Premature ejaculation

There is hardly any research on the causes of premature ejaculation. So far, there are only hunches: Some experts believe it’s due to biological factors, such as an oversensitive penis or changes in how the hormones and nerves interact.

Others think the cause is to be found in emotional factors like relationship problems or fear of failure. Biological and psychological factors may both be responsible and could influence each other.

Some men have had trouble with premature ejaculation since they started having sex. Others only develop it later on in life. This can be referred to as “acquired” premature ejaculation.

It is sometimes claimed that very many men are affected by premature ejaculation. This is based solely on how long it takes to ejaculate, though.

But using scientific methods of diagnosis shows that: It has always been a problem for about 3% of all men. It starts later in life for about 4% of all men. That is because these methods take into account how often premature ejaculation occurs and whether the man sees it as a problem.

If you think you may have premature ejaculation, you can see a urologist or a family doctor. They will ask you about how long it takes on average to ejaculate and also about how often it happens too early, how much it bothers you and whether ejaculation can be delayed. Further testing is done if the doctor thinks there's a medical problem.

Premature ejaculation is diagnosed if the following conditions are met:

• The ejaculation almost always occurs unintentionally within one minute of penetration.
• You have been experiencing premature ejaculation for more than six months.
• The premature ejaculations are very distressing.
• No other medical problem is identified as a cause.

It is not considered to premature ejaculation from a medical perspective if the following are true:

• It only happens occasionally.
• You haven't had sex for quite a long time when it happens. Then it's normal to become aroused more quickly at first and reach orgasm faster.
• The time that it takes to achieve ejaculation is in the normal range, but it feels like it’s too short.

Other things that could affect the time until ejaculation will also be investigated during the doctor's appointment. A prostate inflammation, for instance, is a possible risk factor. If the prostate is inflamed, the cause should be treated first. Signs of that include frequent and painful urination.

Premature ejaculation is sometimes related to erection problems – for instance, if a man is hurrying up because he is worrying about losing an erection. Then the erection problem is the main issue, not the premature ejaculation.

Decisions about whether or how to treat premature ejaculation are a very personal matter. There are various treatment options:

• Specific techniques aim to help make it easier to control ejaculation by intentionally delaying it. One way of doing this is to repeatedly stimulate the penis until right before orgasm, and then to stop.
• Medications can somewhat increase the time it takes to have an ejaculation. They include medicine that is swallowed and numbing medications that are applied to the tip of the penis. Both may have side effects.
• Sex therapy treatments aim to give men and couples more confidence and to overcome fears of sexual inadequacy. Another goal is to focus less on ejaculation and to experience sexuality in a more differentiated way. Relationship problems may also be discussed if they play a role.

Treatment with medication typically involves selective serotonin reuptake inhibitors (SSRIs). In Europe, only one drug from this class (dapoxetine) has been approved so far for the treatment of premature ejaculation. It increases the time until ejaculation, but only by 1 to 1.5 minutes on average. Other SSRIs are much less expensive and more effective. Doctors can prescribe them as “off-label” treatment.

In Germany, the costs of medication for treating premature ejaculation aren't covered by statutory health insurers, regardless of whether they have been approved or not. This is because they are legally considered to be “lifestyle” drugs, which insurers don't have to pay for.

Sexuality can greatly affect your self-esteem. But there’s no need to feel intimidated by a few clichés and a lot of big talk: People who have premature ejaculation are no less “manly” than anyone else.

It becomes a problem when it starts to distress you and affect your sex life. Not being able to control the time it takes to reach orgasm is usually very frustrating.

Some men worry about failing to “perform” in bed and not being able to satisfy their partner. But sex and the time it takes to ejaculate don’t have to be the focus of your love life. There are many other ways to experience sexuality, have orgasms and be intimate. Many people find that their overall satisfaction with their love life and relationship is more important than how long the sex lasts.

Shifting the focus away from sexual intercourse can help. Kissing, petting and becoming aroused in other ways can also be satisfying and help to take the focus off the time it takes until ejaculation.

Some men try to ignore the issue rather than discuss it openly, but that tends to make the problems worse. Talking honestly about your feelings and anxieties is probably a better approach in order to manage premature ejaculation together.

When people are ill or need medical advice, they usually go to see their family doctor or pediatrician first. Information about health care in Germany can help you to navigate the German healthcare system and find a suitable doctor. You can use this list of questions to prepare for your appointment.