Premature ejaculation: an informative guide

An informative guide for understanding and managing premature ejaculation

Premature ejaculation can create frustration and uncertainty and affect both self-esteem and sexual interaction with a partner. It is common, but rarely discussed openly. Available treatments work for some people but not for everyone.

This article is for anyone who feels that ejaculation happens too quickly—whether it has always been that way or is a difficulty that comes and goes.

How common is premature ejaculation?

More than 40% of men aged 18 to 74 experience premature ejaculation occasionally. Around 10% report that it happens consistently. It is also common among teenage boys and young men.

What is premature ejaculation?

Premature ejaculation is usually defined as:

• Ejaculation occurring before or shortly after penetration—within about one minute—and
• Happening more often than you want, and
• Causing some form of psychological distress, such as frustration, stress or avoidance of sex.

Why does ejaculation happen too soon?

There is no single cause of premature ejaculation. It usually involves a combination of factors that varies from person to person. Some men have experienced it since becoming sexually active. For others it begins later in life, sometimes in connection with a new relationship, a change in health or increased stress. The cause may be physical, psychological or connected to how the nervous system processes sexual stimulation.

Common contributing factors include:

• High sexual sensitivity or a low threshold for ejaculation, which may be innate.
• A low threshold for the ejaculation reflex in the central nervous system, meaning the body responds quickly to sexual stimulation.
• Low serotonin activity, involving a brain signalling substance linked to delaying ejaculation.
• Psychological factors such as stress, anxiety, performance pressure, relationship worries or low self-esteem.
• Learned behaviour patterns, such as becoming accustomed to masturbating quickly and secretly.
• Underlying conditions such as depression, anxiety or urological difficulties including prostatitis.
• Insecurity or limited communication in the relationship, making it harder to relax and notice the body’s signals.

Different forms of premature ejaculation

Premature ejaculation can be divided into different forms:

Lifelong—premature ejaculation has been present since the person became sexually active. Possible factors include neurological or psychological causes or limited psychosexual skills.

Acquired—premature ejaculation begins after a period of relatively typical function. Possible causes include physical illness, injury, medication side effects, psychological stress or strain in the relationship.

It can also be described as:

Generalised—the difficulty is not limited to a certain type of stimulation, partner or situation, but occurs consistently during sexual activity.

Situational—the difficulty arises in particular situations and may have been less pronounced with certain partners or in other circumstances. Sexual practices, surroundings and physical or emotional states—such as feeling secure compared with feeling stressed or under pressure—can all affect the time to ejaculation. A partner can influence the situation and help create better conditions for delaying ejaculation.

Premature ejaculation can also vary in severity. In severe cases, ejaculation may occur only a few seconds after sexual stimulation begins.

Some people experience spontaneous ejaculation without sexual arousal or stimulation. This often has an underlying medical cause.

What can you try yourself?

Several methods can be tried to manage premature ejaculation.

The start–stop technique

Step 1: Explore your body without trying to stop ejaculation

This method involves practising being aroused while learning to recognise when ejaculation is approaching. Before beginning the start–stop technique itself, it can be helpful to explore your body’s reactions without trying to control anything.

Try the following:

• Masturbate until you ejaculate in a way that feels natural and pleasurable.
• Allow ejaculation to happen while noticing how it feels. The aim is not to stop it but to observe what happens in your body along the way.
• Notice how your body feels as arousal rises. Can you identify a point when you know it will soon be too late to delay ejaculation? For some, this may feel like tingling, a brief sensation or a small contraction. At first the signal can be difficult to identify and may feel vague, becoming noticeable only when you concentrate closely on bodily sensations.

This step helps improve body awareness and understanding of your sexual response. Take your time and practise for several days before moving to the next exercise.

Step 2: Practise stopping before ejaculation

Once you are better able to recognise your signals, you can begin the start–stop technique:

1. Stimulate yourself—or ask a partner to do so—until ejaculation begins to approach.
2. Stop all stimulation shortly before the “point of no return”.
3. Wait until the urge to ejaculate subsides, often for 30–60 seconds.
4. Begin again and repeat the pause before the point of no return approximately three times.
5. On the fourth cycle, allow ejaculation to occur.

Repeat this exercise every third day until you recognise what happens in your body before ejaculation and can pause before the point of no return. Do not rush; give this step the time it needs.

Step 3: Build stamina

Continue as in step 2, now adding warmth and moisture as further stimulation. You can practise in the shower or masturbate using oil or lubricant. Pause before the point of no return.
Move to the next step when you can masturbate for three minutes without ejaculating and with shorter pauses.

Step 4: Learn to control ejaculation

Continue masturbating in the shower or with oil or lubricant. Instead of stopping when ejaculation approaches, try slowing down before the point of no return. As soon as you feel close to ejaculation, reduce the pace. This exercise is about developing a sense of control by slowing down.

You can also try this during intercourse. Choose a position in which you feel you have control and can set the pace.

Tips for success

• Give each step enough time.
• Practise regularly for several months. Skills improve with practice, and regular training can create better conditions for delaying ejaculation. If you stop practising completely and return to previous patterns, the effect may decrease.
• Begin alone before practising with a partner.
• Book an appointment with a sexologist for clear guidance if the training programme does not help.

Other methods

Breathing and relaxation

Relaxation exercises for the pelvic-floor muscles can reduce unnecessary muscle tension and support better control.

Changing position

Some positions provide stronger stimulation. Try positions in which you have more control and can set the pace yourself.

Local anaesthetic

Local anaesthetic products, such as Emla cream containing lidocaine and prilocaine, may be applied to the glans approximately 20–30 minutes before sex. Anaesthetic sprays are also available. Reducing sensation in all or part of the glans may delay ejaculation. It can take time to find an amount that delays ejaculation without reducing sensation too much. Ask a healthcare professional or pharmacist how to use these products safely and avoid transferring the anaesthetic to a partner.

Condoms

Condoms may also reduce sensation in the glans. Thicker condoms often have a greater effect than thin ones. Condoms containing an anaesthetic are also available.

Medication

Certain medicines that affect the serotonin system are used for premature ejaculation. These treatments require an individual medical assessment and prescription.

• SSRIs
Paroxetine has shown good efficacy for premature ejaculation. A low daily dose of approximately 10–40 mg is used in some treatment plans, and full effect may take two to three weeks. Some people instead use 10–20 mg as needed around one to three hours before expected sexual activity. Dosing and suitability must be assessed by a prescriber.

Priligy (dapoxetine) is another medicine used for premature ejaculation. It is taken one to three hours before expected sexual activity, no more than once in 24 hours. A common starting dose is 30 mg; some patients may be prescribed 60 mg. Nausea and dizziness are common side effects.

These SSRI medicines may affect sperm quality. Discuss treatment with a doctor if you and a partner are trying to conceive.

• Anafranil (clomipramine)
This is another medicine that may be used for premature ejaculation. Doses of 30–60 mg may be prescribed as needed four to six hours before expected sexual activity. It must only be used according to a prescriber’s instructions.

Sexological counselling

Many people seek support from a sexologist for premature ejaculation. A sexologist can offer guidance on managing stress, worry and performance anxiety, and help process difficult experiences. They can also support related concerns such as relationship difficulties, fear of sex or worry about dating, as well as offer practical guidance on improving control and exploring different sexual practices.