What causes premature ejaculation and how can I prevent it?

A complete guide to premature ejaculation

What is premature ejaculation?

If you have difficulties with holding your orgasm or involuntary ejaculate within one minute of vaginal intercourse, this, from a scientific point of view, qualifies as premature ejaculation (PE). Some 30% of men have to deal with this issue at least for a certain period of their life, while for others it can be a life-long problem. Now, we say “problem”, but in fact, in medical terms, there’s nothing unhealthy about coming too early. Neither does it keep you from producing healthy offspring. It’s really only a problem in psychological terms. You and/or your partner would like to enjoy sexual intercourse for a little. Many men with PE are disappointed in their sexual performance, which may prevent them from dating or cause anxiety. Today’s easy access to porn and generally inflated expectations of male virility worsen the problem.

So, even men who typically ejaculate after three or five minutes of sexual intercourse may wrongly think they suffer from PE. That’s not the case. The clinical definition is 60 seconds. Moreover, there are a lot of misconceptions about how long the average intercourse actually lasts. Studies have found it’s around five minutes on average. Ten minutes already is considered to be unusually long and surveys show that intercourse longer than ten minutes for most couples ceases to be enjoyable.   

What causes premature ejaculation?

Science so far hasn’t delivered a convincing answer to why PE is so common. One attempt at explaining PE, looks at the correlation with low brain serotonin levels. Serotonin — often dubbed the happiness hormone —manages a lot of functions in your body, one of which is to regulate the brain’s neural messaging. High serotonin levels correlate with a good mood and emotional happiness. It thus doesn’t surprise that people with depression and anxiety tend to have low serotonin levels. Statistically, people with PE have lower brain serotonin levels. But how this precisely is connected with each other hasn’t been clarified yet. The one thing that’s clear is that raising your body’s serotonin levels can successfully delay your orgasm. 

Another approach to explaining PE is that perhaps nature never intended for many to last longer than a minute or so during sex. After all, as long as semen is dispatched into the vagina your reproductive mission is fulfilled.   

Other things that can cause PE are chronic mental stress (at work or home) and performance anxiety. The latter in particular is an issue for younger men who are new to sex. They most likely have seen porn before having real sex for the first time and now have a very inflated idea of what performance they need to deliver to impress their girlfriends. Of course, the younger we are, the easier it’s to be aroused and ejaculate. This reality doesn’t match expectations and can lead to disappointment. For some men, this can turn into a downward spiral. They get PE precisely because they are afraid of getting PE. This sort of problem typically is temporary and goes away with age and greater sexual experience. But in a few hard cases, this can turn into a life-long condition.      

How to prevent premature ejaculation?

There are several effective ways to overcome PE and enjoy longer sex. We’ll start with the medical options and then look at what therapy and supplements can do for you. 

Premature ejaculation pills

Interestingly, even though PE is a common issue, there isn’t any designated medication for it yet. The most effective medical treatment known to-date and common prescription choice for PE are SSRI antidepressants. In fact, the American Urological Association has recommended SSRI for PE treatment. These come as orally taken pills.  

SSRI means “selective serotonin reuptake inhibitor” and, without getting into the biochemical details, what they do is to raise brain serotonin levels. This is what helps people with depression and one side effect of it is to lower sexual appetite and penile sensitivity. SSRIs thus delay ejaculation, by up to 5-6 minutes on average, which is close to the aforementioned average duration of sexual intercourse.  

Don’t worry, you wouldn’t need to take the SSRI meds every day, like people with depression and anxiety disorder do. For PE, the drug is taken ad-hoc on a need basis, i.e., several hours before you have sex. Depending on which SSRI drug your doctor prescribed, you’ll take one pill 4 to 8 hours before you plan on having sex. Different SSRI medications have varying effects, with some being stronger than others. The most common choices of doctors are sertraline (Zoloft), fluoxetine (Prozac) and paroxetine (Paxil). All are also sold as generic versions and there are other SSRIs as well. 

