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What Is Premature Ejaculation?

What Is Premature Ejaculation?
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Updated on April 1, 2025
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Premature ejaculation (PE) is when a man reaches climax (ejaculates semen during orgasm) sooner than wanted during sex.


If you or your partner are experiencing premature ejaculation, there are several medications and lifestyle changes that can help.

Types of Premature Ejaculation

Some research suggests that ejaculation that occurs less than one minute into intercourse is premature, while other research says less than four minutes.

Premature ejaculation can be lifelong or acquired. Lifelong PE occurs if a man climaxes earlier than wanted, starting with the first time he has intercourse, while acquired PE develops over time.

Causes and Risk Factors for Premature Ejaculation

There are several possible reasons for early sexual climax, and they may overlap. Reasons include:


Low Serotonin Levels

Serotonin, a brain chemical known as a neurotransmitter, plays a significant role in premature ejaculation. Low levels in the brain increase the chances of premature ejaculation.

Psychological Issues

Emotional and mental strain can take its toll on sexual activity.

Stress can inhibit the ability to relax and focus during sex. If a man feels pressure to maintain a long-lasting erection, this could cause an early orgasm in some cases.

"Guys with erectile dysfunction are worried about losing their erection, so they may try to ejaculate quicker," says Justin Dubin, MD, a urologist and men's health specialist with Memorial Healthcare System in Aventura, Florida.

Feeling nervous with a new partner can also set off premature ejaculation.

Anxiety, depression, and lack of confidence may also disrupt normal ejaculation. A man with deep-rooted psychological issues — such as sexual repression — might feel a lack of control tied to bottled-up sexual thoughts and feelings.

Age

While premature ejaculation is most often reported in men ages 18 to 30, older men can also experience this disorder.

For some older men, low testosterone can lead to erections that may not be as firm as they used to be. This can make it difficult to differentiate a premature ejaculation issue from erectile dysfunction.

Other Factors

Additional factors contributing to premature ejaculation may include:

  • Hormonal imbalance
  • Hyperthyroidism
  • Inflammation or infection of the prostate or urethra
  • Neuropathy, such as multiple sclerosis
  • Substance abuse, including alcohol and drugs

How Is Premature Ejaculation Diagnosed?

While many men may recognize that they have premature ejaculation without a doctor's consultation, a healthcare provider can help determine the possible cause and recommend possible treatments.

During diagnosis, a doctor will ask you about your sex life and health history. They may perform a physical exam, concentrating on the genitals and looking for any abnormalities in the penis, testicles, or surrounding areas. They may also consider any other physical, mental, or emotional issues that could be contributing to premature ejaculation.

In some cases, a doctor will refer you to a mental health provider or a urologist, a specialist who treats the urinary tract and the reproductive system.

For some men, getting help for a sexual challenge can be difficult.

Some men may feel embarrassed, says Dr. Dubin, but he notes that premature ejaculation is only a problem if it interferes with your life.

"The issue has to cause distress for you or your partner," he says. "Some people come in and say, 'Listen, I last a minute and 30 seconds. I feel good, and my wife's happy.' If no one's complaining, I'm not going to treat that."

Knowing you're not the only one with PE may help.

"One key that I start with in my practice to reduce the stigma about PE is to discuss the prevalence," says Michael Eisenberg, MD, professor of urology at Stanford Medicine. "Knowledge of the disorder and how common this is can help."

Premature ejaculation is the most frequently experienced type of sexual dysfunction worldwide and may affect as many as 1 in 3 adult men.

Treatment and Medication Options for Premature Ejaculation

Over-the-counter and prescription medications are available for premature ejaculation. Always discuss any treatment with a doctor before starting it.

Erectile Dysfunction Medications

For people who have PE related to their erectile dysfunction, doctors may prescribe erectile dysfunction meds, such as:

  • sildenafil (Viagra)
  • tadalafil (Cialis)
  • vardenafil (Levitra)
  • dapoxetine (Priligy)
  • avanafil (Stendra)
If erectile dysfunction is not an issue, these medications could still be prescribed to address PE when other treatments have failed.

Anesthetic Numbing Agents

Topical anesthetics such as lidocaine and prilocaine in the form of a cream, a gel, or a spray are moderately effective in delaying ejaculation by diminishing sensitivity in the head of the penis, or glans.

Antidepressant Medications

Antidepressants called selective serotonin reuptake inhibitors (SSRIs) may be prescribed even if a patient is not depressed.

"A lot of these medicines have a side effect of causing delayed ejaculation," says Kian Asanad, MD, urologist with Keck Medicine of USC in Los Angeles and director of the USC Fertility and Men's Sexual Health Center.

SSRIs include:

  • paroxetine (Paxil, Pexeva, Brisdelle)
  • escitalopram (Lexapro)
  • citalopram (Celexa)
  • sertraline (Zoloft)
  • fluoxetine (Prozac)
Research suggests that paroxetine is the most effective for premature ejaculation.

Opioids

The pain reliever tramadol (Ultram, Conzip, Qdolo) has been shown to be effective against PE when used sporadically. The drug is in a class of medications called opiate (narcotic) analgesics and can be habit-forming with prolonged use.

