Premature ejaculation (PE) is a persistent or recurrent ejaculation with minimal stimulation before, on or shortly after penetration and before the person wishes it, over which the sufferer has little or no voluntary control which causes the sufferer and / or his partner bother or distress. Multivariate definition encompasses the main dimensions of PE - ejaculatory latency, control and sexual satisfaction.

Premature ejaculation is a condition that affects men of all ages. PE however, is actually more prevalent, involving up to 31% of men aged 18-59, and is considered to be most common among male sexual disorders. PE is more prevalent in young men and in men who lack sexual experience and frequency.
Men with PE often report emotional and relationship distress, and some avoid pursuing sexual relationships because of PE-related embarrassment. Compared with men, women consider PE less of a problem,but several studies show that the condition also causes female partners distress.

Premature ejaculation can be differentiated between two types.
Primary premature ejaculation refers to lifelong experience of the problem (since puberty), and secondary premature ejaculation reference to the problem beginning later in life. It has also been subdivided into global premature ejaculation, when it occurs with all partners and contexts, and situational premature ejaculation, when it occurs in some situations or with specific partners.

The causes of premature ejaculation are unclear. Many theories have been suggested, including that PE was the result of masturbating quickly during adolescence to avoid being caught by an adult, of performance anxiety, of an unresolved Oedipal conflict, of passive-aggressiveness, and having too little sex; but there is little evidence to support any of these theories.

Several physiological mechanisms have been hypothesized to contribute to causing premature ejaculation including serotonin receptors, a genetic predisposition, elevated penile sensitivity, and nerve conduction atypicalities.

The nucleus paragigantocellularis of the brain has been identified as having involvement in ejaculatory control. Scientists have long suspected a genetic link to certain forms of premature ejaculation. In one study, 91 percent of men who have had premature ejaculation for their entire lives also had a first-relative with lifelong premature ejaculation. Other researchers have noted that men who have premature ejaculation have a faster neurological response in the pelvic muscles.

Anxiety has been reported as a cause of PE by multiple authors and is entrenched in the folklore of sexual medicine as its most likely cause despite scant empirical research evidence to support any causal role. Several authors have suggested that anxiety activates the sympathetic nervous system and reduces the ejaculatory threshold as a result of an earlier emission phase of ejaculation. Several authors have suggested the possibility that high levels of anxiety and excessive and controlling concerns about sexual performance and potential sexual failure might distract a man from monitoring his level of arousal and recognising the prodromal sensations that precede ejaculatory inevitability.

When making a diagnosis, physicians should consider the frequency of PE episodes and the time over which PE has been a problem. This information will help determine whether PE is generalized or situational and whether it is lifelong (‘primary PE’, since inception of sexual activity) or acquired (‘secondary PE’, developed after a period of time without PE). Men with PE, whether lifelong or acquired, generally report low or no sense of control over ejaculation, as well as low satisfaction with sexual intercourse, and increased interpersonal distress/bother compared with men without PE, in addition to shorter average latency time in the majority of sexual intercourse episodes. This suggests that a complete diagnosis for PE should incorporate measures of control, latency time, distress and/or bother resulting from PE and sexual satisfaction.

Several treatments have been tested for treating premature ejaculation. A combination of medication and non-medication treatments is often the most effective method. Behavioral therapy is also used to treat PE.

Associated diseases 

  • Dhat syndrome (a condition found in the cultures of the Indian subcontinent in which male patients report that they suffer from premature ejaculation or impotence, and believe that they are passing semen in their urine)
  • postorgasmic illness syndrome (POIS) (a rare disease affecting men, which causes severe cognitive and physical symptoms immediately following ejaculation)
  • prostate hypertrophy (a increase in the volume of the prostate)
  • prostate hyperplasia (a increase in size of the prostate)
  • erectile dysfunction


  • fertility problems
  • relationship problems

Risk factors

  • prostatitis
  • drug side effect
  • prostate hypertrophy
  • severe depression

A direct impact on fertility is in cases, when man ejaculate before he enters his penis to vagina and sperm will not be able to fertilize an egg. But more often this condition cause depression and reduced libido. This was also associated with onset of smoking. Strained relationships and sexual difficulties appear to be central to male infertility-related stress. However, the degree of desperation experienced may vary between clients depending on their situation: age, number of years married, whether primary or secondary infertility and result of investigations.  

Many men attempt to treat themselves for premature ejaculation by trying to distract themselves, such as by trying to focus their attention away from the sexual stimulation. There is little evidence to indicate that it is effective, however, and it tends to detract from the sexual fulfilment of both partners. Other self-treatments include during the act thrusting more slowly, withdrawing the penis altogether, purposefully ejaculating before sexual intercourse, and using more than one condom. Using more than one condom is not recommended as the friction will often lead to breakage. Some men report these to have been helpful.

