques, discussed later—that can help to alleviate the issue.

How Long Is It Normal to Last In Bed?

This depends on how you look at the problem. That is, what the research states and what’s expected in the real world.
Analysis image

Let me start with the clinical studies.

In 2009, scientists conducted a study on 474 men from around the world. They were asked to activate a stopwatch (covered, so they had no idea of the amount of time passing) once they entered their partner’s vagina. They were then required to stop the clock once they had ejaculated.4

Taking the results as a whole—the study illustrated that men last, on average, for six minutes.

There also appeared to be a geographical difference—men from Turkey ejaculated the fastest (after 4.4 minutes) while those from the UK lasted the longest (10 minutes).

Clock imageHowever, don’t assume that across the board, people were ejaculating between the four and ten-minute period. Over thirty of the subjects didn’t orgasm until after 20 minutes.

Which brings me to the real-world aspect of what is “normal” intercourse duration.

Ideally, the time before you ejaculate should be as long as you want it to be.

Sometimes rapid sex is ideal—a “quickie” before work, for example. However, in more romantic situations, an extended session is preferable—lasting from 30 minutes to hours.

Hence, while ejaculating around the six-minute mark is considered medically “normal”—your own desires and needs may determine a shorter or longer time frame.

In women, the story is much more complicated.

Evolution imageFrom an evolutionary perspective, there are advantages to premature male ejaculation. In earlier times, extended sexual intercourse made you vulnerable to predators or other male competitors (obviously it’s difficult to defend yourself while mounting your partner).

However, women can become pregnant without an orgasm—meaning its onset doesn’t have to be speedy.5

Studies illustrate that while men climax nearly 100 percent of the time during intercourse, less than 20 percent of women experience orgasm purely through penile penetration.6

Consequently, in women, it’s more applicable to consider whether they will climax—not how long it takes.

Furthermore, a woman who does orgasm can often do so again very quickly—in men ejaculation often results in the loss of the erection. Meaning, time has to pass before you can restart intercourse.

Imbalance imageThis apparent imbalance between men and women can place additional stress on men to perform—elevating the chance of premature ejaculation.7

Causes of Premature Ejaculation

The causes of premature ejaculation cannot be pinned down to one factor. The scientific world has discovered that it’s an interaction of biological, lifestyle, and psychological issues.

Performance Anxiety

Knowing that a woman requires extended stimulation, and not only penile, to orgasm can place pressure on the man to last. Thus leading to anxiety. 

Anxiety imageThis is counterproductive and leads to premature ejaculation. Experts believe that anxiety stimulates the sympathetic nervous system—preventing men from recognizing the signs that they are getting close to orgasm before it’s too late.8

Excessive Porn Consumption

The rapid increase in the availability of pornography on the internet has been cited to explain a similar rise in the occurrence of premature ejaculation. However, while possible, this may be a case of correlation instead of causation.

However, research suggests that two factors may be at work.9

Firstly, watching excessive porn increases the performance anxiety mentioned earlier. Seeing men with unfeasibly large penises lasting for over 30 minutes, causing multiple orgasms in their partners, and utilizing numerous athletic positions could condition young men into thinking this is “normal.”

Porn imageHence, they believe they have to act out these (usually) unattainable standards—placing them under massive pressure.

Secondly, masturbatory ejaculation during porn-viewing is mainly a solo pursuit. There is no requirement or incentive to last a long time—as there’s no one else to satisfy. Plus, when men begin to enjoy pornography-aided masturbation at a young age, this is often done furtively and as swiftly as possible. Often, to avoid being caught by parents or friends.

Hormonal Imbalance

In 2017, scientists discovered that, as was long thought, there were biological factors at play in premature ejaculation.

However, these scientists assumed that men with high levels of testosterone were more likely to suffer from the condition—a proposition that this research found to be false.10

Hormones imageInstead, experts discovered that men who suffered from premature ejaculation had lower levels of luteinizing hormone, prolactin, and thyroid-stimulating hormone than those who had no problems.

Under this circumstance—the advice of a medical practitioner is required to recommend the appropriate treatment.

Erectile Dysfunction

If men are unable to maintain an erection for an extended period of time—this may cause them to “rush” their lovemaking before it dissipates—resulting in premature ejaculation.

When this is the case, it’s crucial to address the cause—not the symptom. Often solving erectile issues can alleviate early climaxing problems.

Supplement imageWhile there are prescription medicines available—many men have found that natural supplements, such as horny goat weed, can improve erectile dysfunction problems.

Additional Factors

In addition to the leading causes listed above—other reasons for suffering from premature ejaculation can include:

  • Low self-esteem.
  • Depression.
  • Being a victim of sexual or physical abuse.
  • Lacking sexual experience.
  • Finding intercourse unpleasurable.

