Dr. Aimee Paik is an experienced dermatologist who is passionate about men’s health and the ability to improve one's quality of life. She completed her dermatology residency at University of California Irvine, where she was elected Chief Resident and received the Resident Teaching Award, and has been in practice for 10 years.
Dr. Daniel Lanzer is a well known Australian Dermatologist and Cosmetic Surgeon who features prominently on TV and in the media. He has pioneered many new developments in Dermatology and Cosmetic Surgery over the last 30 years.
Jacqui is an experienced health writer with an academic background in pharmacology and marketing. Jacqui aims to make complex science accessible to consumers and to help people become empowered owners of their health.
Welcome to your essential guide for premature ejaculation. We want to acknowledge – early on in the piece – that if you’re more like 30-Second Man than 10-Minute Man, you’re far from alone. In fact, premature ejaculation is the most common sexual problem to affect men1, it’s just that blokes don’t talk about it much because… well… it’s embarrassing.
But it’s time push through the taboo surrounding it and open up the conversation.
If you want to last longer in bed, and help kill the shame and embarrassment that goes with premature ejaculation, it’s time to understand it better and learn what the most effective treatment options are.
So, let’s get started.
In this chapter we define premature ejaculation, so you can determine if it’s really something you need to be concerned about.
We also provide some useful background information and stats and look at the psychological impacts.
Back in the day, hundreds of years ago, ejaculating quickly wasn’t considered a problem. In fact, it used to be something men would strive for.
The male who blew his load fast during sex would be considered the superior one because he could impregnate a female faster, which allowed him to have sex with more females and father more children.
That meant he would win the ‘sperm wars’ and earn his place as head of his tribe.
If you think about it, cavemen weren’t exactly retreating to a cosy bedroom to have sex. They were doing the deed outdoors where animal predators could easily have had them for lunch. So, risk and anxiety made the male want to ejaculate as fast as possible in order to escape danger.
It was literally survival of the fastest.
In those times, there was little to no awareness of the female orgasm, so climaxing quickly wasn’t really an issue for either party.
Fast-forward to the age of Homo Sapiens (modern humans), along with the discovery of the female orgasm, and this whole idea has flipped on its head.
As humans, we now prolong sex purely for pleasure and can generally ‘get busy’ in the safety of our homes without fearing attack by an animal predator. That means quick ejaculation has become more of a disappointment than a benefit.
But how quick is considered too quick?
It’s tough to define because there’s no clear time when a man is supposed to ejaculate during sex.
One man might think he has premature ejaculation because he can’t last for 2 hours, whereas another man might think he has delayed ejaculation because it tagelss him 15-minutes to come.
It depends on your partner too. If they don’t need long to feel satisfied with sex, you may not care how long you last. But if your partner wants hours of sex, you may be frustrated at your inability to hold back.
So, it’s all a matter of perspective.
It varies in the research, but one 2005 study found the average time taken for a man to ejaculate during intercourse was around 5.5 minutes.2
Another 2008 study asked Canadian and American sex therapists what they perceived to be the ‘normal’ time for a man to climax after penetration and they settled on 3-13 minutes.3
That doesn’t mean you’re abnormal if you last more or less time – these numbers are just a guide.
The medical definition, and the guide most doctors use to diagnose premature ejaculation, is: 4
Ejaculating always or nearly always within 1-minute of penetration
Being unable to delay ejaculation during sex all or nearly all of the time
Feeling bothered and frustrated by this and avoiding sex and intimacy as a result
In severe cases, ejaculation can happen before penetration even begins.5
Although the stereotype of premature ejaculation tends to be Jim Levenstein from American Pie – a horny teenager who can’t help but cream his pants at the sight of a hot exchange student – that’s pretty far from the truth.
Premature ejaculation can affect both young and old men and can start early or later in life.
There are two main types:
Starts from a man’s first sexual experience and can continue throughout life if left untreated.1 It may get a bit better with age, but that’s likely because the body is getting older rather than the premature ejaculation improving.6
Occurs in men who have previously had normal ejaculation times before their premature ejaculation started. It can begin at any time in a man’s life7 and is often linked to relationship troubles, stress, or erectile dysfunction.1
There are also two further types of premature ejaculation that are not really considered disorders according to the medical definition:
Where ejaculation time is inconsistent and unpredictable – sometimes it’s quick and sometimes it takes longer.8 It might be because the guy is with a new partner, in a new sexual situation, or he just hasn’t had sex in a while.
