Premature Ejaculation (PE) is a condition in which a man orgasms and ejaculates too soon, sometimes without penetration.
“Too soon” is a relative term – most men would like to last longer! The average length of time before ejaculation during vaginal intercourse is 5.4 minutes1. The International Society for Sexual Medicine officially defines premature ejaculation as consistently ejaculate within one minute of vaginal penetration.
There are a number of causes of PE, including diseases that affect the nervous system (such as diabetes or Parkinson’s disease), thyroid problems, or prostate disease.
It is most often caused by psychological factors. Studies have shown that men who anxiety disorders have an increased risk of Premature Ejaculation.
Treatments for Premature Ejaculation
Counseling or Coaching
Counseling sessions with a qualified sex coach or therapist can help a man identify the triggers that cause a premature ejaculation, and gradual “defuse” the power of these triggers.
Another common treatment approach is training. Men perform a variety of exercises that help them to learn how to identify, modulate and control their arousal level. They may also perform Kegel exercises to strengthen pelvic floor muscles; evidence has shown that this can alleviate PE.
While some men get help from a sex coach or a therapist, others rely on self-help exercise programs.
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Desensitizing agents, also called delay agents, can reduce the physical sensations that trigger ejaculation, and help men achieve better control. Delay agents are available as creams, sprays, and even desensitizing condoms.
The FDA has approved two different active ingredients for use as desensitizing agents: benzocaine and lidocaine; both are local anesthetics. Clinical studies have shown both ingredients to be effective in controlling premature ejaculation. Note that lidocaine breaks down latex, so it should not be used with latex condoms!
One problem with delay agents is that when they come in contact with your partner, they can also decrease their sexual stimulation. In order to avoid this, a product called Promescent contains an agent that increases the absorption through the skin. When used as directed, it is not transferred to the man’s partner. A clinical study2 found that Promescent “appears to be effective in increasing the time to ejaculation and the overall quality of the sexual experience in men with subjective premature ejaculation.”
There are a number of drugs that have been shown to be effective in treating premature ejaculation. However, none of these drugs has been approved by the FDA for treating PE.
A urologist may prescribe a drug for “off-label” use… that is, they may prescribe a drug that is approved for another purpose, but is known to help with PE.
The most promising drugs for treating PE are specific antidepressant families, namely the Tricyclic Antidepressant (TCAs) and the Selective Serotonin Re-uptake Inhibitors (SSRIs).
The most effective SSRI for treating premature ejaculation is Paroxetine; it has been found the increase the time to ejaculation more than eightfold. However, it is also the most likely to cause erectile dysfunction3.
- Waldinger, M D; Quinn, P; Dilleen, M; Mundayat, R; Schweitzer, D H; Boolell, M. “A multinational population survey of intravaginal ejaculation latency time.” Journal of Sexual Medicine. July 2005; 2(4):492-7. <https://www.jsm.jsexmed.org/article/S1743-6095(15)31189-9/fulltext>
- Mark, K P; Kerner, I. “Event-level impact of Promescent on quality of sexual experience in men with subjective premature ejaculation.” International Journal of Impotence Research, August 2016; volume 28, pages 216–220 (2016)
- Jing, Elizabeth; Straw-Wilson, Kristyn. “Sexual dysfunction in selective serotonin reuptake inhibitors (SSRIs) and potential solutions: A narrative literature review.” Mental Health Clinician. July 2016; 6(4): 191–196