Premature ejaculation

Short description: Ejaculation and climax soon after initiating sexual activity

Premature ejaculation

Specialty| Psychiatry, sexual medicine

Premature ejaculation (PE) is a male sexual dysfunction that occurs when a male expels semen (and most likely experiences orgasm) soon after beginning sexual activity, and with minimal penile stimulation.[1] It has also been called early ejaculation, rapid ejaculation, rapid climax, premature climax and (historically) ejaculatio praecox. There is no uniform cut-off defining "premature", but a consensus of experts at the International Society for Sexual Medicine endorsed a definition of around one minute after penetration.[2] The International Classification of Diseases (ICD-10) applies a cut-off of 15 seconds from the beginning of sexual intercourse.[2]

Premature ejaculation is treated with behavioral techniques, medications, and rarely surgery. Combined therapy is often most effective.

Although men with premature ejaculation describe feeling that they have less control over ejaculating, it is not clear if that is true, and many or most average men also report that they wish they could last longer. In males, typical intravaginal ejaculation latency time is approximately 4–8 minutes.[3] The opposite condition is delayed ejaculation.[4]

Men with PE often report emotional and relationship distress, and some avoid pursuing sexual relationships because of PE-related embarrassment.[5] Compared with males, females consider PE less of a problem,[6] but several studies show that the condition also causes female partners distress.[5][7][8]

## Contents

* 1 Cause
* 2 Mechanism
* 2.1 Intromission time
* 3 Diagnosis
* 4 Treatment
* 4.1 Self-treatment
* 4.2 Sex therapy
* 4.3 Medications
* 4.4 Surgical treatments
* 5 Epidemiology
* 6 History
* 6.1 Naturalism
* 6.2 Medicalization
* 7 See also
* 8 References
* 9 Cited sources
* 10 Further reading
* 11 External links

## Cause

The causes of premature ejaculation are unclear. Many theories have been suggested, including that PE was the result of masturbating quickly during adolescence to avoid being caught, performance anxiety, passive-aggressive behavior or having too little sex; but there is little evidence to support any of these theories.[3]

Several physiological mechanisms have been hypothesized to contribute to causing premature ejaculation, including serotonin receptors, a genetic predisposition, elevated penile sensitivity and nerve conduction atypicalities.[9] Scientists have long suspected a genetic link to certain forms of premature ejaculation. However, studies have been inconclusive in isolating the gene responsible for lifelong PE.

The nucleus paragigantocellularis of the brain has been identified as having involvement in ejaculatory control.[10] PE may be caused by prostatitis[11] or as a medication side effect.

PE has been classified into four subtypes - lifelong, acquired, variable and subjective PE. The pathophysiology of lifelong PE is mediated by a complex interplay of central and peripheral serotonergic, dopaminergic, oxytocinergic, endocrinological, genetic and epigenetic factors. Acquired PE may occur due to psychological problems - such as sexual performance anxiety, and psychological or relationship problems - and/or co-morbidity, including erectile dysfunction, prostatitis and hyperthyroidism.[12]

## Mechanism

The physical process of ejaculation requires two actions: emission and expulsion. The emission is the first phase. It involves deposition of fluid from the ampullary vas deferens, seminal vesicles and prostate gland into the posterior urethra.[13] The second phase is the expulsion phase. It involves closure of bladder neck, followed by the rhythmic contractions of the urethra by pelvic-perineal and bulbospongiosus muscle and intermittent relaxation of the external male urethral sphincter.[14]

Sympathetic motor neurons control the emission phase of ejaculation reflex, and expulsion phase is executed by somatic and autonomic motor neurons. These motor neurons are located in the thoracolumbar and lumbosacral spinal cord and are activated in a coordinated manner when sufficient sensory input to reach the ejaculatory threshold has entered the central nervous system.[15][16]

### Intromission time

The 1948 Kinsey Report suggested that three-quarters of men ejaculate within two minutes of penetration in over half of their sexual encounters.[17]