Techniques to Last Longer

While primary premature ejaculation may warrant a visit to your health practitioner—secondary can often be self-treated.

Psychological Treatment

Mindfulness and Distraction

One of the most anecdotally effective techniques is that of mindfulness—concentrating on what’s happening at that present moment—not being distracted by outside factors.

Mindfulness imageConcentrating fully on lovemaking sensations can, over a period of time, enable you to identify the early signs of ejaculation—instead of being surprised. This can allow you to alter position, tempo, or reduce other stimuli to delay ejaculation.

Conversely, there’s the distraction method—often comically referred to in TV shows. This can involve mentally completing complex mathematical calculations or thinking of people or situations that are a turn-off while having intercourse.

However, while this does induce a lower level of arousal, it takes the pleasure out of lovemaking. Additionally, researchers have found it has minimal effect on delaying climax.11

Behavioral Treatment

Delay imageThere are particular behavioral techniques that many men consider beneficial to delaying orgasm. While they don’t work for everyone—they’re a simple method to extend intercourse.

Masturbation Ahead of Sex

Premature ejaculation often results in the man, in an effort to please his partner, suggesting a second attempt. While there may be some delay in achieving an erection again—this often extends into longer lovemaking when it occurs.

This can be replicated by masturbating around 30 minutes before sexual intercourse—which may delay the second orgasm.

Different Sex Positions

Depending on personal preferences and the size and shape of the penis—different positions may be more or less arousing.

Position imageStart with a position that stimulates your penis the least—and when you’re ready to climax—move into one which causes the most sensation.

Slower Tempo

Going hard and fast isn’t just exhausting—it can also induce premature ejaculation.

Lowering your lovemaking speed reduces stimulation and therefore, can delay ejaculation. What’s more, research indicates that sustained and rapid thrusting is less likely to cause a female orgasm than a more leisurely pace.12

Less Penetrative Sex

Research shows that the majority of female orgasms are caused by clitoral stimulation, not vaginal.13

Do not disturb imageHence, it’s possible to suitably please your partner through other means such as oral stimulation of the clitoris first without penetration. You can then follow this with intercourse.

While not preventing premature ejaculation—it does enable both parties to enjoy satisfying sex.

Interruption (Start-Stop)

Considered the first-ever treatment for premature ejaculation, suggested over 50 years ago.14

This involves encouraging your partner to stimulate your penis until you’re almost at the point of climax—at which point they cease.

stop imageWhen you feel that you’re ejaculation is under control again—your partner restarts the arousal. Together, you complete this procedure four times. On the final stimulatory action, you follow through until ejaculation. You should carry out this regime at least three times per week.

Gradually, you’ll find that you’re able to identify and control the climax—without stopping intercourse.

Physiological

Deep-Breathing

Slow, deep, and steady breaths lower anxiety by reducing the stress hormone cortisol—believed to be a cause of premature ejaculation.15 16

Speed image Furthermore, taking your time and avoiding breathless and rapid lovemaking, as mentioned earlier, can ensure that your partner also enjoys more fulfilling sex.

Practice Building Control

Similar to the start-stop method above—this process can enable you to control your own orgasm.

Make love at a steady pace until you feel close to the point of ejaculation—then slow down. If you still anticipate that you’re about to climax—take a break. Stop completely and perhaps continue to stimulate your partner orally. Recommence lovemaking when you feel in control again.

The “Squeeze”

A method developed by the now-legendary sexual dysfunction specialists, Masters and Johnson.17

Squeeze imageAgain, encourage your partner to stimulate your penis until you are nearing the point of ejaculation. They should then stop and squeeze your penis where the head meets the shaft until the feeling of climax has subsided. Repeat four times and then ejaculate.

While preferable with your partner—this can be completed alone if required.

Kegel Pelvic Floor Exercise

A treatment which studies illustrate is useful for sufferers of both primary and secondary premature ejaculation.18

First, you need to locate your pelvic floor muscles. The easiest way to do this is to urinate and then stop mid-stream. Where you feel the squeeze in your pelvic muscles. Once found, you can complete the following kegel exercises (named after the American gynecologist Arnold Kegel).

  1. Squeeze your pelvic floor muscles, hold, and count to three.
  2. Release and again count to three.
  3. Repeat 10 times.
  4. Do this set of exercises three times throughout the course of a day.

exercise image You can complete this exercise in any position—standing, sitting, or lying down. A useful premature ejaculation treatment that you can complete at the office (unlike many of the others—unless you work in an extremely liberal environment).

Strengthening these muscles enhances your ejaculatory control—although you may not witness its results for a few weeks.

Medical Therapies

There are some over-the-counter treatments that can help to alleviate the problems of premature ejaculation.

