Premature Ejaculation: Causes and Cures

By Deepi Brar, M.S., and Chris Woolston, M.S.

How fast is too fast?

You don't need a stopwatch to decide whether you have a problem with premature ejaculation. If you're reaching orgasm before you really want to, that's premature enough. That said, a definition from the International Society For Sexual Medicine notes that men who suffer from premature ejaculation "always or almost always" reach orgasm within about one minute of starting sex. If both you and your partner are happy with your sex life, it doesn't really matter if if takes one minute or 20. But just for the sake of information, the average time from arousal to ejaculation is usually around five to 10 minutes. If you aren't lasting long enough to keep you or your partner satisfied, its time to do something about it.

Does this happen a lot?

Premature ejaculation is a very common problem. According to some estimates, about 30 percent of American men currently have the complaint. Some men may not be aware they have a problem, though, because their partners are reluctant to talk about it. Usually, premature ejaculation (also called involuntary ejaculation) is a temporary condition among young, inexperienced men or people beginning a new relationship.

What causes it?

In most cases, premature ejaculation is caused by one of two things: excitement or anxiety. The first few times a young, inexperienced man has sex with a partner, he may have trouble controlling the way he responds -- it feels involuntary, like being on autopilot. Usually, practice makes perfect. He (and his partner) may also be afraid that what they're doing is wrong, or worried they'll get caught in the act, so the sex is often rushed and unsatisfying. In some cases, the problem doesn't go away over time. Climaxing quickly may begin during youth and then become an unconscious, physically ingrained habit that persists later in life.

If the problem crops up during adult years, it's probably due to anxiety (although the excitement factor can return if, for example, you're having sex after a long break or with a new partner). Any number of things can cause anxiety during sex, including wanting to avoid pregnancy, stress at work or in other areas of your life, and the fear that you may not be pleasing your partner. Premature ejaculation is rarely caused by physical disorders, but possible causes include multiple sclerosis, extreme sensitivity in the penis, injury to the nerves, and other neurological problems.

What can I do if I want to last longer?

In general, try to become more aware of your body and how you respond during sex, from initial excitement, through the "plateau" when you're fully aroused, to the time you reach orgasm. Take deep breaths; this helps interrupt your stress response and forces you to relax. Also, try to be active with your whole body during sex -- using full-body caresses and nongenital touching -- instead of fixating on your penis.

Avoid drugs and alcohol. Although they can slow your response, they'll also keep you from developing the body awareness that will allow you to solve the problem permanently. Thinking about other things -- like football or your latest weekend project -- can be counterproductive too, for the same reason.

You can also try one of these tricks:

• Masturbation. Having sex alone about two to four hours before the big event helps some men have a stronger, longer-lasting erection the second time around.
• The stop-and-start technique. While you're experimenting by yourself or having sex with your partner, take a little break just as you're about to reach your "point of no return" and climax. Try to relax for about 20 or 30 seconds, and then start again.
• The squeeze method. This is like the stop-and-start method, but when you take a break, try squeezing the tip or middle of your penis with your thumb and index finger for several seconds. Stop squeezing, wait about 30 seconds, then continue lovemaking as before. This helps many men delay their orgasms.
• The lower position. Many men find it easier to prolong lovemaking with the woman on top, because you don't have to support your weight and you can relax more. This position can also reduce sensitivity in some men. If you haven't tried it, experiment and see if it helps you.
• Anesthetic creams. Applied to the tip of the penis about 30 minutes before sex, these creams can make the penis less sensitive and delay ejaculation. Be sure to wash the cream off before sex because some studies have shown anesthetic creams may cause loss of erection or vaginal numbness. And remember, it's always a good idea to talk with your doctor first before using any medical product.

Most sex therapists agree that after several weeks of practice, one of these methods can help about 95 percent of men feel more in control and last longer.

What if none of these things helps?

Don't forget that you have other options for pleasing your partner. Most women (about 75 percent) have orgasms through clitoral stimulation. Fingers and toys are perfectly good substitutes in this case, as is oral sex; just ask her what she likes and keep trying until you hit on the right technique.

Since there usually isn't a physical cause for rapid ejaculation, try working on your master sex organ -- your brain. A few sessions with a sex therapist may be enough for you to learn how to deal with your anxieties and relax, often through guided imagery breathing exercises.

Try out various methods; usually one of these suggestions will be the solution. If you don't see any improvement in a few months, you may have a physical problem or a deeper emotional issue to work out. Your doctor or therapist may also recommend antidepressants -- one of their notorious side effects in both sexes is depressed libido and delayed orgasm.

References

Mayo Clinic. Premature ejaculation. 2009. http://www.mayoclinic.com/health/premature-ejaculation/DS00578

American Urological Association. AUA 2008: Definition of premature ejaculation ejaculation by International Society for Sexual Medicine. http://www.auanet.org/content/

Cleveland Clinic. Premature ejaculation. http://my.clevelandclinic.org/disorders/premature_ejaculation/urology_overview.aspx

Last Updated: March 11, 2013

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