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Premature Ejaculation

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Written by Jason Chandrapal, MD.
Interprofessional Advanced Clinical Simulation Fellow. Durham, NC
Last updated October 2, 2023

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What is premature ejaculation?

Premature ejaculation (PE) is when ejaculation occurs sooner than you’d like—and can be very upsetting for one or both partners. PE can happen before or shortly after penetration, but it usually occurs less than 1 minute after. It’s a common issue that’s thought to affect 1 in 3 men at some point in their life.

Dr. Rx

Men often feel embarrassed, overwhelmed, powerless, self-conscious. They may start avoiding intercourse. But premature ejaculation happens to every man sometime during their life. You are certainly not alone. —Dr. Jason Chandrapal

There are a few different causes of PE. Sometimes, it’s triggered by a psychological issue, such as anxiety, depression, or poor body image. But it can also be caused by a medical problem, such as erectile dysfunction or hyperthyroidism.

It’s normal to experience PE from time to time, but you should see your doctor if it’s a common occurrence. Once you figure out the cause, your doctor may recommend treatments like counseling, behavioral changes, and prescription medications.

Common causes of premature ejaculation

1. Erectile dysfunction

Erectile dysfunction (ED), or impotence, sometimes occurs with premature ejaculation. ED is when you cannot get or maintain an erection. If you have ED, you may be so anxious about trying to have an erection that it causes you to ejaculate prematurely.

Your doctor will diagnose ED based on your symptoms. If you have ED and PE, you’ll be treated for ED first. This can sometimes improve PE. If not, PE will also be treated.

Pro Tip

PE will get better. But there is no magic bullet treatment. All treatments take time to work and will require you to actively participate in your care. It’s also important to seek honest input and feedback from your sexual partner. —Dr. Chandrapal

2. Hyperthyroidism

Hyperthyroidism, or an overactive thyroid, is when your thyroid gland makes too much thyroid hormone. This sends many of your body’s processes into overdrive. People who have hyperthyroidism may experience anxiety, which can lead to PE.

The most common cause of hyperthyroidism is Grave’s disease, an autoimmune disease in which your immune system attacks your thyroid. It’s diagnosed with a blood test. Treatment includes either medication or surgery. Once it’s treated, the anxiety should subside.

3. Psychological issues

Psychological causes of PE affect the signals sent between the brain and the penis. It could be from anxiety, sexual abuse, poor body image, relationship issues, stress, or depression. Anxiety is the most common psychological cause of PE. To complicate matters, living with PE can also cause anxiety, creating a vicious cycle.

Treatments may include counseling, open communication with your partner, and improving your diet and exercise habits. Medications, including antidepressants, may be necessary.

Pro Tip

If you are prescribed a medication for PE, ask what the side effects are. —Dr. Chandrapal

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Naturally lasting longer in bed—tips to try first

Strengthening the pelvic floor muscles

The pelvic floor muscles support your pelvic organs and help control urination and bowel movements. Pelvic floor exercises, such as Kegel exercises, can strengthen these muscles to help you delay ejaculation.

To find these muscles, try to stop urinating midstream. The muscles that allow you to do this are the pelvic floor muscles. Practice tightening and relaxing them for a few seconds a couple of times a day.

Condom use

Wearing a condom during sex can decrease sensation and help stop you from ejaculating prematurely. Try thicker condoms, which reduce sensation more than thin ones.

Behavioral techniques

There are several techniques you can perform during sex to prevent PE:

  • Pause-squeeze technique: Before ejaculating, you or your partner squeeze the tip of your penis for several seconds until the urge to ejaculate passes.
  • Start-stop technique: Before ejaculating, temporarily stop penile stimulation, then restart it when the urge to ejaculate subsides.
  • Sensate focus technique: This gradually raises sexual arousal. It starts with non-sexual touching, progresses to sexual touching, and ends with penetration. Following these steps can help you avoid a sudden rush of sexual arousal that may trigger PE.
  • Mental distraction: Focusing on non-erotic thoughts during sex can help you avoid PE by lowering arousal.

The science behind premature ejaculation medicines

While there are no medications FDA-approved for PE, some prescription medications can treat it. These include ED medications, topical ointments and sprays that decrease penile sensation, and antidepressants.

Sildenafil and other phosphodiesterase inhibitors

Sildenafil, tadalafil, and other phosphodiesterase inhibitors are taken to treat ED by increasing blood flow to the penis. They are usually recommended first for men who have both ED and PE. Your doctor may recommend taking it every day or a few hours before you have sex.

Do not take these if your heart isn’t healthy enough for having sex or you take nitrates.

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  • Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are antidepressants that are often the first medication to try if you’ve ruled out other causes of PE and behavioral therapy has not worked. They increase the amount of serotonin (a neurotransmitter) in your brain. (Serotonin appears to play a role in inhibiting ejaculation.) While there are many SSRIs, paroxetine (Paxil) may be the most effective, according to a study in the International Journal of Impotence Research.

It usually takes 5 to 10 days for SSRIs to start working, but in some men, it may take 2 to 3 weeks. You shouldn’t take SSRIs if you’re taking medications that increase serotonin levels, such as MAOIs or linezolid.

  • Clomipramine

Clomipramine is a tricyclic antidepressant that your doctor may recommend if SSRIs don’t work or you can’t tolerate their side effects. The medication enhances the effects of the serotonin and another neurotransmitter called norepinephrine.

Don’t take clomipramine if you have an allergy to other tricyclic antidepressants, you’re taking other drugs that increase serotonin (such as MAOIs or linezolid), or you are recovering from a heart attack.

Topical anaesthetics

These creams and ointments numb the skin of the penis and decrease sensation. They include ingredients like lidocaine and prilocaine.

Other treatments


Oral tramadol is used primarily to treat pain, but it may also be helpful in treating PE because it can increase the activity of serotonin. It’s sometimes used if other treatments are not effective.

Tramadol should be used with caution because it can be addictive and may cause serious side effects, such as difficulty breathing.

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Interprofessional Advanced Clinical Simulation Fellow. Durham, NC
Dr. Chandrapal is the current Interprofessional Advanced Clinical Simulation Fellow at the VA medical center in Durham, NC. Prior to his current position he was a urology resident at Duke University. Originally from Houston, TX he went to undergrad at the University of Texas in Austin, followed by a masters degree from the University of Texas Health Science Center in San Antonio, and medical schoo...
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