When a man complains of having premature ejaculation, when in reality, he has a normal or even extended ejaculation time.8
If you’re experiencing one of the first two types, you’re in good company, according to the stats.
If you're always arriving early in your 20s or 30s, you are probably worried. You’re supposed to be having the best sex of your life, right? What if these years pass by and you never get to experience that kind of fulfilment?
You might feel embarrassed or ashamed and find it hard to discuss with your partner, loved ones, or even your doctor. It can feel like a huge blow to your manhood.
Furthermore, it can contribute to – or worsen – depression and anxiety and also negatively affect your relationship. That’s the dark side of premature ejaculation.
The good news is that there is nothing broken about you or your penis. Ejaculating quickly is not an insurmountable problem and there are several ways you can manage it if you’re willing to talk about it and consider treatment options.
Remember, despite your fears, partners can be understanding and will often be happy to work with you to overcome your challenge or find ways to enjoy sex despite it.
Here, we look at the possible causes of premature ejaculation, including the psychological and physical causes. After reading this chapter you’ll understand why it’s not always a straightforward diagnosis.
You might have heard that masturbating quickly in adolescence or not having sex very often are a few causes, but it’s not quite that simple.
The truth is that the causes are varied and they’re hotly debated amongst doctors and sex therapists, mainly because defining it is so hard (as we explained above).
Most commonly, it is thought to be a psychological or physical thing and can be made worse when you engage in alcohol and drug taking.
What’s going on between your ears affects how your penis can perform on so many levels.
So, let’s break it down.
Ever worried about not being able to keep your boner long enough during sex? Or looked down and been disappointed about the size of your willy?
What about wondering whether your new partner finds you attractive enough? Or perhaps you’ve learnt to associate guilt with sex so you’re in the habit of rushing to climax?
Whatever your concern, if you’re constantly having negative thoughts about your penis, your body, or anything to do with sex, it could be affecting how long you’re lasting in bed.
This vicious cycle of negative thinking and worry is known as performance anxiety and is thought to be one of the main causes of premature ejaculation – especially acquired premature ejaculation.1
In the case of lifelong premature ejaculation, it can actually be the other way around, where the performance anxiety is as a result of the premature ejaculation.1 That means your previous experiences of coming early or losing your stiffy have created fear around it happening again, which then makes it happen again.
Frustration to the max!
We offer some useful advice for managing performance anxiety in chapters 3 and 4.
Stress and anxiety are closely linked, and stress can trigger anxiety.14 As most of you would know, being stressed at work, for example, can cause worrisome thoughts that spill over into your private life.
Yep, your boss has essentially entered your bedroom – Arghhh!
This kind of stress can cause your mind to be elsewhere during sex, causing you to blow your load early or maybe lose your hard on.
One theory is that anxiety activates the sympathetic nervous system (the one that is responsible for activating the fight or flight response) which in turn reduces the ejaculatory threshold.8 That’s the amount of stimulation you need before reaching your ‘point of no return’ (when you can no longer hold back an orgasm).
Another theory is that high levels of anxiety about performing well enough in bed can distract you from monitoring and being in control of your level of arousal, resulting in premature ejaculation.8
Whatever the cause, if the stress and anxiety is chronic and is starting to affect your sex life in the long term, it needs to be managed.
No, this doesn’t mean your dick is sad, but you might be…
When it comes to depression and premature ejaculation, it’s a bit of a chicken and egg situation. Studies show that depression can contribute to premature ejaculation, and premature ejaculation can also make depression worse.8
The underlying reason is not completely understood, but research shows that medical treatments for depression can improve premature ejaculation symptoms. That’s why some treatments for depression are used to manage premature ejaculation as well.
Unless you’re the type who thrives on make-up sex – and let’s face it, that’s more likely to happen in the early days of a relationship – then any kind of tension between you and your partner can put a strain on your sex life. This can translate to problems, including premature ejaculation and erectile dysfunction.