  • ejaculation in less than about 2 minutes
  • poor ejaculatory control
  • dissatisfaction as well as distress the patient, the partner or both

Behavioral therapy

Behavioral techniques have been the mainstay of PE management for many years, although evidence of their short-term efficacy is limited. Some men use self-help approaches gained through personal experience, bibliotherapy (books), or online research. These techniques include masturbation just prior to intercourse, the use of multiple condoms to reduce penile sensitivity, or engaging in distraction techniques (mental exercises) during foreplay, intercourse, or both.

Ancient Chinese Fangzhongshu (Sexual Skills and Methods) Therapy

Ancient Chinese fangzhongshu contains many effective and safe therapies for PE. Fangzhongshu is a set of ancient sexual techniques based on Taoist thought. The main concepts of sexual harmony, attention paid to flirting and foreplay before sex, and artistry in sexual behavior are important guiding principles in this approach to treatment.

Topical therapies

Topical therapies for PE act by desensitizing the penis and do not alter the sensation of ejaculation. A topical cream containing local anesthetics lidocaine and prilocaine was effective in prolonging mean Intravaginal ejaculation latency time (IELT) by 6 to 8 minutes, but this must be applied at least 20 minutes (no longer than 45 minutes) prior to sexual contact.


Pharmacological modulation of the ejaculatory threshold using off-label daily or on-demand selective serotonin re-uptake inhibitors is well tolerated and offers patients a high likelihood of achieving improved ejaculatory control within a few days of initiating treatment, consequential improvements in sexual desire and other sexual domains. 

Selective serotonin reuptake inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) are commonly used in treatment of depression and often used to treat PE, based on the observation that delayed ejaculation is a frequent side effect of this drug class. Treatment with an SSRI class drug activates 5-HT2C receptor, elevates the ejaculatory threshold set-point and delays ejaculation. The extent of ejaculatory delay may vary widely in different men according to the dosage and frequency of administration of SSRI and the genetically determined ejaculatory threshold set-point. Cessation of treatment results in re-establishment of the previous set-point within 5 to 7 days in men with lifelong PE.

Surgical therapy

The surgical treatment of PE is controversial due to the lack of academic proof of its efficacy. Surgical treatment is not included in the guidelines of the European Association of Urology on PE. Additionally, the ISSM (International Society for Sexual Medicine) guidelines state that there is a lack of evidence regarding PE surgery, and that it may cause sexual dysfunction and is therefore not recommended. It has also been reported that circumcision was not found to help treat PE.


A team approach involving a psychotherapist and a physician may best help those couples who suffer more distress or who do not respond to initial therapy. The concept of coaching is within the reach of primary care providers who are sensitive and have time, interest and knowledge to offer the patient brief and targeted psychoeducational interventions. These basic sexual counseling sessions, together with drug therapy, should include efforts to gain feedback on efficacy of self-help and behavioral techniques in the context of the couple sexual relations. These efforts should focus on reducing performance anxiety and bolstering the patient's self-esteem and the couple's communication.

If conservative medical treatments fail to achieve a full term pregnancy, the physician may suggest the patient undergo in vitro fertilization (IVF). IVF and ART (Assisted reproduction technology) generally start with stimulating the ovaries to increase egg production. Most fertility medications are agents that stimulate the development of follicles in the ovary. Examples are gonadotropins and gonadotropin releasing hormone. After stimulation, the physician surgically extracts one or more eggs from the ovary, and unites them with sperm in a laboratory setting, with the intent of producing one or more embryos. Fertilization takes place outside the body, and the fertilized egg is reinserted into the woman's reproductive tract, in a procedure called embryo transfer.
Intracytoplasmic sperm injection (ICSI) is beneficial in the case of male factor infertility where sperm counts are very low or failed fertilization occurred with previous IVF attempt(s). The ICSI procedure involves a single sperm carefully injected into the center of an egg using a microneedle. With ICSI, only one sperm per egg is needed. Without ICSI, you need between 50,000 and 100,000. 

Two techniques that enable to some extent the selection of physiologically normal spermatozoa have recently been developed. One of these is termed intracytoplasmic morphology-selected sperm injection (IMSI). Here, spermatozoa are selected for ICSI and analysed digitally prior to the microinjection procedure in order to deselect morphologically abnormal spermatozoa. With this technique, abnormalities not visible in standard ICSI procedures have been observed. IMSI increases the pregnancy rate during ICSI cycles, and some data suggests that the level of pregnancy termination is also decreased. A second technique recently introduced to assisted reproduction is that of sperm selection with hyaluronic acid (HA), e.g. PICSI. In this technique, mature sperm with HA receptors are distinguished from immature and abnormal sperm since these do not express such receptors.

Men who ejaculate no sperm, because of blocked tubes in their testes, or because of a genetic condition that prevents their sperm being released, require some form of surgical sperm retrieval to enable ICSI to take place. Epididymal sperm obtained by microsurgical aspiration (MESA) or percutaneous sperm aspiration (PESA) and testicular sperm obtained by surgical excision (TESE) or percutaneous aspiration (TESA) are used in ICSI treatment. Alternatively, the retrieved sperm can be cryopreserved for use in future sperm injection attempts. If all efforts to extract vital sperm cells fails, then donated ones may be recommended.

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