Premature Ejaculation: Symptoms, Causes, And Treatments

premature ejaculation

What is Premature Ejaculation?

Premature ejaculation (PE) is a sexual disorder in which the release of semen from the penis occurs before the act of sex is finished. This results in an unsatisfactory sexual experience for the man as well as his partner. The condition is quite common, and its prevalence ranges between 30 and 40 percent of all men.

It is also known as a premature climax, early ejaculation, or rapid ejaculation. By itself, it is not a cause for a serious health scare. The only worrisome thing about it is the psychological distress arising from unfulfilling sexual experiences.

It can often appear in conjunction with erectile dysfunction (ED). This is more likely when psychological distress is the underlying cause of both.

The causes of premature ejaculation are varied and need careful consideration before approaching a treatment method. For detailed knowledge of the symptoms, causes, and treatment of this dysfunction, continue to read this article. But first, let us understand the process of ejaculation.

How Does Ejaculation Occur?

Ejaculation occurs in three phases, stimulation, contraction, and the final release of semen.

Arousal is the first step in the act. It can be a result of verbal or physical sexual advancement. Friction on the head of the penis (glans penis) causes blood flow to increase thereby resulting in an erection.

The second stage occurs when the epididymal walls contract to push the collected sperm into the vas deferens. From there, it travels through the ejaculatory duct to the urethra and finally into the penis. During this journey, several secretions from the prostate gland and the Cowper’s glands (small glands located at the base of the prostate) mix in with the sperm to form semen.

Finally, when a person reaches the state of climax, there are rhythmic contractions at the base of the penis, which result in the ejaculation of semen. Usually, the penis ceases to be erect after this point.

Symptoms of Premature Ejaculation

PE is characterized by an inability to delay ejaculation until the end of the sexual act. All men experience it at some point in their lives. Isolated and infrequent incidents should not trouble you. However, it becomes a cause for concern when it occurs frequently or often enough to cause disruptions in your relationship with your partner.

PE can be lifelong or acquired. Lifelong premature ejaculation is also known as primary premature ejaculation. It is so named because it occurs in all or most sexual encounters that a man has had. Contrarily, acquired PE is said to occur when a man has had normal ejaculation in previous sexual encounters and the PE is recent.

Often, a man might feel that he has PE, but the diagnosis remains inconclusive because the symptoms do not fit the criteria for premature ejaculation. In such cases, there are times when a man can have normal ejaculatory latency, interspersed with episodes of PE. This is termed as a natural variable premature ejaculation.

Causes of Premature Ejaculation

Premature ejaculation most often stems from psychological causes, although certain biological factors may also play a role.

The most common causes of premature ejaculation are:

1. Low Levels of Serotonin

Serotonin (5-hydroxytryptamine or 5-HT) is a neurotransmitter found in your body that carries messages from one nerve cell to another. It has numerous functions in regulating mood, sleep habits, sexual functions, and the clotting of blood, among others.

When serotonin levels fall below normal, a person tends to feel depressed or anxious. This is why serotonin is a key constituent of certain antidepressant medications.

Low levels of serotonin are also associated with shortened time between erection and ejaculation, that is premature ejaculation.

2. Increased Levels of Dopamine

Dopamine is another neurotransmitter that is associated with mood regulation. It has similar functions to serotonin but the pathways through which these functions are carried about are different. Additionally, serotonin has an inhibitory effect on dopamine production.

Studies show that in people with premature ejaculatory problems, there is a decrease in serotonin levels along with an increase in dopamine levels.

3. Psychological Causes

Some psychological causes that can lead to premature ejaculation include:

  • History of sexual abuse
  • Low self-confidence
  • Poor body image
  • Depression
  • Anxiety
  • Worrying about sexual performance (performance anxiety)
  • Feeling of guilt
  • Disharmony in the relationship
  • Stress
  • Sexual repression (repulsion by the idea of having sex)

4. Aging

Although not directly related to PE, aging can sometimes lead to increased instances of premature ejaculation. This can occur due to difficulties around erections, such as erectile dysfunction.

