Premature Ejaculation
What is Premature Ejaculation?Ejaculation is the expulsion of semen from the body. Premature ejaculation (PE) is when ejaculation happens sooner than a man or his partner would like during sex. Occasional PE is also known as rapid ejaculation, premature climax or early ejaculation. PE might not be a cause for worry, but it can be frustrating if it makes sex less enjoyable and impacts relationships. If it happens often and causes problems, your health care provider can help.
In the U.S., about 1 in 3 men 18 to 59 years old have problems with PE. The problem is often thought to be psychological, but biology may also play a role.
How Does Ejaculation Work?Ejaculation is controlled by the central nervous system. When men are sexually stimulated, signals are sent to your spinal cord and brain. When men reach a certain level of excitement, signals are then sent from your brain to your reproductive organs. This causes semen to be ejected through the penis (ejaculation).
Ejaculation has 2 phases: emission and expulsion.
Phase 1: Emission
Emission is when sperm moves from the testicles to the prostate and mixes with seminal fluid to make semen. The vasa deferentia are tubes that help move the sperm from the testicles through the prostate to the base of the penis. (When you are talking about just 1 of these tubes, it is called a vas deferens).
Phase 2: Expulsion
Expulsion is when the muscles at the base of the penis contract. This forces semen out of the penis. Mostly, ejaculation and orgasm (climax) happen at the same time. Some men climax without ejaculating. In most cases, erections go away after this step.
Premature Ejaculation and Erectile Dysfunction (ED)
Sometimes PE is a problem for men who have erection problems (erectile dysfunction or ED). This is when men are not able to get or keep an erection that's firm enough for sex. Since an erection goes away after ejaculation, it can be tough to know if the problem is PE or ED. ED should be treated first. Premature ejaculation may not be a problem once the ED is treated.
Causes
Serotonin
Though the exact cause of PE is not known, serotonin may play a role. Serotonin is a natural substance in your body made by nerves. High amounts of serotonin in the brain increase the time to ejaculation. Low amounts can shorten the time to ejaculation, and lead to PE.
Psychological Issues
- Psychological, or mental health, issues can be involved in PE and may include:
- depression
- stress
- guilt
- unrealistic expectations about sexual performance
- history of sexual repression
- lack of confidence
- relationship problems
- Taking care of emotional problems often helps.
- Other Issues
- PE and Age
PE can happen at any age. Aging is not a direct cause of PE, though aging does cause changes in erections and ejaculation. For older men, erections may not be as firm or as large. Erections may not last as long before ejaculation occurs. The feeling that ejaculation is about to happen may be shorter. These changes can lead to an older man ejaculating earlier.
PE and Your Partner
With PE, you may feel you lose some of the closeness shared with a sexual partner. You might feel angry, ashamed or upset, and turn away from your partner. Premature ejaculation may not only affect you, it may also affects your partner. PE can cause partners to feel less connected or feel hurt.
Talking about the problem is an important step. Couples counseling or sex therapy can be helpful. Exercises, such as the squeeze technique, may be helpful for you and your partner to prolong an erection (see the treatment section of this article for details). Most importantly, a couple should learn ways to relax. Worry (such as performance anxiety) can make PE worse.
Diagnosis
It is typical for men to be able to have at least some control of if and when they ejaculate during partnered sex and masturbation. If a man does not feel that he has control of when ejaculation occurs, and if there is worry by the man or his sexual partner(s), PE may be present.
When PE gets in the way of your sexual pleasure, you should see your health care provider. The diagnosis is determined by whether ejaculation occurs early, late, or not at all. Most often, your health care provider will diagnose PE after a physical exam and talking with you. Some questions he or she may ask are:
- How often does PE happen?
- How long have you had this problem?
- Does this happen with just one partner, or all partners?
- Does PE happen with each attempt at sex?
- What type of sexual activity (i.e., foreplay, masturbation, intercourse, use of visual cues, etc.) do you take part in and how often?
- How has PE changed your sexual activity?
- How are your personal relationships?
- Is there anything that makes PE worse or better (i.e., drugs, alcohol, etc.)?
- Lab testing is only needed if your health care provider finds something during your physical exam.
Treatment
Psychological therapy, behavioral therapy and drugs are the main treatments for PE. You can talk with your health care provider to decide the best choice for you. More than one type of treatment may be used at the same time.