Evidence as of 2005[update] supports an average intravaginal ejaculation latency time (IELT) of six and a half minutes in 18- to 30-year-olds.[18][19] If the disorder is defined as an IELT percentile below 2.5, then premature ejaculation could be suggested by an IELT of less than about two minutes.[20] Still, it is possible for some men with abnormally low IELTs to be satisfied with their performance and not report a lack of control.[21] Likewise, those with higher IELTs may consider themselves premature ejaculators, and suffer from quality of life issues normally associated with premature ejaculation, and even benefit from non-pharmaceutical treatment.[22]

## Diagnosis

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines premature ejaculation as "A persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately 1 minute following vaginal penetration and before the person wishes it," with the additional requirements that the condition occurs for a duration longer than 6 months, causes clinically significant distress, and cannot be better explained by relationship distress, another mental disorder, or the use of medications.[2] These factors are identified by talking with the person, not through any diagnostic test.[2] The DSM-5 allows for specifiers whether the condition is lifelong or acquired, applying in general or only to certain situations, and severity based on the time under one minute, however these subtypes have been criticised as lacking validity due to insufficient evidence.[23]

The 2007 ICD-10 defined PE as ejaculating without control, and within around 15 seconds.[2]

## Treatment

Several treatments have been tested for treating premature ejaculation. A combination of medication and non-medication treatments is often the most effective method.[24]

### Self-treatment

Many men attempt to treat themselves for premature ejaculation by trying to distract themselves, such as by trying to focus their attention away from the sexual stimulation. There is little evidence to indicate that it is effective and it tends to detract from the sexual fulfillment of both partners. Other self-treatments include thrusting more slowly, withdrawing the penis altogether, purposefully ejaculating before sexual intercourse, and using more than one condom. Some men report these to have been helpful.[3]

### Sex therapy

Several techniques have been developed and applied by sex therapists, including Kegel exercises (to strengthen the muscles of the pelvic floor) and Masters and Johnson's "stop-start technique" (to desensitize the male's responses) and "squeeze technique" (to reduce excessive arousal).[24]: 27

To treat premature ejaculation, Masters and Johnson developed the "squeeze technique", based on the Semans technique developed by James Semans in 1956.[25] Men were instructed to pay close attention to their arousal pattern and learn to recognize how they felt shortly before their "point of no return", the moment ejaculation felt imminent and inevitable. Sensing it, they were to signal their partner, who squeezed the head of the penis between thumb and index finger, suppressing the ejaculatory reflex and allowing the male to last longer.[26][27][28]

The squeeze technique worked, but many couples found it cumbersome. From the 1970s to the 1990s, sex therapists refined the Masters and Johnson approach, largely abandoning the squeeze technique and focused on a simpler and more effective technique called the "stop-start" technique. During intercourse, as the male gets the sensation of approaching climax, both partners stop moving and remain still until the male's feelings of ejaculatory inevitability subside, at which point, they are free to resume active intercourse.[26][29][30][31][32]

The functional-sexological approach to treating premature ejaculation, as developed by François de Carufel & Gilles Trudel, offers a novel method focusing on sexual function improvement without interrupting sexual activity. This treatment, distinct from traditional behavioral techniques like the squeeze and stop-start methods, has demonstrated significant improvements in the duration of intercourse, sexual satisfaction, and overall sexual function. A pivotal study by De Carufel & Trudel (2006) showcases the effectiveness of this approach.[33] Moreover, the Cochrane review on psychosocial interventions for premature ejaculation recognizes the De Carufel study as having a low risk of bias, highlighting its methodological robustness among psychosocial intervention studies.[34] This acknowledgment points to the functional-sexological treatment as a promising avenue for individuals and couples grappling with premature ejaculation, suggesting a shift towards more contemporary and empirically supported treatments in the field.[35] Access to functional-sexological therapy can be limited due to a shortage of qualified professionals. A study published in the Journal of Sex & Marital Therapy found that many individuals experience difficulties in seeking treatment for sexual concerns, largely due to a lack of awareness about available services and the scarcity of trained sex therapists, making these services appear inaccessible to those in need.[36]

