Premature ejaculation

Ejaculation is the peak of male orgasm, when the semen squirts out.

How to know if you have premature ejaculation

In premature ejaculation, the point of no return arrives too soon. In the 1950s, a man was said to be a premature ejaculator if he lasted less than a certain time (say 2 minutes) or a certain number of strokes (say 100) before ejaculating. These arbitrary definitions are rubbish; they were based on ignorance of how long most men actually take to climax. The so-called ‘experts’ were surprised by the following information.

Dr Alfred Kinsey reported that 75% of men ejaculate within 2 minutes of vaginal penetration.
In Shere Hite’s survey of 11 239 men, 21% reported that they ejaculated within 1 minute of penetration, and 62% within 5 minutes.
The Hite survey also showed that there is great variation between men; for example, 7% said they did not ejaculate before 15 minutes.

The best definition of premature ejaculation is climaxing before you or your partner wish you to. This common-sense definition means that climaxing speedily after penetration is not necessarily a problem (for example, if a man pleasures his partner for a long time beforehand until she reaches orgasm).

Some men climax even before they enter their partner. If this is the case, you have the most severe type of premature ejaculation.

Premature ejaculation is common

Many men and their partners wish intercourse could last longer than it does.

In the Hite survey, about 70% of men said ‘yes’ to the question ‘Do you ever orgasm too soon after penetration – in other words, are you unable to continue intercourse for as long as you would like?’
In a survey of 5000 readers of a UK tabloid newspaper, 10.8% responded yes to the question ‘Do you always come too quickly?’ (Update 2005;71(5):39–43)..
A UK study of 5000 men aged 16–44 found that 11.7% had experienced premature ejaculation for at least 1 month in the past year. The problem lasted for more than 6 months in only 2.7%, suggesting that it probably affects many men some of the time (British Medical Journal 2003;327:426–7).

Premature ejaculation is common in young men, but the problem solves itself with time.

Causes of premature ejaculation

Is it a physical problem? It used to be thought that premature ejaculation was the result of a physical problem, such as irritation or inflammation of the urethra (the tube in the penis for urine and semen) or prostate gland, and there were nasty treatments such as squirting silver nitrate into the opening. There is no evidence that premature ejaculation is caused by such conditions. In almost every case, the man is physically normal; very rarely, it can be the result of a neurological condition such as multiple sclerosis.

Is it in the genes? Most men with premature ejaculation have a close relative (father, brother or son) with the same problem, which suggests that genes may be involved in some men. Scientists think that a brain chemical, serotonin, helps to control the speed of ejaculation. A particular gene (known as 5-HTTLPR) appears to be responsible for the amount and activity of serotonin. There are three types of the gene, and men with one of the types tend to ejaculate more quickly than men who have the other types.

Is the penis hypersensitive? There is no evidence that it happens because the penis is hypersensitive. Researchers tested the sensitivity of the skin of the penis in men who considered themselves premature ejaculators and men who were not, and found no difference. It also seems to be a myth that circumcision makes a difference; the American sex researchers Masters and Johnson tested the sensitivity of the glans (head) of the penis in circumcised and non-circumcised men and found them to be the same.

Is it hyperarousal? Premature ejaculation is more likely when the level of sexual excitement and arousal is high. This why it is more likely with a new partner, and why it is common in young men during their first sexual relationships.

Is it just a habit? In some men, the time of ejaculation is simply a habit, starting early when a youth learns to masturbate or have sex as quickly as possible for fear of being caught. It is certainly more common in younger men. Like all habits, it can be unlearnt.

Is it related to erectile dysfunction (‘impotence’)? If you have erectile dysfunction, premature ejaculation may occur.

How to deal with premature ejaculation

It is very important to discuss the problem with your partner. Otherwise, your partner may wonder what is happening, or think it is their fault. The techniques for unlearning premature ejaculation need your partner's help another reason for talking about it.