On the flipside, relationship problems can start because of premature ejaculation.16
If you’ve had satisfying sexual relationships with other partners in the past where premature ejaculation wasn’t a concern, it's possible that issues between you and your current partner could be causing the premature ejaculation.17 In this instance, resolving the issues is likely to help.
If, on the other hand, your partner is having trouble accepting your existing premature ejaculation and it’s causing a rift between you, it might be time to seek professional help.
If you experience this, the last thing you want to have is premature ejaculation as well. It’s like losing the same game twice.
Unfortunately, though, they’re often linked.
The reason may be because a guy needs extra intense stimulation to maintain his erection, which then triggers his early arrival. Or, it may be that he’s trained himself to come quickly because he’s afraid of losing his hard on.1
Furthermore, he might be experiencing performance anxiety about the erectile dysfunction, which only makes him come even faster!12
Sometimes your anxious thoughts or your nagging girlfriend aren’t to blame, but there’s actually a physical issue at play.
For men with lifelong premature ejaculation, it could be:5,19,20
For men with acquired premature ejaculation, it could be:21,22,23,24
It will take a visit to the doctor to diagnose this, so yes, you will have to swallow your embarrassment and get it checked out.
Booze and party drugs make you feel good, and they might even help big willy last longer in the sack. But there’s actually a tipping point after which they can start to ruin your sex life.
Alcohol is a depressant, and heavy use can dampen mood, decrease sexual desire, and make it difficult to get erections or reach orgasm while under the influence. The more you drink the worse it gets.
So, if you think your premature ejaculation is a problem now, then drowning your problem in alcohol can result in no nooky at all. Probably not your original plan.
Then there’s recreational drugs such as ecstasy (MDMA) and cocaine. These may serve to delay ejaculation in the short term (and are often used for that very reason), but overuse and long-term use can make premature ejaculation worse.24
Do not use recreational drugs to manage your PE!
In this chapter, we describe a variety of natural treatment options that you can do in the privacy of your home. They’re particularly good for men experiencing acquired premature ejaculation related to performance anxiety.
Try some out and see what works best for you.
Unlike you, we’re not here to disappoint. ;)
Depending on what type of premature ejaculation you have, there are different ways to prevent and manage it.
If you have acquired premature ejaculation, these natural and home treatments might be enough on their own. Alternatively, or you may need to combine them with medical or psychological treatments for greater effectiveness. We’ll address these a bit further down.
You know you have premature ejaculation and so does your partner, but it’s the one topic you avoid like the plague.
Well, it’s time to man up and speak up.
Being able to name what is happening to you and having your partner respond in a loving and kind way can get you out of the web of worries about whether you are going to last or not. You might even find that your partner doesn’t care as much as you do about how long you last.26
Studies have shown that couples who communicate openly and honestly about any kind of sexual dysfunction have the best chance of dealing with the issue effectively.27 Furthermore, talking about sex in general with your partner can serve to enhance your sex life.
Talking about premature ejaculation with casual partners is super embarrassing, but there are ways you can turn an awkward situation into a positive one.
Picture this: You’re on a hot date and the connection between you is great. The flirting begins and things get a bit physical. One thing leads to another and before you know it, you’re both in bed, naked and aroused.
You’re so turned on that foreplay is all you need to get to your max arousal level. When the action starts, it’s all over (for you) in 10 seconds.
There’s an awkward silence and you see a mixed look on your new partner’s face. What do you do?
If you go with number 2, chances are they will be more aroused knowing the effect they’ve had on you and admire your confidence in a situation when most men would lose theirs.
During sex, it feels great to be in control and fully immersed in the moment, but stress can rob you of that great feeling.
If that’s you and you’re starting to experience premature ejaculation or erectile dysfunction when you never used to, then it’s time to take back control.
Meditation, breathing exercises and yoga can help relax the nervous system and can increase mindfulness and awareness in the moment.28 Even 10 minutes a day can make a difference to your mindset and your libido, which can in turn help with premature ejaculation.