### Medications

See also: Chemistry:List of investigational sexual dysfunction drugs

Pharmacological treatments for premature ejaculation, particularly selective serotonin reuptake inhibitors, topical anesthetics, and tramadol, increase intravaginal ejaculatory latency time compared with placebo; adverse events are common and overall evidence quality is limited by methodological heterogeneity and risk of bias.[37]

Dapoxetine, a selective serotonin reuptake inhibitor, has been approved for the treatment of premature ejaculation in several countries.[38][39][40] Other SSRIs are used off-label to treat PE, including fluoxetine, paroxetine,[41] sertraline, citalopram, escitalopram and clomipramine.[38] The opioid tramadol, an atypical oral analgesic is also used.[38][42] PDE5 inhibitors appear more effective than placebo and outcomes may be enhanced when combined with SSRIs for premature ejaculation, but the evidence is heterogeneous and of uncertain methodological quality.[43] The full effects of these medications typically emerge after 2-3 weeks, with results indicating about ejaculatory delay of up to 4 times greater than before medication if the medication is combined with psychotherapy.[38] Premature ejaculation can return upon discontinuation,[38] and the side effects of these SSRIs can also include anorgasmia, erectile dysfunction, and diminished libido.[38]

Topical anesthetics such as lidocaine and benzocaine, commonly known as delay sprays, that are applied to the tip and shaft of the penis have also been developed to essentially numb the intended area. These topical anesthetics are applied 10–15 minutes before sexual activity and have fewer potential side effects as compared to SSRIs.[44] However, this is sometimes disliked due to the reduction of sensation in the penis as well as for the partner (due to the medication rubbing onto the partner if condoms are not used).[45] In North America, the most popular delay spray, Stud 100, is approved by the FDA and Health Canada.[46]

### Surgical treatments

Two different surgeries, both developed in South Korea, are available to permanently treat premature ejaculation: selective dorsal neurectomy (SDN)[47] and glans penis augmentation using a hyaluronan gel.[48][49] Circumcision has shown no effect on PE.[50] The International Society for Sexual Medicine guidelines do not recommend either surgical treatment due to the risk of permanent loss of sexual function and insufficient reliable data[50][51][23] and on the basis of violating the medical principle of non-maleficence as the surgery can lead to complications, of which some might not yet be known.[50] The most common complication of surgery is the recurrence of PE, reported to occur in about 10% of surgeries.[50] Other sources consider SDN as a safe and efficient treatment[52] and these surgeries are popular in Asian countries.[23][51]

## Epidemiology

Premature ejaculation is a prevalent sexual dysfunction in males;[53] however, because of the variability in time required to ejaculate and in partners' desired duration of sex, exact prevalence rates of PE are difficult to determine. In the "Sex in America" surveys (1999 and 2008), University of Chicago researchers found that between adolescence and age 59, approximately 30% of men reported having experienced PE at least once during the previous 12 months, whereas about 10 percent reported erectile dysfunction (ED).[54] In males, although ED is the most prevalent sex problem after age 60, and may be more prevalent than PE overall according to some estimates,[55] premature ejaculation remains a significant issue that, according to the survey, affects 28 percent of men age 65–74, and 22 percent of men age 75–85.[54] Other studies report PE prevalence ranging from 3 percent to 41 percent of men over 18, but the great majority estimate a prevalence of 20 to 30 percent—making PE a very common sex problem.[5][11][53][56][23][57][58][59]

There is a common misconception that younger men are more likely to develop premature ejaculation and that its frequency decreases with age.[60][61] Prevalence studies have indicated, however, that rates of PE are relatively constant across age groups.[9]

## History

### Naturalism

Male mammals ejaculate quickly during intercourse, prompting some biologists to speculate that rapid ejaculation had evolved into genetic makeup of human males to increase their chances of passing their genes.[62][63]

Ejaculatory control issues have been documented for more than 1,500 years. The Kamasutra, the 4th century BCE Indian marriage handbook, declares that "if a male be long-timed, the female loves him the more, but if he be short timed, she is dissatisfied with him."[64][65]

Waldinger summarizes professional perspectives from early in the twentieth century.[66]