Topical (Anesthetic) Creams and Sprays

Applied to the penis around 20 minutes before intercourse—these creams and sprays have a numbing effect on the genitalia—reducing stimulation and delaying ejaculation.

cream imageTypically including the anesthetics lidocaine and prilocaine—studies show that they can extend intercourse duration up to six times.19

However, some users (around three percent) reported the loss of erections due to non-sensory stimulation.

Condoms

In some circumstances, merely wearing a standard condom can reduce sensation sufficiently to prevent premature ejaculation—the thicker, the more effective.

Additionally, some manufacturers retail condoms, which also include an anesthetic such as benzocaine for a double-pronged approach. Often you will see these labeled as “climax-control.”

Penis Rings

penis ring imageAn increasingly popular tool to prevent premature ejaculation is the constriction ring or “penis-ring.” A tight-fitting band designed to restrict blood flow in the penis.

Success, however, appears to be mainly anecdotal. Clinical studies indicate that it has no effect on delaying climax. Although, many men report that it increases sexual pleasure.20

Psychosexual Counselling

As the cause of premature ejaculation is often psychological—talking with your partner, whether under the guidance of a trained therapist or without—can be beneficial.

discuss imageDon’t pretend that there isn’t a problem. Often simply discussing premature ejaculation relieves anxiety and reduces the symptoms.

When you speak together, bear in mind these three factors:

  1. In most circumstances, premature ejaculation can be easily treated and solved.
  2. It’s incredibly common—if you know three other men, one of them statistically suffers from it.
  3. Discussing premature ejaculation can relieve stress, depression, and arguments in both parties.

Other Premature Ejaculation Tips 

In addition to the above treatments, consider these as alternative ways to reduce the anxiety and concern relating to premature ejaculation.

Incorporate Toys Into Your Lovemaking

Firstly, toys can make sexual relationships more pleasurable. A sex-life which has become routine can be spiced up with the introduction of gratifying paraphernalia—whether for men or women.

couple imageSecondly, with the emphasis taken off purely intercourse—this can lower the concerns and anxiety associated with sex that can cause premature ejaculation.

Thirdly, it enables you to pleasure your partner and ensure they have a satisfying climax before you commence full-on penetration.

Another Round

So, the worst happens, and you climax too early—it doesn’t mean it’s time to feel disappointed, roll over, and fall asleep. Keep going.

You can continue to pleasure your partner with your hands, tongue, or sex toys. Once your erection has returned recommence intercourse. As mentioned earlier, sex post ejaculation is likely to be extended—providing both you and your partner with enhanced pleasure.

Adult Circumcision

surgeon imageA drastic route maybe—but one that appears to be effective.

By removing the foreskin, researchers suggest that the glans (head) becomes desensitized—reducing tactile stimulation and preventing premature ejaculation.

Research shows that men who have been circumcised in adulthood found that the time to climax was extended.21

Diet

Eating healthily can improve all-around sexual health.

diet imageScientists have shown that those who are overweight are more likely to suffer from premature ejaculation than those that aren’t. So, a balanced diet combined with regular exercise will improve your lovemaking. 22

However, it’s often challenging to meet all our nutritional requirements through food intake alone. Consider supplementation, especially those which are high in zinc and magnesium—minerals which are known to promote sexual performance.23 24

Hypnosis

Both clinical and anecdotal evidence indicates that hypnosis can be an effective treatment for premature ejaculation.

hypnosis imageHowever, these studies also explain that the positive results men experience are lower than those from desensitization and behavioral methods.25

Talking and Pleasing Her in Other Ways

Sex isn’t all about penetrative intercourse—unless you purely want to procreate.

A healthy, fulfilling, and satisfying sex-life involves talking to your partner. Discover what she likes—and importantly, what she doesn’t enjoy.

discussion imageFrank and open discussions relieve anxiety and stress and allow you to take a holistic approach to lovemaking. Incorporate romantic dinners, toys, cosplay, role-play, food, aphrodisiacs, oils—the list is endless.

Once you realize that ejaculation is one tiny part of a greater sexual whole—you’re on the road to the ultimate in orgasmic gratification—for both of you.

Summary

While premature ejaculation is an issue that needs to be addressed—it’s far from an insurmountable problem.

Follow the above advice and discover which methods work best for you. Often, men find that a combination of two or three strategies is the ideal way to finally overcome early climaxing.
happy couple image

More than anything—talk to your partner.

Both understanding and supporting each other’s wants, problems, and concerns is the ideal way to solve premature ejaculation—and, for that matter, any other hurdle you may face together.

This article has been medically reviewed by Dr. Biswadeep Das on August 2019

The information on this website has not been evaluated by the Food & Drug Administration or any other medical body. We do not aim to diagnose, treat, cure or prevent any illness or disease. Information is shared for educational purposes only. You must consult your doctor before acting on any content on this website, especially if you are pregnant, nursing, taking medication, or have a medical condition.

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