Common-sense measures for dealing with premature ejaculation

A simple method worth trying is to take a deep breath as you get close to climax. This briefly shuts down the ejaculatory reflex
Have sex more often – you are more likely to ejaculate prematurely after a long gap
For the same reason, masturbating before intercourse may help
Stop for a break during sexual activity. Think about something boring. This will allow your level of arousal to fall temporarily
Use a condom to decrease sensation.
Have sex with the woman on top – men are less aroused in this position than when they are on top (‘missionary position’)
Learn to control your anal muscles. Contract your buttocks around the anus as if you were trying to prevent a bowel movement. Start by doing this ten times in a row, and increase to 50 times twice a day. Some men find either contracting or relaxing these muscles when ejaculation is near helps them to last longer
When your penis is first inside your partner’s vagina, try to make shorter thrusts or a circular motion – this can delay ejaculation and you can then progress to the usual in-and-out technique when you and your partner are ready

‘Unlearning’ premature ejaculation. The main methods are the so-called squeeze technique and stop–go technique. They involve stimulating the penis almost to the point of ejaculation and then stopping. The idea is to train the man to remain in a state of high arousal without actually ejaculating. About 90% of men are ‘cured’ by these techniques for a while, but it usually takes about 14 weeks of practising 3–5 times a week. Unfortunately about 60% of men find that the problem comes back after about a year, and the ‘unlearning’ has to be gone through again. These techniques are not as easy as they sound. They also require a good relationship with your partner, because they need require patience and they interfere with having sex spontaneously.

Squeeze technique

The squeeze technique is best done by the couple, but the man can do it alone by masturbation if there is no partner or she is not willing to participate
The couple start by being as relaxed as they can, and free from distractions
The couple kiss and caress until the man is aroused, and then she takes his penis in her hand and begins stroking it
The man concentrates on his feelings of arousal, to increase his sexual awareness (he does not try to think of other things in an attempt to distract himself from ejaculation)
When he feels he is about to ejaculate, he signals to his partner
She immediately stops stimulating him and applies firm but gentle pressure around the penis where the glans (head) meets the shaft. She applies this pressure for 10–20 seconds
She then lets go, and they wait without doing anything for about 30 seconds
The procedure is repeated several times before ejaculation is allowed to occur

Stop–go technique

The stop–go technique is essentially the same as the squeeze technique, but the squeeze is omitted
As soon as the man is about to ejaculate, he signals to his partner and she stops stroking his penis for about 30–60 seconds
Repeat the ‘stop–go’ steps four or five times before allowing ejaculation to occur. It is simpler than the squeeze technique, and seems to work just as well

The usual problems are that you go too far and ejaculate, or you lose your erection and cannot regain it. If these occur, do not worry – just try again another day. It may take several weeks to master the techniques.

The next step is to do exactly the same, but using a lubricant jelly (such as KY jelly) to increase sensation and more closely resemble the situation of being in the vagina.

When you find that you are beginning to be able to delay ejaculation, you can start to have intercourse with the woman on top. She lowers herself backwards and downwards onto the erect penis and makes gentle coital movements. You signal to her when ejaculation is about to happen. She then remains perfectly still, or lifts herself off and either does nothing or applies the squeeze, before resuming intercourse in the same position.

Reducing sensation. If the glans (head of the penis) becomes less sensitive, ejaculation may be delayed. There are various ways of reducing sensation. The main problem with the local anaesthetic products is that numbness may cause you to lose your erection.

Using a condom is the most obvious method. Choose a thicker condom labelled ultrastrong or superstrong.

Premjact (Stud 100) is a local anaesthetic spray that has been approved by the drug regulatory authorities in the USA and UK. It is available from pharmacies; you do not need a doctor's prescription. You spray it onto the head and shaft of the penis (3–6 sprays) up to 10 minutes before intercourse. It is not totally effective on its own, but is useful if you have successfully retrained with the squeeze or stop–go techniques, but feel that you are in danger of slipping back. A problem is that some of the local anaesthetic may rub off onto the female partner, causing her genital area to lose some feeling temporarily. To prevent this, use a condom after applying the spray. Although it has been used for 25 years, there have been no good scientific studies to determine how effective it really is (Medical Journal of Australia 2008;11:662–6).

