Merck Manual

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Premature Ejaculation

By

Irvin H. Hirsch

, MD, Sidney Kimmel Medical College of Thomas Jefferson University

Last full review/revision Jul 2020| Content last modified Jul 2020
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Premature ejaculation is ejaculation that occurs too early, usually before, upon, or shortly after penetration.

  • The cause is most likely to be anxiety, other psychologic factors, or very sensitive penile skin.

  • Behavior modification therapy, including strategies to delay ejaculation, helps most men.

Premature ejaculation often causes distress to couples.

Many experts believe that premature ejaculation almost always results from anxiety or other psychologic causes. Others think that oversensitive penile skin may be a cause. Having intercourse less frequently than desired may worsen the problem by making the man even more sensitive. Premature ejaculation is rarely caused by a disease, although inflammation of the prostate gland, overactivity of the thyroid gland, or a nervous system disorder can cause the condition.

Treatment

  • Behavior modification therapy

Behavior modification therapy can help most men overcome premature ejaculation. A therapist provides reassurance, explains why premature ejaculation occurs, and teaches the man strategies for delaying ejaculation.

Other methods that can help a man delay ejaculation include drug treatment (with a selective serotonin reuptake inhibitor, such as fluoxetine, paroxetine, or sertraline or with a tricyclic antidepressant such as clomipramine). Local treatments, which tend to decrease sensation, such as application of an anesthetic to the penis and use of condoms may help men delay ejaculation. Sometimes a combination of drug treatment and behavior modification therapy may be needed. When premature ejaculation is caused by more serious psychologic problems, psychologic therapy may help.

Learning to delay ejaculation

Two techniques are commonly used to treat premature ejaculation. They also help reduce the anxiety that often aggravates the problem. Each technique trains the man to experience high levels of excitement without ejaculating. Both involve self-stimulation of the penis (while masturbating) or stimulation by a partner until the man feels that he will soon ejaculate. When done with a partner, stimulation is at first by hand and later before or during intercourse.

In the stop-and-start technique, stimulation is stopped. With the squeeze technique, the man or his partner squeezes for 10 to 20 seconds the part of the penis where the head (glans) meets the shaft, preventing ejaculation and decreasing the strength of the erection. In both techniques, stimulation can resume after about 30 seconds. With practice, more than 95% of men learn to delay ejaculation for 5 to 10 minutes or even longer.

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