Sex researcher Alfred Kinsey did not consider rapid ejaculation a problem, but viewed it as a sign of "masculine vigor" that could not always be cured.[67] The belief that it should be considered a disease rather than a normal variation, has also been disputed by some modern researchers.[68]

### Medicalization

In the 19th century, a symptom called spermatorrhoea invented by William Acton in 1857, meaning excessive or involuntary semen discharge, was developed and at the time used as a medical justification of celibacy.[69][70] Spermatorrhoea was later sub-classified into other symptom clusters based partially on how it affected semen.[70] Treatment for spermatorrhoea at the time included catheterisation, cauterisation, circumcision, and sticking needles through the perineum into the prostate.[70] In the 19th and early 20th centuries, cultural stigma towards researching sexuality drove its unpopularity as a subject of study among doctors and in publications.[69] The first recognition the symptoms described in spermatorrhoea as a disorder in itself is believed to be in 1883, termed ejaculatio praecox.[70] The origin of the modern version of ejaculatio praecox, called premature ejaculation, is thought to have begun with Alfred Adler before major developments of psycohanalytic theory.[71]

Through the mid 20th century, Sigmund Freud published widely accepted and virtually unchallenged theories that rapid ejaculation was due to neurosis, that penetrative sex was the only right way to achieve female orgasm, and that a man's erection was essential to female orgasm.[72][73] It stated that males who ejaculate prematurely have unconscious hostility toward females, so they ejaculate rapidly, which satisfies them but frustrates their partners, who are unlikely to experience orgasm that quickly.[74] Freudians claimed that premature ejaculation could be cured using psychoanalysis. But even years of psychoanalysis accomplished little, if anything, in curing premature ejaculation.[74] In 1974, there was no evidence found to suggest that men with premature ejaculation harbor unusual hostility toward females. This so-called coital imperative has later been argued as a medically recognised disorder that did not actually serve the satisfaction of women but rather contributed to the pressure on and pathologisation of men in obtaining a so-called optimal time to ejaculation.[73][75]

## See also

* Anorgasmia
* Delayed ejaculation
* Edging (sexual practice)
* Pre-ejaculate
* Retrograde ejaculation
* Erectile dysfunction
* Blue balls
* Pull-out method
* Foreplay
* Dapoxetine

