Premature ejaculation (PE) is one of the most common sexual health condition guys experience. And it’s also one of the most challenging. It causes distress for both partners and, often, it’s ignored until it has taken a toll on a man’s confidence and his relationships.
Because hardly anyone talks about it, a lot of men who experience P.E. assume it’s “just the way they’re built.” They don’t realize this is a medical condition–let alone one that can be treated. Others are aware but too embarrassed to seek help.
It takes courage and confidence to tackle this issue and that is what you are showing by coming to this site. We are here to help you find the solution that’s right for you.
Although no single treatment works for everyone, most men can be treated successfully, no matter what the cause. Whether your P.E. is related to stress, depression, performance anxiety, guilt, relationship problems, low levels of serotonin in the brain, or erectile dysfunction, there will be an answer, even if it isn’t one we can provide with telemedicine.
If things don’t go as planned or if you experience an adverse side effect, don’t give up. Everyone is different, and this will be a process to dial in the exact solution that works best for you. Never hesitate to contact your physician – we are here for you and we’ll help you work through the solutions.
That is our job–to help you find your path to the kind of intimacy you and your partner would like to share.
What is Premature Ejaculation (P.E.)?
One of the problems with the diagnosis and treatment of P.E. is that, until recently, there has not been agreement on what constitutes premature ejaculation. Many men believe they orgasm more quickly than they should only to discover that their time to orgasm is well within the average range. Other men might orgasm in 2 minutes but find it is neither a cause for concern for them nor their partner.
The lack of consistency in understanding who should be treated and how they should be treated led to confusion both among doctors and their patients. In 2009 and again in 2013, the International Society for Sexual Medicine (ISSM) convened a select panel of experts to develop “an evidence-based set of guidelines for patients suffering from lifelong premature ejaculation (PE).” Their goal was “to develop clearly worded, practical, evidence-based recommendations for the diagnosis and treatment of PE for family practice clinicians as well as sexual medicine experts.” To a large extent, they succeeded and a summary of their understanding of PE is stated below.
According to the International Society of Sexual Medicine (ISSM) premature ejaculation is a male sexual dysfunction characterized by the following:
- Ejaculation that always or nearly always occurs prior to or within about 1 minute of vaginal penetration from the first sexual experience—Lifelong Premature Ejaculation (LPE),
OR a clinically significant reduction in latency time (time it takes to reach orgasm after engaging in sex), often to about 3 minutes or less–Acquired Premature Ejaculation (APE);
- The inability to delay ejaculation on all or nearly all vaginal penetrations; and
- Negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intimacy.
All three elements must be included for PE to be diagnosed.
Another definition of PE that has been suggested by the World Health Organization (WHO) is “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.” This second definition is more flexible. It is also inclusive of gay men and their partners, which is a welcome addition to the definition.
What Causes P.E.?
For men with LPE, the cause is unknown but it is believed to be a genetic predisposition. In one family study, 88% of first degree relatives of men with lifelong P.E. (of less than 1 minute) also had P.E. of less than 1 minute. Genetic studies have been scant and conflicting but it is possible that people with certain genetics are more prone to be affected by P.E.
Medical conditions can also sometimes cause P.E. Some factors that have been associated with P.E. include erectile dysfunction, anxiety, depression, hypersensitivity of the glans penis, prostatitis, chronic pelvic pain syndrome, or thyroid disorders. Men with acquired P.E. often have other conditions that contribute to the issue (e.g., erectile dysfunction (ED), chronic prostatitis, and high levels of performance anxiety).
Additionally, data gathered by the National Health and Social Life Survey (NHSLS) indicate that there are health-related and psychosocial predictors of sexual difficulties. In particular, “the risk of P.E. is substantially higher in men who have poor to fair health, have emotional problems, or are under stress. Men who experience a greater than 20% drop in household income are also at increased risk.”
It is interesting that stress, whether from financial misfortune or poor health can lead to acquired P.E.. Erectile dysfunction and PE often occur together and E.D., in particular, can be a sign of an underlying illness wreaking havoc on a man’s sexual function.
Whatever the cause of P.E., the impact on the quality of life of men and their partners is considerable.
What is the Typical Time it Takes to Orgasm?
Time to Ejaculate After Vaginal Penetration
There have been several solid studies over the past 15 years concerning the time it takes for men to ejaculate during sex. The reason this is important is that it helps doctors, men, and women know how to define premature ejaculation.
A study titled, A five-nation survey to assess the distribution of the intravaginal ejaculatory latency time among the general male population, provides some insight.
Using a hidden timer, the researchers measured how long it took for men (from The Netherlands, United Kingdom, Spain, Turkey, and the United States) to orgasm and ejaculate after their penis was inserted into the vagina, called the Intravaginal Ejaculatory Latency Time, or IELT. Foreplay was not timed and no same-sex couples were included. They took note of condom use and circumcision.
The results were fascinating. The average was just about 6 minutes, with men from Turkey having the shortest time (4.4 minutes) and the men in Great Britain having the longest time (the longest IELT) (10 minutes).
