The clinical definition of premature ejaculation is a pattern of ejaculation occurring during sexual activity within 1 minute after vaginal or anal penetration, or before the individual wishes it to occur. For reference: studies place the average time of sexual intercourse across the population at slightly above five minutes. The upper range of “normal” intercourse is 10-12 minutes. Forget about the 30+ minute intercourse you may see in porn; that’s just not the norm.
Up to 30 percent of men experience early ejaculation against their will, at least for a period of time. However, for many, it can be a life-long issue.
So far, there’s no fully satisfying explanation for why so many men can’t help orgasming early. Premature ejaculation appears to correlate with low levels of serotonin in the brain. Some 95 percent of serotonin resides in your gut, where it plays an important role for your digestion, but the remaining 5 percent functions as a neurotransmitter, carrying information back and forth between brain cells.
Brain serotonin levels can affect your mood and emotional wellbeing. Generally, the higher your serotonin levels, the happier and more balanced you are. By the same token, people with clinical depression and anxiety disorders, often have very low serotonin levels. How and why low serotonin levels make it more difficult for you to control and delay ejaculation is a subject of ongoing research.
Besides serotonin levels, chronic stress and anxiety can also cause or worsen premature ejaculation. If you are anxious about your ability to perform, for example, this can lead to additional stress and worsen your lack of control.
You should be aware, that from a medical standpoint, there is nothing wrong with premature ejaculation. In reality, it can put a lot of psychological pressure on men who want to enjoy sex longer, and better pleasure their partners. But, it will not impact your physical health, nor does it lower your chances of getting a woman pregnant. Premature ejaculation thus isn’t an illness or deficiency, and may in fact be a common, natural occurence
There are several things you can do to bring your ejaculation successfully under control and enjoy longer intercourse with your partner. Here’s an overview of the most common tools and medications:
There aren’t any pills or medications that are specifically designed and approved for treating premature ejaculation in the U.S.. However, antidepressants of the SSRI class are often prescribed by doctors as a treatment, and many studies have shown them to be very effective at delaying ejaculation. In fact, the American Urological Association recommends their use to treat premature ejaculation.
SSRI stands for “selective serotonin reuptake inhibitor”. By inhibiting reuptake of seratonin in the brain, SSRIs increase the amount of seratonin that's avalilable. Elevated serotonin levels can then treat depression, anxiety and other psychiatric disorders. One common side effect of SSRIs is reduced sexual appetite and sensitivity, and because of this side effect, SSRIs are ieffective in the treatment of premature ejaculation. Studies show that SSRIs can delay ejaculation by 5-6 minutes on average, which would bring the duration of intercourse into the “normal” range.
SSRIs are more effective when taken daily, but can also be takn as needed with good effect. Serotonin levels take some time to build up, which means the medication, when taken as needed, is typically taken 4-8 hours before sex. Different SSRIs have different effects and some are stronger than others. Popular choices are sertraline (Zoloft), paroxetine (Paxil), fluoxetine (Prozac) and escitalopram (Lexapro). All of them are available in generic form.
Discuss with your doctor whether you should take sertraline or another SSRI, or first try alternative treatments. Your doctor can also inform you about the side effects of SSRIs, which can include dizziness, insomnia, diarrhea, and mood swings. It’s important to be aware of these side effects before taking an SSRI.
Before you consider an SSRI, it’s worth exploring other options. One option is a cream or sprays that, when applied to the tip of your penis, has a numbing effect. This reduces penile sensitivity, which then helps to delay ejaculation. Wearing a condom has a similar effect but not with the same level of intensity. Lidocaine and prilocaine are the most often used medications for this purpose. Just like with an SSRI, treating premature ejaculation isn’t the intended purpose of lidocaine or prilocaine, which are in fact topical anesthetics.
Creams that combine the two medications are a popular choice which requires a prescription. Prilocaine as a stand-alone substance is available over the counter.
Ask a doctor for instructions on how to use either cream or spray. They are normally applied 5-10 min before sexual intercourse and then carefully washed off after a few minutes. If not properly cleaned off, they may numb your partner’s genitals.
There are several exercises that can teach you how to better control or postpone ejaculation. A behavioral therapy expert specializing in sexual behavior, can help you learn more about different exercises. One often-applied exercise is the so-called “squeeze method.” First, your partner stimulates your penis until you are just about to orgasm. Your partner then squeezes your penis for several seconds, which will weaken your erection and the urge to ejaculate. Timing this right requires some practice, but after a while, this method will let help you better determine when you may climax, and you’ll eventually learn how to delay orgasm yourself.
You can also train your pelvic muscles to become stronger, which will allow for better ejaculation control. Exercises you can do include tightening your anal muscles as if you want to avoid passing gas and stopping peeing midstream. Try to hold the muscle in the contracted position for several seconds each time. When practiced several times a day over the course of several months, these exercises can strengthen pelvic muscles. Talk to a therapist to learn more about this and other exercises.
Masturbating a few hours or shortly before you have sex also is an effective method to delay ejaculation.
Being open with yourself and your partner about your premature ejaculation and the concerns and worries it may cause you is important. A good psychologist can help with that. Therapy can make you more relaxed and improve your self-confidence. In some cases your partner even can join the therapy, which will make them more understanding of your issue.
There’s a huge market of natural remedies and supplements that promise to delay ejaculation, ranging from Ayurvedic to Chinese herbs. This also includes the use of acupuncture for premature ejaculation. There’s some preliminary evidence that a few herbs may indeed have a delaying effect on ejaculation, but more research is needed.
Acupuncture has not shown to be benefiicial for this issue.
Seek advice from an expert on alternative medicine before you start taking natural supplements for premature ejaculation. A serious problem is that side effects of medical herbs areoften poorly studied or unknown altogether. Since these are natural products, there can be dangerous impurities depending on where and how a supplement was obtained or produced, such as coontamination with heavy metals or pesticides.