If you regularly climax too quickly during sex and are unable to control it, you could be experiencing premature ejaculation. It’s a specific condition that’s easy to write off or confuse for something else, but it’s fairly straightforward.

What are the criteria for premature ejaculation?

Dr. Amin Herati, Director of Male Infertility and Men’s Health at John Hopkins, says there are three criteria to premature ejaculation (PE):

  1. shorter than average time before ejaculation (roughly 1 to 2 minutes or less, according to Herati)
  2. the inability to stop it from happening
  3. dissatisfaction or stress affecting you or your partner afterward
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A 2005 study focusing on sex involving vaginal penetration found that, for people without PE, the median time between penetration and ejaculation was 7.3 minutes. Herati says people with PE typically climax 1 to 2 minutes or less into sex.

While accounts vary, some studies say PE can affect up to 30 percent of men, regardless of ethnicity or age. Research suggests that increased age is not a risk factor for PE like it is for erectile dysfunction. In fact, PE is equally common among men ages 18 to 59.

While PE can cause a lot of frustration and embarrassment, you can find help by acknowledging it and learning more.

Premature ejaculation can be a lifelong condition (known as primary PE), or it can occur only later in life (known as secondary PE). While both forms of the condition result in early ejaculation, they have very different causes.

“Primary is more likely due to hypersensitivity of the nerves that run in the penis,” Herati says. “Secondary can be hormonal. So in some cases, we see low testosterone or we see abnormalities in the thyroid level.”

Hormones aren’t the only culprit for secondary PE — research also suggests that psychological or relationship problems, an infection of the prostate, performance anxiety, and other factors could lead to the condition.

“With the wide variety of causes, it’s entirely possible to develop PE after a long run of regular-length ejaculations,” says Herati.

Here are eight possible causes of PE.

1. Hormonal imbalances

Herati says hormonal issues, such as low testosterone and hyperthyroidism, are among the main causes of PE that he’s seen.

The link between testosterone and PE is “controversial,” says Herati. A 2020 study found that testosterone replacement led to a 4.8-fold increase in the time before ejaculation during vaginal penetrative sex. But research from 2014 found no relationship between PE and low testosterone.

Although research results are mixed, fluctuating hormone levels throughout your life could lead to developing PE.

2. Neurological imbalances

Like hormone imbalances, having too much or too little of a neurotransmitter could lead to PE.

“In some cases, if the serotonin levels are too low and the dopamine levels are too high, then that can lead to an easier time getting to climax,” Herati says.

3. Prostatitis

This condition, which involves infection and inflammation of the prostate, can commonly cause PE as well as a bunch of other unpleasant effects, like painful ejaculation or frequent urination. (Yikes!)

4. Genetic predispositions

“Unfortunately, some people are born with predispositions to PE, like having hypersensitive nerves in the penis,” Herati says.

“I can’t really make the connection for how stress or emotional trauma would lead to [PE],” he continues. But some research suggests otherwise — a 2016 review concluded that depression was associated with an increased risk of developing PE.

Although Herati argues against a direct connection between the two, he agrees that hormonal and neurotransmitter imbalances provoked by stress or frustration could lead to PE, as demonstrated in some studies.

5. Performance anxiety or relationship problems

In a 2005 study, men with PE reported experiencing higher levels of performance anxiety than those without PE. These men reported feeling “totally preoccupied with thoughts about controlling their orgasm, with the anxious anticipation of a possible failure,” researchers wrote.

6. Anxiety and depression

Research suggests these mental health conditions are more common in men experiencing PE. However, like Herati, some experts warn that anxiety and depression could be an effect of PE rather than the cause.

7. Alexithymia

Alexithymia is a condition in which you cannot describe or identify emotions in yourself or others. A 2007 study found that this condition could be a risk factor for PE.

8. Sexual beliefs and childhood upbringing

Researchers have found that people with strong views against sexuality, usually instilled by parental figures during childhood, also have a significant prevalence of PE.

Many natural and pharmaceutical treatments can help address PE and improve sexual performance. Because PE has a wide variety of causes, not all of these techniques will work for everyone.

Consult a medical professional before trying pharmaceutical treatments such as hormone replacement or antidepressants.

Masturbation before sexThis is a common treatment for PE. Try masturbating an hour or two before sex to delay climax.
Taking a break from sexWhile seemingly counterintuitive, a break could help take the pressure off sexual encounters.
The pause-squeeze methodWhen you feel the urge to ejaculate during sex, pull out and have your partner squeeze your penis between the head and shaft until the urge passes, says Herati. Repeat as necessary.
The stop-start methodSimilarly, you can skip the squeeze and pause sex when you feel the urge to come, says Herati. Resume when the feeling passes.
Pelvic floor exercisesWeak pelvic floor muscles could contribute to PE. Research suggests that exercising these muscles could help improve the condition. Here’s a handy guide.
CounselingA counselor can help you confront past traumas and recognize patterns of thinking that might cause or exacerbate PE. Psychosexual counseling is known to be effective in treating PE.
Condom use or topical anestheticNumbing agents like benzocaine can help dull hypersensitive nerves and prolong the time before climax (but be careful when using these, as it’s possible to pass them to your partner). Condoms do the same. For the best of both worlds, you can buy “climax control” condoms over the counter, which often contain a numbing agent.
Hormone replacement therapyA doctor may prescribe testosterone replacement therapy or a similar treatment if they find that you have a hormone imbalance.
Certain antidepressantsSimilarly, a doctor may prescribe SSRIs or other antidepressants to balance your neurotransmitters. While SSRIs are commonly used and effective in treating PE, they were not created for this purpose.

According to Herati, some people with secondary PE can fully recover, while some others may have to contend with the condition for the rest of their lives.

“Recovery will likely come for the people who have hormone abnormalities,” he says, “but if, say, your nerves are more sensitive, then that might be a bit more [difficult to recover from].”

However, there’s still hope — Herati says that occasionally, those with primary PE might be able to adjust to sex and resolve the issue on their own. It might just take longer.

Where does sex drive come in?

“Because PE is connected to testosterone levels and testosterone is related to sex drive, having a lower libido may be connected with PE,” says Herati. “If somebody’s sex drive is low, then that could be a reason why they may have problems with premature ejaculation.”

Consider taking this with a grain of salt, as there’s also research to suggest that testosterone has no relation to PE.

Herati specifies that while there’s no evidence showing a direct relationship between libido and PE, it’s possible that maintaining sexual intercourse over time could lead to recovery — as long as your PE isn’t linked to hormonal imbalances or other physiological conditions.

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“If it’s causing distress for the patient and the partner, then seek advice and get help,” says Herati.

You may feel uncomfortable approaching a doctor about a sexual health problem. But PE can often be a sign of hormonal imbalances, coexisting erectile dysfunction, or other problems in your body, so it’s a good idea to talk about your concerns with a professional.

If you’re looking for online resources, check out https://prematureejaculation.help/. The self-evaluation could help you determine if you have PE. The site also mentions exercises and products that might help.

If you’re considering sex therapy, the American Association of Sexuality Educators, Counselors, and Therapists is a great resource for connecting with licensed sexual health practitioners near you.

Likewise, the American Urological Association has a great tool to connect you with a qualified local specialist.

While premature ejaculation might make you feel alone or even like a failure, rest assured that you have plenty of helpful options to try. Finding a solution starts with understanding your body and being consistent about giving it the care it needs.

“[PE] is correctable,” says Herati. “But you have to be very patient to find the right combination [of treatments] and do what’s best.”