## References

1. ↑ Jern, Patrick (2015). "Ejaculation, premature". The International Encyclopedia of Human Sexuality. pp. 328–330. doi:10.1002/9781118896877.wbiehs126. ISBN 978-1-4051-9006-0.
2. ↑ 2.0 2.1 2.2 2.3 2.4 Serefoglu, Ege Can; McMahon, Chris G.; Waldinger, Marcel D.; Althof, Stanley E.; Shindel, Alan; Adaikan, Ganesh; Becher, Edgardo F.; Dean, John et al. (June 2014). "An evidence-based unified definition of lifelong and acquired premature ejaculation: report of the second international society for sexual medicine ad hoc committee for the definition of premature ejaculation.". Sexual Medicine 2 (2): 41–59. doi:10.1002/sm2.27. PMID 25356301.
3. ↑ 3.0 3.1 3.2 Strassberg, D. S., & Perelman, M. A. (2009). Sexual dysfunctions. In P. H. Blaney & T. Millon (Eds.), Oxford textbook of psychopathology (2nd ed.), (pp. 399–430). NY: Oxford University Press.
4. ↑ Jern, Patrick; Santtila, Pekka; Witting, Katarina; Alanko, Katarina; Harlaar, Nicole; Johansson, Ada; von Der Pahlen, Bettina; Varjonen, Markus et al. (2007). "Premature and delayed ejaculation: Genetic and environmental effects in a population-based sample of Finnish twins". The Journal of Sexual Medicine 4 (6): 1739–1749. doi:10.1111/j.1743-6109.2007.00599.x. PMID 17888070.
5. ↑ 5.0 5.1 5.2 Barnes T.; I. Eardley (2007). "Premature Ejaculation: The Scope of the Problem". Journal of Sex and Marital Therapy 33 (3): 151–170. doi:10.1080/00926230601098472. PMID 17365515.
6. ↑ Byers, E.S.; G. Grenier (2003). "Premature or Rapid Ejaculation: Heterosexual Couples' Perceptions of Men's Ejaculatory Behavior". Archives of Sexual Behavior 32 (3): 261–70. doi:10.1023/A:1023417718557. PMID 12807298.
7. ↑ Limoncin, E. (2013). "Premature Ejaculation Results in Female Sexual Distress: Standardization and Validation of a New Diagnostic Tool for Sexual Distress". Journal of Urology 189 (5): 1830–5. doi:10.1016/j.juro.2012.11.007. PMID 23142691.
8. ↑ Graziottin, A.; S. Althof (2011). "What Does Premature Ejaculation Mean to the Man, the Woman, and the Couple?". Journal of Sexual Medicine 8: 304–9. doi:10.1111/j.1743-6109.2011.02426.x. PMID 21967392.
9. ↑ 9.0 9.1 Althof, S. E. (2007). "Treatment of rapid ejaculation: Psychotherapy, pharmacotherapy, and combined therapy", pp. 212–240 in S. R. Leiblum (Ed.), Principles and practice of sex therapy (4th ed.). NY: Guilford. ISBN 978-1593853495
10. ↑ "Demonstration of ejaculation-induced neural activity in the male rat brain using 5-HT1A agonist 8-OH-DPAT". Physiol. Behav. 62 (4): 881–91. 1997. doi:10.1016/S0031-9384(97)00258-8. PMID 9284512.
11. ↑ 11.0 11.1 Althof, S.E. (2010). "International Society for Sexual Medicine's Guidelines for the Diagnosis and Treatment of Premature Ejaculation". Journal of Sexual Medicine 7 (9): 2947–69. doi:10.1111/j.1743-6109.2010.01975.x. PMID 21050394.
12. ↑ "Archived copy". https://uroweb.org/wp-content/uploads/EAU-Guidelines-on-Sexual-and-Reproductive-Health-2021.pdf.
13. ↑ "Five meters of H(2)O: the pressure at the urinary bladder neck during human ejaculation". Prostate 44 (4): 339–41. 2000. doi:10.1002/1097-0045(20000901)44:4<339::AID-PROS12>3.0.CO;2-Z. PMID 10951500.
14. ↑ "Ejaculatory physiology and dysfunction". Urol. Clin. North Am. 28 (2): 363–75, x. 2001. doi:10.1016/S0094-0143(05)70145-2. PMID 11402588.
15. ↑ "Physiology of male sexual function". Ann. Intern. Med. 92 (2 Pt 2): 329–31. 1980. doi:10.7326/0003-4819-92-2-329. PMID 7356224.
16. ↑ "Identification of a potential ejaculation generator in the spinal cord". Science 297 (5586): 1566–9. 2002. doi:10.1126/science.1073885. PMID 12202834. Bibcode: 2002Sci...297.1566T.