Based on your needs and medical history your doctor will decide which SSRI drug will be the best option for you and educate you about the potential side effects. Typical side effects may include diarrhea, dizziness, unstable moods, and insomnia. It’s very important that you know what side effects to look out for and that you carefully monitor how you respond to the first few times of using the medication.

Premature ejaculation creams

Aside from SSRI pills, another option for tackling PE are numbing creams (they also come as sprays and gels) that reduce your penis’ sensitivity and thereby delay ejaculation. Lidocaine and prilocaine are the most well-known options here and they often are sold in combination creams and require a prescription. Their original purpose is topical anesthesia; the use for treating PE was only discovered later.  

You apply the cream on the top of your penis about five to ten minutes before sex (so, it allows for more time flexibility than the SSRI pills) and let it stay there for a couple of minutes. Then you need to clean the cream away, otherwise, you risk numbing your partner’s vagina or anus — something you definitely want to avoid. So, rinse or wipe your penis properly, and then you are ready for sex. 

Premature ejaculation exercises & therapy

It doesn’t always have to be medication. You can first try improving your condition through PE exercises or therapy. There are special exercises that teach men how to better manage and extend ejaculation. Talk to a sexual behavior therapist to learn more about the various exercises, but one well-known and tried exercise is the “squeezing method.” It’s fairly easy but it requires some teamwork with your partner. To start with, let your partner arouse you and stimulate your penis just until you are a few seconds short of orgasming. On an agreed-upon sign your partner then kills off the approaching orgasm by firmly squeezing the penis for a few seconds. Repeat the process once or twice and practice this exercise frequently. With time you’ll learn to manage your orgasm better and eventually can delay it. 

Another useful exercise focuses on the pelvic muscles. The stronger these muscles are, the easier it’s to control ejaculation. Tighten your anal muscles just like when you want to kill a fart and stop peeing in midstream. Keep the muscle contracted for several seconds, then loosen up and contract again. It takes some time to strengthen your pelvic muscles, but the great thing about this exercise is that you can do it virtually anywhere — nobody will notice. 

For other exercise ideas, seek help from a specialized therapist. Psychiatrists also can over help. They can teach you to open up on the PE, make it easier to talk about it with your spouse or partner and reduce related anxieties. This can make men more relaxed and improve their confidence. There even is partner therapy, which can help your partner to better appreciate your situation.
 
One more exercise deserves special mention, although it doesn’t address the root cause of PE. Simply masturbate before having sex. Chances are high you already discovered this method. It’s quite effective in wearing down your sexual appetite and penile sensitivity.
 

References:

Cooper, Katy, et al. “Complementary and Alternative Medicine for Management of Premature Ejaculation: A Systematic Review.” Sexual Medicine, vol. 5, no. 1, Mar. 2017, pp. e1–e18, www.sciencedirect.com/science/article/pii/S2050116116300721, 10.1016/j.esxm.2016.08.002. Accessed 14 Mar. 2020.

Althof, Stanley E., and Chris G. McMahon. “Contemporary Management of Disorders of Male Orgasm and Ejaculation.” Urology, vol. 93, July 2016, pp. 9–21, www.sciencedirect.com/science/article/pii/S0090429516001898, 10.1016/j.urology.2016.02.018. Accessed 14 Mar. 2020.

Pastore, Antonio L., et al. “Pelvic Floor Muscle Rehabilitation for Patients with Lifelong Premature Ejaculation: A Novel Therapeutic Approach.” Therapeutic Advances in Urology, vol. 6, no. 3, 20 Feb. 2014, pp. 83–88, www.ncbi.nlm.nih.gov/pmc/articles/PMC4003840/, 10.1177/1756287214523329. Accessed 14 Mar. 2020.

Sridharan, Kannan, et al. “Pharmacological Interventions for Premature Ejaculation: A Mixed-Treatment Comparison Network Meta-Analysis of Randomized Clinical Trials.” International Journal of Impotence Research, vol. 30, no. 5, 2018, pp. 215–223, www.ncbi.nlm.nih.gov/pubmed/29921893, 10.10

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