Premature ejaculation is a common condition that affects many men, often causing frustration, anxiety, and relationship problems. It can be caused by a combination of psychological and biological factors, but the good news is that it's treatable. With a range of behavioural techniques, medical options and lifestyle changes, men can regain control and improve both their sexual health and confidence.
Premature ejaculation is a very common problem. It is estimated that 1 in 3 men will experience this difficulty at some point in their lives. In some cases, it is a specific issue that resolves itself spontaneously, especially if it occurs during the first sexual encounters, but in other cases it becomes a difficulty that prevents maintaining a satisfactory sex life. In this case, it is necessary to seek specialised help. Although many men are ashamed to talk about it, premature ejaculation is an issue that can be resolved.
Early ejaculation affects a significant proportion of the male population worldwide. Studies estimate that between 20% and 30% of men experience premature climax at some point in their lives, regardless of age or ethnicity[1]. According to a multicentre observational study, the average intravaginal ejaculatory latency time (IELT) for men with premature ejaculation is approximately 1.8 minutes, compared to 7.3 minutes for men without the condition[2]. As well as impacting sexual satisfaction, the condition leads to increased personal distress and interpersonal difficulties, with up to 70% of men suffering from the problem reporting high levels of anxiety[3].
The International Society for Sexual Medicine (ISSM) Ad Hoc Committee for the Definition of Premature Ejaculation developed the first evidence‐based definition for lifelong premature ejaculation in 2007[4]. Premature ejaculation is typically defined as climax that occurs earlier than desired during sexual activity, often within a minute of penetration. While occasional premature ejaculation is common for many men, if it is persistent, it may be considered a medical problem.
There are two main types of premature ejaculation:
Rapid ejaculation can vary in severity, but for many men it can lead to frustration, anxiety, avoidance of sexual intimacy and psychogenic erectile dysfunction.
The condition becomes a disorder and you should seek help if:
The main symptom is the inability to control the moment of climax. In this sense, it is difficult to refer to a specific time, since each couple may take more or less to reach sexual satisfaction. But, in general, premature ejaculation occurs when the man takes a little more than a minute to ejaculate after penetration. In fact, in some cases, ejaculation occurs before penetration.
What is more, this inability to control ejaculation does not only occur during intercourse, but in numerous instances also during masturbation. As a result, it is common for a man who suffers from this sexual disorder to be insecure in his relationships with his partner. He may even avoid the sexual encounter because it becomes a source of tension.
Early ejaculation can be a problem that a man has had all his life, since the beginning of his sexual relations, in which case it is called primary premature ejaculation, since control of the ejaculatory reflex has never been achieved.
In other cases, the difficulty occurs at some point in a man's sexual life, in which case it is called secondary premature ejaculation. It is an acquired disorder because the man was able to control his ejaculatory reflex at some point.
Understanding the causes of premature ejaculation can help determine the most appropriate treatment. The causes of premature ejaculation are usually divided into psychological and biological factors.
Often, premature ejaculation is a combination of psychological and biological factors. Other contributing factors include erectile dysfunction, which can cause men to rush intercourse for fear of losing an erection, and excessive use of alcohol or recreational drugs.
The effects of impotence extend beyond the bedroom. Emotionally, men may feel embarrassed, guilty or even a sense of failure. This can affect self-esteem and lead to withdrawal from sexual activity, which can strain romantic relationships.
In partnerships, lack of sexual satisfaction can cause tension. Communication may break down and both partners may feel frustrated or disconnected. If left untreated, the emotional toll of premature ejaculation can lead to more serious mental health problems such as anxiety or depression.
In a study, lack of ejaculatory control led to greater dissatisfaction and emotional distress, including feelings of inadequacy, disappointment, and anxiety[5]. Lack of ejaculatory control led to dissatisfaction with sexual intercourse and increased emotional distress, with far-reaching implications for both men with premature ejaculation and their partners.
Fortunately, premature ejaculation is very treatable. There are several options available, from behavioural techniques to medical treatments, each tailored to the needs of the individual.
Simple lifestyle changes can also play a role in managing premature ejaculation:
However, a strict division between pharmacological and non-pharmacological treatments for premature ejaculation may not be the most effective way to treat patients with this condition. As the impact of early climax on a patient and their partner is multifactorial, exclusive treatment may not meet some needs. In particular, pharmacological treatment alone may not be able to address the significant emotional distress associated with premature ejaculation, interpersonal relationships and unrealistic patient expectations[6].
While treatment can help, coping strategies are also essential for managing the emotional aspects of premature ejaculation. First and foremost, open communication with a partner is key. Being honest about the problem can reduce the shame associated with it and strengthen the relationship.
Relaxation techniques such as mindfulness can help men stay present and reduce anxiety during sexual activity. Practising deep breathing or progressive muscle relaxation before sex can also calm nerves and prolong performance.
Finally, if difficulties persist, it is important to seek professional help. Urologists, sex therapists and psychologists are trained to deal with sensitive issues such as this and can guide men to effective solutions. Many men also find solace in online or face-to-face support groups, where they can share their experiences without judgement.
Premature ejaculation is a common and treatable condition, yet many men suffer in silence due to embarrassment or lack of understanding. By addressing the psychological and biological causes, exploring treatment options and communicating openly, men can regain control of their sexual health. For those struggling with erection disorders as well, remember that help is available and, with the right approach, it is possible to improve both sexual satisfaction and overall well-being.
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