17. ↑ Kinsey, Alfred (1948), Sexual Behavior in the Human Male, Philadelphia: W. B. Saunders Co
18. ↑ "Ejaculation delay: what's normal? [July 2005; 137-4"]. http://www.bandolier.org.uk/band137/b137-4.html.
19. ↑ "A multinational population survey of intravaginal ejaculation latency time". The Journal of Sexual Medicine 2 (4): 492–7. 2005. doi:10.1111/j.1743-6109.2005.00070.x. PMID 16422843.
20. ↑ "Proposal for a definition of lifelong premature ejaculation based on epidemiological stopwatch data". The Journal of Sexual Medicine 2 (4): 498–507. 2005. doi:10.1111/j.1743-6109.2005.00069.x. PMID 16422844.
21. ↑ Brock, Gerald B.; Bénard, Francois; Casey, Richard; Elliott, Stacy L.; Gajewski, Jerzy B.; Lee, Jay C. (2009). "Canadian Male Sexual Health Council Survey to Assess Prevalence and Treatment of Premature Ejaculation in Canada" (in en). The Journal of Sexual Medicine 6 (8): 2115–2123. doi:10.1111/j.1743-6109.2009.01362.x. PMID 19572961. https://linkinghub.elsevier.com/retrieve/pii/S1743609515326023. "Nevertheless, it is well accepted that men with IELTs below 1.5 minutes may be “happy” with their performance and do not report a lack of control, and therefore, do not suffer from PE.".
22. ↑ Shindel, Alan W.; Althof, Stanley E.; Carrier, Serge; Chou, Roger; McMahon, Chris G.; Mulhall, John P.; Paduch, Darius A.; Pastuszak, Alexander W. et al. (2022). "Disorders of Ejaculation: An AUA/SMSNA Guideline" (in en). Journal of Urology 207 (3): 504–512. doi:10.1097/JU.0000000000002392. ISSN 0022-5347. PMID 34961344. http://www.auajournals.org/doi/10.1097/JU.0000000000002392. "Waldinger et al. conceptualized two provisional diagnoses that may be applicable in the context of men who have concerns about PE but do not meet specific criteria for either lifelong or acquired PE. Natural variable PE is defined as occasional short ELT that occurs irregularly and inconsistently and over which the man feels diminished sense of control. This condition is typically minimally or non-disruptive of overall sexual satisfaction and does not occur with a frequency that poses serious impediment for the patient. Subjective PE (SPE, also known as PE-like dysfunction) is defined as subjective concern or preoccupation about short ELT that is within population norms.24 Data on management of these provisional conditions is limited; for the time being education and/or psychosexual therapy, rather than pharmacotherapy, are favored as the treatments of choice for Natural variable PE and SPE.".
23. ↑ 23.0 23.1 23.2 23.3 Serefoglu E.C.; T.R. Saitz (2012). "New Insights on Premature Ejaculation: A Review of Definition, Classification Prevalence, and Treatment". Asian Journal of Andrology 14 (6): 822–9. doi:10.1038/aja.2012.108. PMID 23064688.
24. ↑ 24.0 24.1 Hatzimouratidis, K.; Giuliano, F.; Moncada, I.; Muneer, A.; Salonia, A.; Verze, P.; Parnham, A.; Serefoglu, E.C. (2017). EAU Guidelines on Erectile Dysfunction, Premature Ejaculation, Penile Curvature and Priapism. European Association of Urology. http://uroweb.org/wp-content/uploads/16-Male-Sexual-Dysfunction_2017_web.pdf.
25. ↑ Kaplan (1974), pp. 298–299
26. ↑ 26.0 26.1 Castleman, M. (2004). Great Sex. Rodale, Inc.. pp. 136–138. ISBN 978-1594869914. https://archive.org/details/GreatSex/mode/2up.
27. ↑ Masters, W.; V. Johnson (1970), Human Sexual Inadequacy, Little Brown & Company
28. ↑ Belliveau, F.; L. Richter (1970). Understanding Human Sexual Inadequacy. Hodder and Stoughton.
29. ↑ Kaplan (1989), pp. 48–58