Focusing on the breath has the additional benefit of distracting your thoughts. By thinking about your breathing more, you’re thinking less about sex, which can decrease arousal and allow you to last longer.
Also, small studies have shown that yoga can prolong the intravaginal ejaculation latency time – a fancy way of saying the time it takes you to come after penetration.29
If you don’t like the man in the mirror because he’s carrying a bit of a spare tyre (and maybe even some man boobs), then it’s time for some lifestyle changes.
Research shows that overall poor health increases a man’s risk for sexual dysfunction, including premature ejaculation.30
Being overweight can cause you to lose sexual confidence, which can contribute to performance anxiety.
Schedule time in your week for regular exercise. Working up a sweat will cause the release of hormones and trigger physiological reactions that boost libido. Additionally, the emotional awareness of being healthy and fit gives you a better outlook on life and translates into a better sex life overall.28
Make sure you’re getting 7-9 hours of sleep each night because it reduces stress and keeps the immune system healthy.28
Lastly, ditch those burgers and chips and replace them with nutritious whole foods (minimally processed or unprocessed foods) that give your body the fuel it actually needs.
In particular, include foods that are rich in zinc and magnesium such as beef, lamb, oysters, yoghurt, spinach, almonds, pumpkin seeds, soy beans and dark chocolate.
Research has found a link between zinc deficiency and sexual dysfunction in men, so ensuring you get enough zinc in your diet – or using supplements if you don’t – may improve ejaculation time.31
Magnesium may also play a role: One study found that men with premature ejaculation tend to have lower levels of magnesium in their semen.32
These have a poor evidence base compared to other types of medical treatments, but they might be worth trying if prescription medicines aren’t your thing.
Recent research33 published in Sexual Medicine compared the benefits of acupuncture, Chinese herbal medicine and Ayurvedic (Indian) herbal medicine for treating premature ejaculation.
Acupuncture was found to slightly increase the time it takes to ejaculate after penetration by about half a minute compared to placebo.
Chinese herbal medicine increased the ejaculation time after penetration by about 2 minutes, and Ayurvedic herbal medicine increased the time by nearly 1 minute.
Small gains, but gains nonetheless!
These can work wonders either on their own or when combined with other medical or psychological treatments.
Kegels aren’t just for pregnant women, they’re for guys like you too!
Strengthening your pelvic floor muscles can have a surprisingly big impact on your ability to hold off a climax.
A 2014 Therapeutic Advances in Urology study34 discovered that in a group of men with lifelong premature ejaculation, the pelvic floor exercises led to an improvement in body and pelvic floor awareness, which helped them improve their self-confidence and sense of control of their ejaculatory reflex.
Your pelvic floor muscles are the ones you use to stop yourself from weeing or passing gas. You can strengthen them by clenching and holding for three seconds. Do this 10 times then rest for a while. Perform this routine three times per day. Gradually increase how long you hold the clench and practice doing it while lying down, sitting, standing and walking.
This method is also called edging. It’s when you have sex until you’re close to orgasm, then stop and cool off for a while. It’ll help you recognise where your ‘point of no return’ is in order to learn to control the sensations prior to ejaculation.35
During your break, it’s a great opportunity to focus on your partner for a bit to ensure they’re having a satisfying sexual experience as well.
Sounds like a yoga teacher’s exercise instruction, but it’s actually for your penis.
When you feel the urge to ejaculate, stop having sex and squeeze the end of your penis just beneath the head. Hold for several seconds until your body no longer wants to climax. You (or your partner) can repeat this as much as necessary. It also helps train you to hold back.
This is one of the easiest ways to cope with premature ejaculation. Just let your climax happen, laugh it off with your partner, and gear up for round two. Most partners don’t care that much anyway.
Every guy has a refractory period (the period of time after he climaxes) before he can finish again. It’s a perfect opportunity to focus on your partner’s experience for a little bit. Once you’re ready for another go, it will take you substantially longer to climax again.
The best part about this approach is that there’s no anxiety. There’s no holding back or squeezing your muscles or using condoms. You get maximum enjoyment out of sex. And who knows? Taking pressure out of the situation may be just what you need to hold off that first orgasm.
