What causes premature ejaculation?

All you need to know about early ejaculation and how to delay it


What is premature ejaculation?

Premature ejaculation in clinical terms refers to men getting an orgasm — the discharge of semen — during sexual intercourse earlier than they would like. There is no definition for how early that is, since some men may choose to come thirty or sixty seconds into the intercourse. In fact, for many men the ejaculation timing varies between short and longer durations, depending on how aroused they and their partners are and external circumstances (time of day, location, etc.).  

However, for doctors, premature ejaculation typically means a male orgasm that involuntarily occurs within one minute of intercourse, especially if this happens every time during sex and requires only minimal stimulation. To put things into context: on average sexual intercourse lasts 5 ½ minutes and the upper range is a little over 10 minutes. We are not comparing ourselves against the hour-long tour de force often shown in porn, which is far from reflecting the reality of the average bedroom. 

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Premature ejaculation is a surprisingly common problem, affecting 20-30 percent of men, most of them below the age of 40. It obviously is more common in younger men, but for some men it can be a lifelong condition that lasts well into old age. 


In terms of physical health, there’s nothing wrong with premature ejaculation. From nature’s point of view, fast ejaculation actually is an advantage, since in the animal kingdom it raises the chances of impregnating the female. Prehistoric cavemen probably also didn’t waste much thought on whether they came early or not during sex. Of course, this offers little consolation to modern man, who wants to enjoy the act longer and also give pleasure to his partner. Coming too early can be a very upsetting experience and in some men even lead to lasting psychological issues, such as embarrassment or fear of dating.   


Causes of premature ejaculation

Currently, there’s still no satisfying scientific answer to why some men experience premature ejaculation and others don’t, or why for some it’s only an issue during their 20s, whereas for others it’s a life-long problem. It all may come down to the fact that it’s really not a physical health problem and there’s no impact on procreation, i.e., evolution has no genetic incentive to sort out males who ejaculate early.     


Research has shown that premature ejaculation correlates with low serotonin levels in the body and brain. Serotonin is a neurotransmitter that, among many other functions, delivers information between brain cells. It’s often nicknamed the “happiness hormone” because it appears to be responsible for a positive mood and mental health. People who suffer from depression, anxiety and other mental health problems, show low serotonin levels.


Because low serotonin levels affect both mental health and ejaculation timing, many websites claim that depression can cause premature ejaculation. That’s not correct. The two merely are correlated.


Aside from the serotonin deficit, other triggers that can cause premature ejaculation are intense stress, relationship problems, performance anxiety or a temporary emotional imbalance. But these all are short-term factors, and so is their negative effect on ejaculation.    


How to delay ejaculation?

The one good thing about premature ejaculation is that it’s easily treatable. Across psychological therapy, behavioral therapy and medications, there are numerous treatment options and they often can be combined.


Psychological therapy can help identify underlying mental issues, such as stress or relationship problems, that may be behind the early ejaculation. This therapy can also help you to become more relaxed about the issue and reduce fears prior to sex by boosting your self-confidence. Couple therapy is also possible and can make your partner more sensitive and understanding. In fact, talking with your partner openly about the problem and your associated feelings and concerns, especially when it’s a new partner, is strongly recommended.  


Behavioral therapy also is an option, as it can teach you and your partner several exercises that can delay ejaculation. One popular example is the squeezing method, where your partner arouses your penis, bringing it close to ejaculation, and then squeezes it with a tight grip that weakens the erection. When frequently practiced, this method provides you with a better understanding of your climax and ultimately allows you to control it better with your own will. Talk to a sex therapy expert to learn more about this and other exercises, such as pelvic floor exercises, you can do to control and delay your ejaculation. 


Numbing sprays and creams are available that when applied directly on top of the penis tip half an hour before sex lower the penis’ sensitivity and delay ejaculation. It’s similar to the numbing effect of a condom but much stronger. Lidocaine and prilocaine, both of which are local anesthetics, are the most often prescribed topicals for this purpose. Creams combining the two substances are available on prescription and prilocaine on its own as a spray can be bought as an OTC drug. Bear in mind that these topical medications have to be washed off carefully several minutes before intercourse or otherwise they will cause an unpleasant numbness for your partner. 


Sertraline and other SSRI (selective serotonin reuptake inhibitor) class medications, such as fluoxetine and paroxetine, are the most effective way to improve ejaculation timing. These drugs are antidepressants and one of their more common side effects are reduced libido and orgasm problems. For men who suffer from premature ejaculation this side effect comes in handy. You don’t need to take SSRI daily like a person trying to heal a depression would do, but only when you need it, i.e., before you have sex. 


When taken 4-8 hours prior to sexual activity, sertraline or the other SSRI will delay your orgasm and ejaculation. Research shows that — with minor to moderate variations between the different SSRI — ejaculation on average can be delayed to about 5-6 minutes, which is in line with the “normal” average mentioned at the start of this article.


While SSRI aren’t directly approved for treating premature ejaculation by the U.S. FDA, doctors prescribe them for this purpose and their use is recommended by the American Urological Association. The common choices are sertraline (Zoloft), paroxetine (Paxil), fluoxetine (Prozac) and escitalopram (Lexapro). All of these also are available as generic medication. 


There’s a range of unwanted side effects to SSRI, which can occur even if the drug is only used occasionally rather than daily. These include diarrhea, dizziness, insomnia, and mood swings. Therefore, if you consider using sertraline or another SSRI to improve your ejaculation control, it’s important that you first talk to your doctor and learn more about the risk of side effects. Your doctor may also suggest alternative treatment options you haven’t yet explored.



  1. Waldinger, Marcel D, et al. “A Multinational Population Survey of Intravaginal Ejaculation Latency Time.” The Journal of Sexual Medicine, vol. 2, no. 4, 2005, pp. 492–7,, Accessed 17 Dec. 2019
  2. Vasilenko, Sara A., et al. “Timing of First Sexual Intercourse and Young Adult Health Outcomes.” Journal of Adolescent Health, vol. 59, no. 3, Sept. 2016, pp. 291–297, Accessed 17 Dec 2019.
  3. Lewis, Gemma, et al. “The Clinical Effectiveness of Sertraline in Primary Care and the Role of Depression Severity and Duration (PANDA): A Pragmatic, Double-Blind, Placebo-Controlled Randomised Trial.” The Lancet Psychiatry, vol. 6, no. 11, Nov. 2019, pp. 903–914,, Accessed 17 Dec. 2019.
  4. 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,, Accessed 17 Dec. 2019.

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