30. ↑ Metz, M.; B. McCarthy (2003). Coping With Premature Ejaculation. New Harbinger Publications. pp. 123–128. ISBN 9781572243408.
31. ↑ Silverberg, S. (2010). Lasting Longer: The Treatment Program for Premature Ejaculation. Physicians Medical Press. pp. 44–57.
32. ↑ Birch. R.W. (2007). A Short Book About Lasting Longer. PEC Publishing. pp. 27–38. ISBN 978-1449523237.
33. ↑ De Carufel, F., & Trudel, G. (2006). Effects of a new functional-sexological treatment for premature ejaculation. Journal of Sex & Marital Therapy, 32(2), 97-114.
34. ↑ Cochrane Database of Systematic Reviews. (2011). Psychosocial interventions for premature ejaculation. Cochrane Database of Systematic Reviews.
35. ↑ Hartmann, Uwe (2007). "Re: Effects of a New Functional-Sexological Treatment for Premature Ejaculation". European Urology 52 (4): 1259–1261. doi:10.1016/j.eururo.2007.07.021. PMID 17933037. https://www.europeanurology.com/article/S0302-2838(07)00932-3/fulltext.
36. ↑ Herbenick, Debby; Fu, Tsung-chieh; Bowling, Jill; Fahs, Breanne; Schick, Vanessa (2023). "The US Public's Use of and Interest in Sex Therapy". Journal of Sex & Marital Therapy 49 (3): 256–273. doi:10.1080/0092623X.2023.2264470. https://www.tandfonline.com/doi/full/10.1080/0092623X.2023.2264470.
37. ↑ Raisi, Firoozeh; Soleimani, Robabeh; Ahmadzadeh, Azin; Sadati, Seyedeh Nasibeh; Fakhrian, Arghavan; Jalali, Mir Mohammad (2025-06-03). "Efficacy and safety of pharmacological treatments in patients with premature ejaculation: an umbrella review of meta-analyses of randomized controlled trials". The Journal of Sexual Medicine 22 (6): 1014–1023. doi:10.1093/jsxmed/qdaf094. ISSN 1743-6109. PMID 40326158. https://pubmed.ncbi.nlm.nih.gov/40326158.
38. ↑ 38.0 38.1 38.2 38.3 38.4 38.5 Crowdis, Marissa; Nazir, Saad (2022), "Premature Ejaculation", StatPearls (Treasure Island (FL): StatPearls Publishing), PMID 31536307, https://www.ncbi.nlm.nih.gov/books/NBK546701/, retrieved 2022-07-19
39. ↑ Hutchinson, K; Cruickshank, K; Wylie, K (May 1, 2012). "A benefit-risk assessment of dapoxetine in the treatment of premature ejaculation.". Drug Safety 35 (5): 359–72. doi:10.2165/11598150-000000000-00000. PMID 22452563.
40. ↑ McMahon, CG; Althof, SE, Kaufman, JM, Buvat, J, Levine, SB, Aquilina, JW, Tesfaye, F, Rothman, M, Rivas, DA, Porst, H (February 2011). "Efficacy and safety of dapoxetine for the treatment of premature ejaculation: integrated analysis of results from five phase 3 trials.". The Journal of Sexual Medicine 8 (2): 524–39. doi:10.1111/j.1743-6109.2010.02097.x. PMID 21059176.
41. ↑ Zhang, Dong; Cheng, Yue; Wu, Kerong; Ma, Qi; Jiang, Junhui; Yan, Zejun (2019-01-03). "Paroxetine in the treatment of premature ejaculation: a systematic review and meta-analysis". BMC Urology 19 (1): 2. doi:10.1186/s12894-018-0431-7. ISSN 1471-2490. PMID 30606186.
42. ↑ Wong, BL; Malde, S (Jan 2013). "The use of tramadol "on-demand" for premature ejaculation: a systematic review.". Urology 81 (1): 98–103. doi:10.1016/j.urology.2012.08.037. PMID 23102445.
43. ↑ James, Marrissa Martyn-St; Cooper, Katy; Ren, Shijie; Kaltenthaler, Eva; Dickinson, Kath; Cantrell, Anna; Wylie, Kevan; Frodsham, Leila et al. (2017-02-01). "Phosphodiesterase Type 5 Inhibitors for Premature Ejaculation: A Systematic Review and Meta-analysis" (in English). European Urology Focus 3 (1): 119–129. doi:10.1016/j.euf.2016.02.001. ISSN 2405-4569. PMID 28720356. https://www.eu-focus.europeanurology.com/article/S2405-4569(16)00015-8/abstract.