This is similar to the ‘get the first one out of the way’ approach, but you do it alone. If you’re worried that you’ll finish too quickly in the bedroom, handle your business by yourself before sex. The release will make you less likely to orgasm quickly during penetrative or oral sex.
This may seem to run counter to our last strategy, but hear us out.
Like most guys, you probably rush right to the end when you masturbate. There’s no one else to please, so why wait, right? But this can train your body to reach the finish line as fast as possible.
If you limit your climaxes to only the sex you have with your partner, you may grow accustomed to the slow climb toward orgasm. This will teach you to enjoy the whole experience, rather than the final moment.
When you think sex, you probably think penetration, but that’s not all sex is about. There are so many ways to get sexual pleasure, such as massages, touching each other, manual masturbation (using fingers, hands, tongue or other part of the body), taking a bath together or even using sex gadgets.
Have a conversation with your partner about your premature ejaculation and agree to avoid penetrative sex for a while. Focus on other kinds of sexual acts that don’t cause you to climax quickly. This can help you relax and worry less about your impending orgasm.
Despite what you may think, extended intercourse is not actually what brings a woman to orgasm.
We know that’s why most of you think you need to last longer in bed, but research consistently shows that only around 25% of women reliably have orgasms during intercourse, no matter how long it lasts.36
It’s not actually the vagina that triggers orgasms in women, but the clitoris. For the clueless guys out there, that’s the little bump outside the vagina an inch or two above it beneath the top junction of the vaginal lips.
One Belgian study showed that when men use their hands, tongues, and/or vibrators to help women to orgasm, few women care how long men last.36
So maybe you just need to understand how to press your partner’s buttons better?
Condoms are tough for some guys because they limit sensitivity, but that’s actually a bonus if you struggle with premature ejaculation. Wearing a condom can lighten the experience enough for you to last longer before finishing. The thicker the condom the better.17 But don’t double bag (use one condom over another) as it can break the condom.37
Another useful trick is to use more lube. It’ll reduce friction, which may help you last longer.
Changing sexual positions not only keeps things exciting in the bedroom but it also interrupts intercourse and can allow the sensitivity of your penis to be reduced for a short time.
Different positions can also mean your penis experiences more or less sensitivity. For example, the missionary position can result in greater sensitivity, whereas the female on top can help a guy last longer.
Test other positions out and see which work best for you in terms of reducing sensitivity.
We know, watching porn is pretty fun. We all do it, and since high-speed internet came into existence, we’re able to do it even more. In fact, it’s so accessible now, that it’s possible to overdo it and rewire our brains as a result.
According to research, porn consumption increases dopamine production in the brain – similar to addictive drugs. If we have too much of it, it can cause faster ejaculations.38
Also, many guys masturbate to porn just to ‘get off’ in the shortest time possible or because they’re worried about being caught.
Porn can also cause you to have unrealistic expectations of sex, which means you can have trouble getting turned on when you’re with a partner because regular sex seems boring in comparison.
So, if you think porn is part of your issue, it’s time to break the habit.
Positive change won’t happen overnight, especially if you’ve been watching it consistently for a long time, but you will begin to notice a difference the longer you abstain from it.
Need some support? Our online psychologists can help.
If your premature ejaculation is mainly due to performance anxiety, stress, or relationship issues, this chapter will discuss some different therapy options.
These two words might make you picture candles, blindfolds and soft music, but that’s just woo woo stuff you see in the movies.
Sex therapy is actually a specialised type of psychotherapy. It’s provided by licensed psychologists who have advanced training in issues related to sexual and relationship health.
As a client, you’ll meet in the therapist’s office – or online – either alone or with your partner.
It’s normal to feel anxious at first, especially if you have trouble talking about sex in general, but your therapist should make you feel comfortable.
During the sessions, your therapist will want to understand what factors are impacting on your sex life. These might include lack of confidence, having kids, illness, disability or previous negative sexual experiences. They will then work with you to resolve these issues.
Chances are you’ll also get ‘assignments’ to do at home, such as trying some of the behavioural techniques described above or working on communication strategies with your partner.
Importantly, everyone will be keeping their clothes on! The therapist will not have sexual relations with anyone or show anyone how to have sex.
