Premature ejaculation (PE) is quite a common male sexual dysfunction, including between 30-70% of men of all ages. Nowadays it is described as a general difficulty or inability to exercise voluntary control over ejaculation or to delay it; this lack of control generates increasing levels of frustration, stress and even fear in males negatively affecting their sexual life and, by extension, generally damages couple relations and partnerships. Apart from control, the other important matters defining premature ejaculation are time, perceived as shorter than that needed to fulfil a complete and joyful intimate relation, and the experience of negative emotions and feelings. Quantifying a satisfying duration for a sexual relationship is complex and multifactorial, and instead, the problem should be considered in terms of mutual satisfaction within the couple. The average duration of male sexual intercourse, evaluated as the intravaginal ejaculatory latency time (IELT or time spent between penetration and ejaculation), varies between 5 and 8 minutes, with high variability in the results of the available studies. But there are couples who report having an absolutely normal sex life with intercourses lasting less than a minute, as well as men who perceive they have a problem even with ejaculation latencies over 5 or even 8 minutes. Thus, it is important to consider not only the time of the sexual intercourse, but also the perception of lack of control, dissatisfaction with the subjective perception of ejaculation latency and discomfort and interpersonal difficulties that result from this ejaculatory disorder. Premature ejaculation is considered primary when present from the first sexual experience in an individual’s life, or secondary if it happens later in life. It is also possible to distinguish between a generalized disorder, where ejaculation is always premature (almost 65% of cases), and a situational disorder that occurs only in certain situations or with a particular partner. The International Society for Sexual Medicine (ISSM) has proposed a definition for lifelong premature ejaculation as: “A male sexual dysfunction characterized by ejaculation which always or nearly always occurs prior to or within about one minute of vaginal penetration, and 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”. Possible causes can be psychological, social, relational or biological. Psychological or emotional problems may include anxiety, depression, dissatisfaction with one's body, concern about erectile difficulties, or relationship problems; whereas biological disorders may include hormonal problems, imbalances in brain neurotransmitters such as dopamine or serotonin or inflammation of the seminal pathways, including prostatitis. Stress and erectile dysfunction are the main risk factors, but some studies suggest that there may also be a genetic component. The negative effects of the disorder can invade practically all aspects of life, from the relationship between partners to psychological well-being and even to fertility in cases where intravaginal ejaculation is not possible (this most severe form of premature ejaculation is also called "ante portam", when ejaculation occurs before the penetration). Given the scale of the problem, the multitude of potential causes and the difficulty of making a correct diagnosis, a doctor should be consulted as soon as one experiences difficulty in ejaculatory control, shortening of average ejaculation time, or if the inability to control duration of intercourse is perceived as a problem by either partner, to receive timely support and, if necessary, referral to the appropriate specialist.

Suggested readings

  • Hatzimouratidis, K., Giuliano, F., Moncada, I., Muneer, A., Salonia, A., Verze, P., EAU Guidelines on Erectile Dysfunction, Premature Ejaculation, Penile Curvature and Priapism, European Association of Urology, 2017, pp. 24-31
  • International Society of Sexual Medicine; Premature Ejaculation: Definition; http://www.issm.info/education-for-all/featured-education/
  • Waldinger, M.D., Quinn, P., Dilleen, M., Mundayat, R., Schweitzer, D.H., Boolell, M., A Multinational Population Survey of Intravaginal Ejaculation Latency Time, J. Sex. Med. 2005.
  • Patel, K., Hellstrom, W.J., Central regulation of ejaculation and the therapeutic role of serotonergic agents in premature ejaculation, Curr. Opin. Investig. Drugs, 2009 Jul;10(7).
  • Edited by: Mulhall, J.P., Hsiao, W., Men's Sexual Health and Fertility - A Clinician's Guide, Springer 2014
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