5. Erectile Dysfunction

Men who already have erectile dysfunction may also experience premature ejaculation at the same time. ED is not a cause of premature ejaculation. However, the anxiety of maintaining an erection throughout may cause the person to rush through the sexual act. This can lead to premature ejaculation.

6. Other Causes

Some other factors that can cause premature ejaculation to include:

  • Infection of the urethra
  • Hormonal imbalance
  • Genetic factors
  • Sexual inexperience
  • Problems with the spinal cord

When Should You See A Doctor?

Premature ejaculation is not a major cause of concern, aside from its effects on sexual well-being. Yet, you should seek medical advice if:

  • It occurs often enough to cause disruptions in your relationship
  • It starts to cause damage to your self-image
  • It causes you to avoid sexual encounters

Diagnosis of Premature Ejaculation

To arrive at a diagnosis, your doctor will ask you about your sexual history. Based on the frequency of sexual encounters in which you experienced early ejaculation, he/she will then decide whether you have premature ejaculation or natural variable premature ejaculation.

Treatment of Premature Ejaculation

Treatment of premature ejaculation mostly centers around psychological counseling and behavioral changes. The commonly prescribed treatment regimen for premature ejaculation includes:

1. SSRIs

SSRIs, or selective serotonin reuptake inhibitors, help in delaying ejaculation. These cause serotonin levels in the blood to remain elevated, thus improving the symptoms of premature ejaculation.

Examples of such drugs include sertraline, fluoxetine, and paroxetine.

2. Erectile Dysfunction Medication

If the person also has erectile dysfunction, treating it can lead to an improvement in ejaculatory latency (time between erection and ejaculation).

Some ED medications that are used to cure premature ejaculation are phosphodiesterase-5 inhibitors such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra).

Also read: 5 Common Side Effects of PE Medicines In Men

3. Pelvic Floor Muscle Exercises

Kegel exercises or pelvic floor muscle exercises help treat several sexual dysfunctions including premature ejaculation. They are done by focusing on holding in urine and flatus (gas) and alternating between tightening and relaxing the muscles in the pelvic area. This can be done numerous times throughout the day.

4. Behavioral Therapy

Behavioral therapy for treating PE includes:

4.1. Squeeze Technique

This is done by stopping midway during sexual intercourse, ideally just before the beginning of an orgasm, and squeezing the shaft of the penis. After about twenty seconds or so, the pressure on the shaft is released and the person can resume sexual activity.

4.2. Stop-Start Method

Pausing and resuming sexual activity just before orgasm is another effective way to prolong the act.

4.3. Masturbation

Masturbating before sexual intimacy helps to delay ejaculation because of the refractory period (period of rest during which ejaculation cannot occur).

5. Reducing Sexual Stimulation

Decreasing the intensity of sexual stimulus can also help to delay ejaculation. This can be done by wearing thick condoms or multiple condoms. Some condoms contain numbing agents such as lidocaine, which reduce sensation in the penile skin, thus delaying climax.

Another method is to apply topical numbing creams or sprays (anesthetics) to the penis. A side effect of such usage is that sexual pleasure may be hampered due to the loss or reduction of sensation.

6. Counseling

Psychological counseling is an important part of PE therapy. A trained psychotherapist will help you overcome your sexual inhibitions and other stress-inducing concerns. Also, they can better aid you in understanding what mental condition is leading to episodes of premature ejaculation. Antidepressants might be of additional help in some cases.

For more tips on improving PE, read: 7 Ways To Last Longer In Bed.


Premature ejaculation is not a grave illness. Even so, it can be a major cause of psychological distress in men who suffer from it for a long time. It can also negatively impact a person’s relationship with his partner.

For this reason, it is important to understand the root cause of PE, its symptoms and frequency, which will help diagnose the disorder, and the treatment options available. This article should help you know these details after which you can discuss with a health practitioner about your condition and decide on methods to improve it.


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