Condom use and circumcision were not factors and the men who felt that they didn’t last long enough lasted 5.2 minutes (average).
It seems that usual times of vaginal penetration are not that much longer in average men than for men who suffer from premature ejaculation, which can be defined as lasting as long as 3 minutes.
Time to Orgasm with Masturbation:
In one study, men who experienced premature ejaculation (P.E.) were asked to measure the time it took for them to masturbate both in a medical office and at home. The time it took for them to reach orgasm was compared to men who did not experience P.E. The reported times for men with P.E. was 3.42 minutes and for men without PE 8.84 minutes.
This last estimate is probably the most reasonable approximation. Knowing what is typical can help define what is not typical, what might be considered Premature Ejaculation (P.E.).
There are two types of PE
Men with P.E. generally fall into two groups: those who have it from their first sexual experience and those who develop it later. Men with lifelong P.E. tend to orgasm more quickly than men who acquire it later in life. Also, men with acquired P.E. tend to have psychological issues that are at the source of the problem, though medical issues must always be considered.
The good thing is that many of the interventions work for both groups. One stark difference is that men with lifelong P.E. should be cared for with the understanding that any psychological difficulties they experience more likely resulted from their P.E. and were not the cause. In most cases, advice should be focused on helping them restore their confidence and develop a comfort with sexual interactions. This, along with effective medical treatment, allows men to experience sexual pleasure without the constant dread of disappointing their partners or of having a less than satisfactory personal experience.
Men with the acquired form of P.E. generally are able to last a little longer (up to 3 minutes) but still reach orgasm far more rapidly than they are accustomed. It may be sudden and unexpected but it can be disturbing. Concern may even feed into a “negative feedback loop” so that each sexual event that is marked by premature ejaculation only adds to the concern and anxiety the man feels, which only makes the P.E. worse.
Finding the reason can be helpful but so can breaking the cycle of negative experiences with medical interventions. It is remarkable that the initial cause can be far more easily assessed if the problem it causes is brought under control. However, simply resolving the problem with medication will never match eliminating the reason for taking the medication. That is why, even if medical therapy works perfectly, the search for the source of the condition is vital.
How Common Is P.E.?
The estimates vary greatly. Much of the variance is due to the different definitions of P.E. that have been applied over the years. They can be as flexible as that of the American Urological Association (2004), which stated that P.E. was “Ejaculation that occurs sooner than desired, either before or shortly after penetration, causing distress to either one or both partners,” or as tightly defined as the more recent definitions supplied above by the ISSM and WHO.
According to some studies, “20–30% of the male population are affected by P.E. at any one time, and some experts believe that up to three out of four men experience P.E. sometime during their lives, although many or most may never raise the subject with their physician, suggesting that P.E. is undoubtedly more common than current statistics would suggest.”
In studies, it has been noted that despite the high number of men who have P.E. and the emotional weight it places on them and their partners, “only 12% of the men surveyed with self‐reported PE had consulted a physician.”
What are Some Consequences of P.E.?
Premature ejaculation, like E.D., is a non‐life‐threatening but often psychologically devastating medical condition having serious consequences on quality of life that adversely affects intimate relationships and marital harmony. It can result in isolation, resentment, arguments, and silent suffering. There is a strong relation between P.E. and the incidence of divorce. Often, it is not sexual dissatisfaction that causes a relationship to dissolve but the emotional toll the worry, concern, and diminished self-confidence takes on the couple dealing with PE.
Some couples seek care when they are unable to conceive because the man has an orgasm before he can place the penis in the vagina. This is called anteportal PE. It has been estimated “that between 5% and 20% of men with LPE suffer from anteportal PE.”
How does Roman treat Premature Ejaculation (PE)?
Although no single treatment works for everyone, most men can be treated successfully. There are multiple medications that can be tried, different topical therapies, and varied techniques that can be used alone or in unique combinations. Some people see immediate results. Others will find they need to try a few different methods before finding the right solution. If things don’t go as planned or if you experience an adverse side effect, don’t give up. You have options and we are here to help you find your path to the kind of intimacy you and your partner would like to share.
Sertraline is in a category of medication called SSRIs and is indicated for anxiety and/or depression. It was quickly realized that depressed men on SSRIs like sertraline had a side effect that many of them considered bothersome: it took more time and stimulation to reach ejaculation. The side effect that was so bothersome to depressed men became a much-needed treatment for men who had premature ejaculation. Men who do not have anxiety or depression and use SSRIs to treat P.E. are not using the medications as they were originally intended.
Nevertheless, for many men with P.E. it works and this “off-label” use is recommended by the American Urological Association (AUA) for the treatment of P.E.. Although there are potential side effects with any medication, men without a diagnosis of anxiety or depression don’t typically experience any changes in mood when they take sertraline. For men with excellent erectile function and P.E., sertraline is a perfect choice because it delays ejaculation and does not depend on improving erectile function to do so.
Learn more about sertraline
Sildenafil is primarily thought of as an erectile dysfunction (E.D.) medication, but it can be extremely effective for P.E., as well. What is most interesting is that E.D. often is an underlying cause of P.E. Sometimes, the same stress that causes either one can cause both. However, E.D. itself can begin a cascade of changes that result in P.E.
