An Introduction to Premature Ejaculation and Tips to manage it

By Dr. Gaurav Garg (Uro) in Urology

Sep 18 , 2023 | 5 min read


Premature ejaculation is a prevalent condition characterised by the persistent and uncontrollable release of semen shortly after sexual arousal and penetration, often before the individual desires. It can lead to frustration, anxiety and hinder a satisfying sexual experience for both partners. Additionally, it can impact the confidence and intimacy of individuals and couples. The blog aims to shed light on what PE is, its underlying causes, treatment options, and how partners can offer meaningful support. Whether you're someone experiencing PE or looking to better understand, this comprehensive guide will provide valuable insights.

What are Some Causes of Premature Ejaculation?

The causes of PE can be both psychological and physiological. Psychological factors such as poor body image, performance anxiety, sexual abuse, depression, relationship issues, and stress can contribute. Physiological factors may include genetics, abnormal hormone levels, and hypersensitivity of the penis. Several conditions can also impact premature ejaculation directly or indirectly, exacerbating or contributing to its development. These include:

  • Erectile dysfunction: ED and PE often coexist. When an individual experiences difficulty achieving or maintaining an erection, they may rush through sexual activities to avoid losing their erection, leading to premature ejaculation. Conversely, the anxiety associated with PE can contribute to ED.
  • Chronic prostatitis: Chronic prostatitis is the inflammation of the prostate gland. It can cause discomfort and pain, leading to heightened sensitivity and muscle tension in the pelvic region, potentially contributing to premature ejaculation.
  • Thyroid disorders: Thyroid dysfunction, especially hyperthyroidism (overactive thyroid), can influence the body's hormonal balance. Hormonal imbalances might impact the control over ejaculation and lead to PE.
  • Neurological conditions: Neurological disorders like multiple sclerosis, spinal cord injuries, and neuropathy can interfere with nerve signals that control ejaculation. The disruption of these signals can contribute to the inability to delay ejaculation.
  • Anxiety, stress and depression: General anxiety, performance anxiety, and high levels of stress can heighten arousal levels and lead to premature ejaculation. Psychological factors play a significant role in PE, and anxiety exacerbates the issue. Depression can affect sexual desire and arousal. Individuals experiencing depression may have a diminished capacity to control their ejaculatory response, leading to PE.
  • Relationship issues: Turmoil within a relationship, a lack of emotional connection, or communication problems can create stress and anxiety during sexual encounters, contributing to premature ejaculation.
  • Substance abuse: Using substances like alcohol, recreational drugs, and certain medications may impact neurotransmitter activity in the brain, potentially affecting ejaculatory control.

The relationship between different conditions and premature ejaculation can vary among individuals. Treating the underlying condition, whether through medical intervention, therapy, or lifestyle changes, can sometimes lead to improvements in premature ejaculation.

Symptoms of Premature Ejaculation

The most common symptom of PE is the inability to delay ejaculation, leading to unsatisfactory sexual experiences. This can cause emotional distress, affect self-esteem, and create challenges within relationships. It is important to note premature ejaculation can occur in all sexual situations, including masturbation (or solo play). When the following are consistently experienced, it might be a sign of a more significant issue:

  1. Rapid ejaculation: The primary symptom of PE is ejaculating sooner than desired during sexual activity. This can happen shortly after penetration or even before it, leading to feelings of frustration and dissatisfaction for both partners.
  2. Lack of control: Individuals with PE often struggle to control their ejaculatory response. Despite efforts to delay ejaculation, it can occur without intentional control and lead to difficulties in prolonging sexual encounters.
  3. Negative self-image: People with PE may develop a negative self-image related to their sexual performance. This can extend beyond the bedroom and affect their confidence in other aspects of life.
  4. Performance anxiety: The fear of ejaculating prematurely can lead to performance anxiety, perpetuating the cycle of early ejaculation. The anxiety itself can contribute to the occurrence of PE.
  5. Loss of sexual intimacy: Frequent PE can lead to a loss of the emotional and physical intimacy that comes with prolonged sexual encounters. This may strain emotional connections within relationships.
  6. Distress and frustration: Persistent PE can cause distress and frustration, creating a negative cycle where anxiety about PE exacerbates the condition. This emotional burden can impact overall well-being.

When to See a Specialist?

If PE constantly disrupts your sexual experiences and negatively impacts your emotional well-being or relationship, consulting a healthcare professional like a general physician, urologist, or sex therapist can be extremely beneficial since they can help identify the root causes and provide tailored solutions.

Now that we know what PE is about, let's discuss some long-term approaches and tips to improve performance.

Approaches to Manage Premature Ejaculation

Some steps can be taken to manage PE. These include:

  • Behavioural techniques: Behavioural techniques aim to gradually build control over ejaculation through practice and self-awareness. Techniques like the "start-stop" method and the "squeeze" technique can help improve ejaculatory control over time.
  • Kegel exercises: Kegels are for everyone with pelvic floor muscles. Kegel exercises involve contracting and relaxing the pelvic floor muscles. These muscles are integral for the functioning and control of the bladder, bowel and the muscles that play a role in controlling ejaculation. Strengthening these pelvic floor muscles through Kegel exercises can enhance control and delay ejaculation.
  • Counselling and therapy: Sex therapy can address psychological factors contributing to PE, such as performance anxiety or relationship issues. Anxiety, depression and stress that contribute to PE can also benefit from counselling and therapy. Therapists work with individuals and couples to identify triggers, manage performance anxiety, improve communication, and develop coping strategies.
  • Medications: In some cases, doctors might prescribe selective serotonin reuptake inhibitors (SSRIs) to help delay ejaculation. 
  • Lifestyle changes: Lifestyle changes can indirectly impact PE. Reducing stress, adopting a healthy diet, exercising regularly, and getting enough sleep are important for overall well-being and improving ejaculatory control.
  • Patience and consistency: Managing PE is a gradual process. Consistent practice of techniques, exercises, and therapies is key to long-term improvements. Celebrate even small victories along the way.

Supporting Someone Experiencing Premature Ejaculation

Partners can and should offer support by maintaining open communication, showing understanding, and participating in any recommended exercises or techniques. Mutual patience and a focus on emotional connection can alleviate feelings of pressure.

Tips for Prolonging Sexual Intimacy

Some tips for prolonging sexual intimacy are:

  • Focus on foreplay: Engage in extended foreplay to enhance arousal and delay ejaculation.
  • Experiment with positions: Certain positions can help reduce sensitivity and prolong the experience.
  • Distraction techniques: Mentally divert your attention from the imminent climax to prolong the session.
  • Controlled breathing: Deep, controlled breathing can help reduce anxiety and delay ejaculation.

Understanding the causes of premature ejaculation, seeking professional help when needed, and adopting various techniques can pave the way to improved ejaculatory control and enhanced sexual well-being. Partners play a crucial role in providing understanding and support, fostering a sense of togetherness on the journey toward a satisfying and fulfilling sexual connection.