Want to engage in therapy? Our Mosh psychologists can help.
We can already hear you saying “no way”, but put the stigma aside for a moment and hear us out.
A lot of blokes can have a hard time communicating, which can lead to relationship problems such as a lack of intimacy. If things get bad, it can trigger other sexual issues such as premature ejaculation or erectile dysfunction.
A couples counsellor usually focuses on assisting couples to build better communication and strengthen their relationship. They often work with issues of betrayal, infidelity, and pre-marital counselling – sex may not be discussed at all.
You might be surprised at the difference open and honest communication with your partner can make to your sex life.
Ideally, we should all be mindful during sex, but often our minds can wander – from playing porn films in our brains, worrying about how we’re performing in bed, thinking about work, or wondering what our butt looks like.
So how can you bring your attention back?
Start a mindfulness meditation practice.
Mindfulness involves the building of a body-mind connection. It’s an understanding of sensations and emotions, as they are experienced within the body. It’s a focus on the present, rather than the future or the past.
Men who are dealing with premature ejaculation can’t always identify the sensation that tells them that they’re reaching a point of no return. However, with mindfulness, they may be better able to identify it and control it.
A mindfulness practice can also help you unpack the negative meaning you have attached to sex because of your premature ejaculation.
For example, if you’ve had multiple negative experiences linked to premature ejaculation, you may have developed a story in your head that says you are unworthy of sex and love until you overcome this problem. Mindfulness can help to separate these thought links.
There are lots of apps to help get you started, but it’s quite simple to do on your own.
Simply sit still in your chair for 10-20 minutes each day. During this time, close your eyes and guide your attention to different locations in your body and ask yourself “what do I feel?” Always focus on the sensations themselves, not the story behind the sensations. If your mind wanders, gently guide it back.
After a few weeks of flexing your mindfulness muscle, start incorporating that skill into sex and ask yourself the same questions: "What do I feel? Where do I feel it? Can I pay close enough attention to detect subtle changes in those sensations?"
Over time, you’ll learn to identify the sensation related to the sexual stimulation before you orgasm and be better able to control it.
If the natural and at home treatments aren’t quite enough, you may need to take it up a notch.
Here, we discuss some medical options.
This is the hot question, and the answer depends on what’s causing it.
Lifelong premature ejaculation cannot be cured, but can be managed with psychological and/or medical treatment in 75% of cases.20
For acquired premature ejaculation, it’s possible to get rid of or manage the issue by treating the underlying causes. Treatment will of course depend on the cause.
This is a really easy-to-use, at-home treatment that works by reducing the sensitivity of the skin on the penis.
The main ingredients are usually lidocaine and/or prilocaine – two types of anaesthetics.
One study published in the urology journal BJU International showed that men with premature ejaculation who used the anaesthetic spray lasted on average 2.4 times longer than those who didn’t use it.
You simply apply the spray or cream 10-20 minutes before sex. You may also want to put a condom on top during sex to prevent the spray/cream being absorbed by your partner.
For more long-lasting results, it’s best to combine this treatment with psychological therapy and some of the behavioural tips and tricks we mentioned above.
Australian law prevents us from mentioning certain medications until you’ve spoken to a doctor, so our lips are sealed.
What we can say, though, is there are clinically proven ways to manage both primary and secondary premature ejaculation with medicines, if needed.
Remember: All medications can have side effects. It’s important to understand these and discuss them with the doctor before using any medication.
This is the bit where we give ourselves a plug, because, well, we think we’re worth it and we’re sure you’ll think the same if you decide to come on board.
With our help, you can get a doctor- or psychologist-tailored treatment plan to manage your premature ejaculation. We’ll tailor treatment to meet your budget and needs, and ship it to your door discreetly every 3 months. That makes us affordable and predictable.
To start answer some simple questions about your health and medical history.
Text, call or video chat with an Australian doctor where they'll figure out the best course of treatment for you.
Confirm your treatment and partner pharmacy and your prescription will be delivered to your door.
This information is not intended to be a substitute for professional medical advice, diagnosis, or treatment. It should never be relied upon for specific medical advice. If you have any questions or concerns, please talk to your doctor.