Severence Secret is a cream that is available only in Asia. It consists of herbal extracts, and some studies have indicated that it helps to delay ejaculation, but it may cause itrritation and a burning sensation (Medical Journal of Australia 2008;11:662-6).

Drugs

Dapoxetine is a new medication for premature ejaculation. On average, it increases the time before ejaculation by 3–4 times, that is from less than 1 minute to about 3 minutes (Lancet 2006;368:929–37). In the research studies, the men using it and their partners said that sex was more satisfying. It is taken 1–3 hours before sex whenever you need to; it does not have to be taken every day. On average, it increases the time before you ejaculate by about 50%. Some men noticed nausea, diarrhoea, headache or dizziness, especially with the higher strength tablets. Dapoxetine is from the same family as SSRI antidepressants (selective serotonin reuptake inhibitors), but is weaker and shorter-acting, and has been specially tailored for premature ejaculation.

SSRI-type antidepressants, such as sertraline and paroxetine, delay ejaculation as a side effect, and some doctors used to prescribe them for this purpose (although they are not officially licensed for this use). They take several hours to have an effect, and you should take them every day for them to remain effective; your doctor might advise taking a low dose every day, and a ’top-up’ 3-4 hours before intercourse (Medical Journal of Australia 2008;11:662-6). However, dapoxetine now seems a better option.

Clomipramine is an antidepressant drug that has a good effect on premature ejaculation, but it has side-effects such as dry mouth, constipation, nausea, sleep disturbance and dizziness (Medical Journal of Australia 2008;11:662–6).

If you also have erectile dysfunction (impotence). Premature ejaculation may occur if you have an erection problem, so look at the section on erectile dysfunction.

Counselling

In the past it was thought that premature ejaculation was psychological and that counselling was the answer. This may sometimes be the case, and you are likely to know whether there is a stress in your life that is causing the sexual problem. If you have always had premature ejaculation, it is more likely that any psychological problems are the result rather than the cause of premature ejaculation. In this situation, counselling can be useful in helping to improve self-esteem, but will not cure the premature ejaculation.

For more information, Dr Phil Hammond discusses premature ejaculation in his Expert guide

Written by: Dr Margaret Stearn
Edited by: Dr Margaret Stearn
Last updated: Thursday, June 10th 2010

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Comments on this article

Posted by trans on 11/03/2012 at 06:02

i have premature ejaculation less than two minutes, is there any problem with my penis is my penis sensitive if this is the case so tell me if there any surgery for penis, if there is problem in food so suggest me the proper food for increase my orgasim thank u very much

Posted by rajkumar.t on 12/09/2011 at 04:21

this is very very useful site. i tried stop and go method. it is really useful.

Posted by raghu on 24/06/2010 at 11:48

good i have learnt a lot but want to rearn more about penis problems

Posted by testicles on 03/04/2010 at 04:28

I am a boy about 21.I masturbate regularly.and i feel a slight pain in my right testicle.As my right testicle is lower than that of my left..could u tell me what is the problem

Posted by Anonymous on 18/11/2009 at 08:03

I have suffered from premature ejaculation since the age of 18 and the only thing that works with me after trying out numerous methods as mentioned above is Stud 100. I swear by this product and last 10 - 15 minutes with it where before I would last 1 minute.

Posted by Anonymous on 29/10/2009 at 01:44

I used to have sex for over 30 minuites to over an hour. I was very experimental. But recently i had a motorbike accident, and had to have an operation on my testicle... I still have both. But... Now I don't seem to be able to last long anymore, I'm with my new girlfriend and I just feel so embaressed that I have to finish her off with my fingers. I really don't like it, it's really putting me down.

Posted by Junaid on 17/07/2009 at 10:23

My problem is that as and when I penetrate my penis into vagina,I ejaculate, no time is left...a lot of sensitivity on my penis head comes and even my wife hold my penis its quickly vanish. Please help me what I exactly use for that

Posted by adam on 10/07/2009 at 07:34

i have been masturbating over 5 years now and i used to take a lot of time to ejaculate in the begginning but from past three years i cum too early . I dunno wat to do . I want to unlearn the whole thing n go back to my old self . can stopping masturbation help ? I am worried sick .