Premature Ejaculation (PE): Causes, Exercises and Treatment

"Finishing too fast" is something many men keep to themselves. Some worry so much that they avoid sex altogether. I want to tell you that premature ejaculation is the most common sexual problem in men. It is nothing strange, and it can improve if you understand how it works and train in the right way.

What is premature ejaculation?

According to the International Society for Sexual Medicine (ISSM), premature ejaculation has three elements:

1. Time: ejaculating sooner than you want
2. Control: being unable to control or delay ejaculation on nearly every occasion
3. Impact: it causes distress or frustration, or makes you avoid intimacy

There are two types:

• Lifelong PE: present since you first started having sex, usually ejaculating within about 1 minute of penetration
• Acquired PE: things used to be normal, then the time clearly shortened, usually to about 3 minutes or less

An older clinic article said "ejaculating within 3 minutes is premature ejaculation", which isn't entirely right. The 3-minute figure applies to acquired PE, and the diagnosis also requires lack of control and distress. A study by Waldinger (2005) found that the median time from penetration to ejaculation in ordinary men is only about 5–6 minutes, not as long as in the movies.

Lifelong

Lifelong PE

• Present since first sexual experiences
• Usually within about 1 minute of penetration
• Biological and genetic factors involved

Acquired

Acquired PE

• Was normal, then time clearly shortened
• Usually about 3 minutes or less
• Look for causes, e.g. ED, prostate, thyroid

vs

PE requires timing, lack of control and distress together.

Common causes

• Excitement and anxiety, especially with a new partner, or fear of losing the erection
• Nervous system sensitivity and serotonin: in lifelong PE, biological and genetic factors play a part
• A habit of rushing, for example always masturbating to finish quickly
• Erectile dysfunction (ED): fear of going soft leads to rushing to finish
• Prostatitis or an overactive thyroid in some men
• Stress and relationship issues

On hormones, the older article said that a testosterone imbalance makes you finish fast. Current evidence does not clearly show testosterone is a main cause; low testosterone is more often linked to lower desire or delayed ejaculation. A doctor will check hormones when other symptoms suggest a problem.

The PE and ED cycle

Many men ejaculate quickly and lose confidence. Next time they worry more; worrying makes erections weaker; fearing they'll go soft, they rush, and then ejaculate quickly again, round and round like a snake eating its own tail. If you have both problems, the EAU guidelines recommend treating the ED first or at the same time. Read more in Erectile dysfunction (ED).

1. 1
   Early ejaculationConfidence drops
2. 2
   Worry next timePredicting it will happen again
3. 3
   Weaker erectionAnxiety suppresses erections
4. 4
   Rush before softeningHurrying leads to early ejaculation again

If both problems exist, EAU guidance advises treating ED first or at the same time.

Training techniques (behavioural therapy)

1. Stop–start

During masturbation or sex with a partner, when you feel close to the point of ejaculating, stop the stimulation and rest until the sensation fades, then start again. Repeat 3–4 times before allowing yourself to ejaculate.

2. Squeeze

When you are close to ejaculating, gently squeeze just below the head of the penis for about 10–20 seconds until the urge to ejaculate fades, then carry on.

3. Learn your own arousal levels

Try rating your arousal from 0 to 10 and practise staying at around 6–7 without going over to 9. Practising mindful, slow masturbation, without porn and without rushing, helps you recognise your body's signals better. Read Sex toys and safe masturbation.

4. Breathing and pelvic floor exercises

Breathe slowly from your belly during sex and practise pelvic floor squeezes regularly. Research shows they help with control. See the details in Stress, relaxation and erections.

5. Change the goal of sex

Sex isn't only penetration. Spend more time on foreplay, value whole-body touch and caring for each other afterwards. If a second round doesn't happen, that's fine; there are many ways for a couple to enjoy each other. Talking openly takes a lot of pressure off. Read Sensate Focus.

These techniques need consistent practice over several weeks, and work better when done together with a partner.

Medical treatment (as assessed and prescribed by a doctor)

Condoms with a numbing agent inside are another option you can use yourself, and they protect against infections at the same time. Read about the dedicated medicine in Dapoxetine (Priligy): how to use it safely.

When to see a doctor

• Premature ejaculation causes you distress or affects your relationship
• Things used to be normal and have changed, especially with burning or difficulty when urinating, pelvic pain, or palpitations and weight loss
• You also have erection problems
• You have practised on your own for a while and it still hasn't improved

At Dr. Kris Clinic we assess premature ejaculation from both the physical and psychological sides, teach training techniques, provide sexology counselling for individuals and couples, and consider medicine safely when appropriate. There's no judgement here. You can consult in person in Surat Thani or online, and consultations in English are available.