Men with E.D. often attempt to keep themselves erect with increasing levels of stimulation either with a partner or when masturbating. This intense stimulation can inadvertently result in ejaculation before they would like and can occur even when the penis is not fully erect. When a full erection is supported by a PDE5i like sildenafil, the need to maintain an erection with overly energetic stimulation is no longer necessary and a more well-timed orgasm can follow.
However, men who take one of these medications for E.D. and who do not have P.E. report that they will find it takes longer to orgasm than they might have anticipated so a biological effect of sildenafil may be at work also.
Sildenafil can work especially well when there is some degree of E.D. as well as P.E.
Learn more about sildenafil
Tadalafil is the same medicine as in Cialis and is in the same class of drugs as Sildenafil. It is a PDE5 inhibitor, which means it has been used primarily to treat erectile dysfunction. Two of the great advantages of Tadalafil are that it can be taken in a low dose every day (convenient), or on an “as-needed” basis (and lasts for 36 hours when used that way), and works for both ED and PE (1 medicine, 2 solutions). One of the major downsides for many patients is that tadalafil is much more expensive than sildenafil.
Despite the expense, a daily regimen may be the most convenient way for some men to manage their PE. Taking a pill at the same time every day becomes part of a routine and removes the requirement to prepare differently on the days you anticipate having sexual activity.
Some men with mild PE say they only need a little help. If intermittent use works (even if less well than daily use), it may be enough of an improvement. Also, some men only have sex once or twice a month and they prefer taking a pill only when they know they will be sexually active. This makes sense, as well. Taking 10 mg, or even 20 mg, once every two weeks may be less costly than low dose, daily use of 2.5 mg or 5 mg.
Whatever choice men make and even if it is the perfect solution at the time, circumstances change, so the way the medication is used may change, as well. No one knows their life better than the patient, so the choice is theirs.
Learn more about tadalafil
OTHER TREATMENTS AND TECHNIQUES:
Topical anesthetics can be applied to the penis just before sexual activity. They come as creams, lotions, or sprays and are available over-the-counter. The advantage of topical applications is that the side effect rate is low and they are effective to some degree in almost everyone. Some men like the topical therapies because they feel they give them the sensations they want without becoming too desensitized. Other men find that they feel so little that their enjoyment of sex is affected. It is a very individual response and it can take practice to learn which agent works best.
Some men prefer the creams and lotions, while others swear by the sprays that are available over-the-counter. The creams and lotions can be difficult to control in terms of the area covered and the amount used. They can also spread to the partner. The sprays make it much easier to control the area covered and the amount used. The science behind the use of these agents is well established in the US and international literature.
Men can learn through trial and error when to apply the agent and how much. Through experience, they discover how long it will work and if it fits their lifestyle. The spray decreases (but does not eliminate) sensation and thereby prolongs the time before ejaculation.
The good news is that there is an abundance of topical anesthetics available. The ones most often used with positive results are Promescent Spray and K-Y Duration Spray.
Condoms can help with PE by decreasing penile sensitivity and have the added benefit of reducing the likelihood of transmission of sexually transmitted infection or unwanted pregnancy. Since they are always recommended to prevent transmission of sexually transmitted infections, condoms are usually the first thing men have tried for PE. Using a spray, cream, or lotion with a condom is surprisingly effective for some men. It delays orgasm, gives some men just the right amount of pleasurable sensation, and when used with a topical anesthetic prevents the spread of the anesthetic to a partner.
The squeeze and start-stop techniques are 2 different strategies that can be practiced during masturbation or sexual activity and, over time, can improve control over ejaculation. As an ongoing method of prolonging sex, it has some significant drawbacks. Interrupting sex or focusing on when to squeeze to avoid an orgasm is not a practical way to stay “in the moment” during sex. However, as a training method during masturbation or as a playful exercise with a partner, they can lead to an improved control over orgasming. Also, some men are able to incorporate the techniques comfortably into their sexual repertoire.
Counseling, whether in person, by telephone, or by text messaging, may increase the likelihood of success for some patients. The reality is that men who have had lifelong issues have often suffered silently with a burden that weighs on them every time they consider developing a physical and emotional attachment to another person. They face disappointing the very person they hope to please the most. For many men, it terminates relationships before they begin and can lead to isolation and a loss of companionship. Men with P.E. face increased risks of divorce and relationship stress often more as a result of the emotional consequences of having P.E. than from the P.E. itself.
Men who develop P.E. later in life may have developed it as a result of an underlying condition but often it is related to some relationship or personal stress. Uncovering the reasons the P.E. developed are as important as breaking the cycle with medical interventions.
Also, psychotherapy can be enormously helpful in restoring a man’s sense of value and worth beyond the ability to delay an orgasm, which often restores their capacity to experience sex as they had before P.E. developed.
Any of the above treatments can be combined with any one or more of the other treatments. Although it’s often best to keep things simple, the good news is that combination therapy can help treat men who don’t respond satisfactorily to single mode therapies.