Premature ejaculation: what it is, why it happens and what helps

Premature ejaculation means ejaculating sooner than you or your partner would like during sex. It is one of the most common sexual concerns men have, and one of the least talked about. The good news is that it is well understood, and most men who look for help find something that works for them.

What counts as premature ejaculation?

Almost every man finishes sooner than he wanted now and then, especially with a new partner, after a long break or when he is tired or anxious. Occasional episodes like these are normal and are not a cause for concern.

Doctors start to talk about premature ejaculation when it happens most of the time, the man feels he cannot delay it, and it causes him or his partner distress. Medical societies use different time guides: the International Society for Sexual Medicine describes ejaculation that always or almost always happens within about a minute of penetration, while the Urology Care Foundation mentions "usually less than 2 to 3 minutes". The clock matters less than how often it happens and how much it bothers you.

In the United States, about 1 in 3 men aged 18 to 59 report problems with it, according to the Urology Care Foundation.

Lifelong or acquired

Doctors often ask when the problem started, because the answer points to different causes.

• Lifelong premature ejaculation has been there since a man's first sexual experiences.
• Acquired premature ejaculation starts later, after a time when it was not a problem.

Why it happens

The exact cause is not known, and for many men several things play a part.

Psychological and relationship factors are the most common:

• anxiety about sexual performance, which often feeds itself: worrying about finishing too soon makes it more likely;
• stress, depression or low self-confidence;
• problems or tension in the relationship;
• habits learned early on, for example rushing.

Physical factors can also be involved:

• difficulty getting or keeping an erection, which can lead a man to rush;
• an overactive or underactive thyroid;
• inflammation or infection of the prostate or urethra;
• the balance of serotonin, a chemical messenger in the brain that affects how quickly ejaculation happens.

What helps

Treatment is aimed at the cause, and different approaches can be combined.

Talking about it

Communicating your concerns with your partner can go a long way, and the NHS recommends involving your partner as much as possible. Anxiety shrinks when it no longer has to be hidden. Our guide to talking to your partner about finishing too soon has practical ideas for starting that conversation.

Techniques you can practise

• The stop-start technique: stimulation stops just before the point of no return and starts again once the urge has passed.
• The squeeze technique: similar, but when stimulation stops, the head of the penis is squeezed firmly for 10 to 20 seconds, and you wait about 30 seconds before starting again.

Both take regular practice, ideally with your partner, and they do not work for everyone. A thicker condom, which reduces sensation, also helps some men.

Delay sprays and creams

Sprays and creams containing a local anaesthetic, such as lidocaine or prilocaine, reduce the sensitivity of the head of the penis. They need care to use well; our guide to delay sprays and creams explains how they work and what to watch for.

Treatment from a doctor

A doctor can prescribe medicines that delay ejaculation, such as certain antidepressants (SSRIs) taken daily or a few hours before sex. If a man also has difficulty getting or keeping an erection, doctors usually treat that first, because premature ejaculation may stop being a problem once it is treated.

Counselling

Psychosexual counselling or sex therapy helps with anxiety and relationship issues, and teaches techniques to "unlearn" the habit. Partners can take part, and couples often find it easier to work on together.

When to see a doctor

See a doctor if finishing too soon:

• happens most of the time, or has gone on for weeks or months;
• worries you, causes stress or gets in the way of your relationship;
• started suddenly after years without a problem;
• comes with difficulty getting or keeping an erection, pain, or a burning feeling when you pass urine.

A doctor will usually talk through what has been happening and may examine you. Tests are only needed if something is found. You are not alone, and this is a conversation doctors are used to having.