Lifestyle Changes for Premature Ejaculation

Men with PE issues may improve their condition by changing their exercise habits and diet and by exploring techniques that can directly address the problem.

Exercise

Exercise benefits almost all aspects of health, including sex and ejaculation. Research consistently shows that men who work out regularly are less likely to experience premature ejaculation compared with those who are sedentary.

Some scientists say that as regular exercise boosts the metabolism, it also improves the nervous system involved in ejaculatory control. In addition, physical activity enhances cardiovascular health, which may improve blood flow to the penis and decrease the likelihood of early climaxes.

Regular exercise also helps with weight loss, and excess belly fat has been linked to imbalances in testosterone and estrogen levels, which can affect male sexual performance.

Pelvic and Behavioral Therapy

  • Pelvic Floor Exercises Research suggests that exercises to strengthen pelvic floor muscles, or Kegel exercises, may extend time until ejaculation.

  • The “Pause-Squeeze” Technique With this, your partner repeatedly squeezes your penis during sex until the urge to ejaculate passes.

  • The “Stop and Start” Method This requires repeatedly stimulating the penis to the point of orgasm but then stopping.

Other Methods

A few other possible approaches for delaying orgasm during sex include:

  • Masturbating an hour or two before intercourse
  • Wearing a condom to reduce sensitivity of the penis
  • Focusing your mind on nonsexual distractions

Stress Reduction

Practicing relaxation techniques such as deep breathing, mindfulness, or yoga can also help to manage anxiety and to exert more control over ejaculation.

Intimacy-Building

Premature ejaculation can cause partners to feel less connected or hurt. Talking about the issue openly can help you and your partner explore the problem together and find a solution. This can also reduce stress, which tends to make PE worse.

"You might be surprised to find that most partners are accepting and open to learning how to get past it together," says Raevti Bole, MD, a urologist at Cleveland Clinic in Ohio. "In addition to your PE treatment, experts may recommend focusing on your partner and learning other ways to enhance intimacy together."

Mental Health Treatment for Premature Ejaculation

Your healthcare provider can help you understand if a mental health professional can help address psychological, emotional, or relationship problems that may be related to your PE.

Psychological causes of premature ejaculation can include early sexual experiences, sexual abuse, poor body image, depression, worrying about PE, and guilty feelings that cause you to rush through sex.

General anxiety and relationship problems can also cause PE. Mental health treatment may be an option.

Therapy

A therapist can work with you to identify problems in your sex life or personal relationship that may be influencing ejaculation, such as performance anxiety, depression, and stress.

There are several types of psychotherapy that might work for you:

Related Conditions

In addition to erectile dysfunction, other physical health issues may be connected with premature ejaculation, including:

  • Chronic Pelvic Pain Aching in the pelvis area directly affects the nerves and muscles involved in sexual function, leading to issues with ejaculatory control.

  • Thyroid Disorders An imbalance in thyroid hormones may contribute to sexual dysfunction and early orgasm.

  • Substance-Use Disorders Drug use may be linked to low testosterone levels, erectile dysfunction, and changes in mood that can trigger PE.

The Takeaway

  • Premature ejaculation affects 1 in 3 adult men, according to research.
  • Medical treatments can help delay orgasm, but men may first want to explore at-home techniques and lifestyle changes that could be just as effective.
  • Although premature ejaculation may be considered a physical problem, it can be related to psychological and emotional issues that counseling or therapy can help resolve.

Common Questions & Answers

What causes premature ejaculation?
Premature ejaculation has many possible causes, including anxiety, psychological problems, and physical conditions such as thyroid disorders or pelvic pain.
Yes, it is possible to treat premature ejaculation with lifestyle changes, such as getting regular exercise, and physical techniques, such as Kegel exercises. Topical medications may help, and certain antidepressants are sometimes prescribed "off-label" to treat premature ejaculation.
No, the two issues are different but can be related. Premature ejaculation is when a man ejaculates too quickly during sex. Erectile dysfunction is when a man has difficulty achieving or maintaining an erection.

Resources We Trust

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
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  2. Mayo Clinic staff. Premature Ejaculation. Mayo Clinic. July 14, 2022.
  3. What Is Premature Ejaculation? Urology Care Foundation. June 2023.
  4. Gul M et al. Current and emerging treatment options for premature ejaculation. Nat Rev Urol. August 25, 2022.
  5. Coskuner ER et al. Premature Ejaculation and Endocrine Disorders: A Literature Review. The World Journal of Men's Health. March 22, 2021.
  6. Premature ejaculation. Mayo Clinic. July 14, 2022.
  7. Premature Ejaculation. Cleveland Clinic. September 27, 2023.
  8. Sathianathen N et al. Selective serotonin re‐uptake inhibitors for premature ejaculation in adult men. Cochrane Database. March 21, 2021.
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  10. How Can Anxiety Influence Premature Ejaculation? International Society for Sexual Medicine.
  11. Premature Ejaculation Symptoms and Causes. Mayo Clinic. July 2022.
  12. How Might Substance Abuse Impact Male Sexual Function? International Society of Sexual Medicine.
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