44. ↑ Shabsigh, Ridwan; Kaminetsky, Jed; Yang, Michael; Perelman, Michael (April 2017). "Pd69-02 Double-Blind, Randomized Controlled Trial of Topical 4% Benzocaine Wipes for Management of Premature Ejaculation: Interim Analysis" (in en). Journal of Urology 197 (4S). doi:10.1016/j.juro.2017.02.3143. ISSN 0022-5347. http://www.jurology.com/doi/10.1016/j.juro.2017.02.3143.
45. ↑ MacCarty E.J.; Dinsmore W.W. (2010). "Premature Ejaculation: Treatment Update". International Journal of STD & AIDS 21 (2): 77–81. doi:10.1258/ijsa.2009.009434. PMID 20089991.
46. ↑ "Health Canada". https://dhpp.hpfb-dgpsa.ca/dhpp/resource/46020.
47. ↑ Zhang, G.-X.; Yu, L.-P.; Bai, W.-J.; Wang, X.-F. (2012). "Selective resection of dorsal nerves of penis for premature ejaculation". International Journal of Andrology 35 (6): 873–879. doi:10.1111/j.1365-2605.2012.01296.x. PMID 22882515.
48. ↑ Kim, J. J.; Kwak, T. I.; Jeon, B. G.; Cheon, J.; Moon, D. G. (2004). "Effects of glans penis augmentation using hyaluronic acid gel for premature ejaculation". International Journal of Impotence Research 16 (6): 547–51. doi:10.1038/sj.ijir.3901226. PMID 15057258.
49. ↑ Kwak, T. I.; Jin, M. H.; Kim, J. J.; Moon, D. G. (2008). "Long-term effects of glans penis augmentation using injectable hyaluronic acid gel for premature ejaculation". International Journal of Impotence Research 20 (4): 425–428. doi:10.1038/ijir.2008.26. PMID 18548080.
50. ↑ 50.0 50.1 50.2 50.3 Anaissie, James; Yafi, Faysal A.; Hellstrom, Wayne J. G. (2016). "Surgery is not indicated for the treatment of premature ejaculation". Translational Andrology and Urology 5 (4): 607–612. doi:10.21037/tau.2016.03.10. PMID 27652232.
51. ↑ 51.0 51.1 Moon, Du Geon (2016). "Is there a place for surgical treatment of premature ejaculation?". Translational Andrology and Urology 5 (4): 502–507. doi:10.21037/tau.2016.05.06. PMID 27652223.
52. ↑ Yang, D. Y.; Ko, K.; Lee, W. K.; Park, H. J.; Lee, S. W.; Moon, K. H.; Kim, S. W.; Kim, S. W. et al. (2013). "Urologist's Practice Patterns Including Surgical Treatment in the Management of Premature Ejaculation: A Korean Nationwide Survey". The World Journal of Men's Health 31 (3): 226–31. doi:10.5534/wjmh.2013.31.3.226. PMID 24459656.
53. ↑ 53.0 53.1 "Premature ejaculation". Mayo Clinic.com. http://www.mayoclinic.com/health/premature-ejaculation/DS00578.
54. ↑ 54.0 54.1 Laumann, E.O. (1999). "Sexual Dysfunction in the United States: Prevalence and Predictors". Journal of the American Medical Association 281 (6): 537–44. doi:10.1001/jama.281.6.537. PMID 10022110.
55. ↑ "Next Men's Clinic Erectile dysfunction in the community: trends over time in incidence, prevalence, GP consultation and medication use—the Krimpen study: trends in ED". J Sex Med 7 (7): 2547–53. July 2010. doi:10.1111/j.1743-6109.2010.01849.x. PMID 20497307.
56. ↑ Mathers, M.J. (2013). "Premature Ejaculation in Urological Routine Practice". Aktuelle Urologie 44 (1): 33–9. doi:10.1055/s-0032-1331727. PMID 23381878.
57. ↑ Tang, W.S.; E.M. Khoo (2011). "Prevalence and Correlates of Premature Ejaculation in a Primary Care Setting: A Preliminary Cross-Sectional Study". Journal of Sexual Medicine 8 (7): 2071–8. doi:10.1111/j.1743-6109.2011.02280.x. PMID 21492404.
58. ↑ Porst, H. (2007). "The Premature Ejaculation Prevalence and Attitudes (PEPA) Survey: Prevalence, Co-morbidities, and Professional Help-Seeking". European Urology 51 (3): 816–824. doi:10.1016/j.eururo.2006.07.004. PMID 16934919.
59. ↑ Rowland, D. (204). "Self-Reported Premature Ejaculation and Aspects of Sexual Functioning and Satisfaction". Journal of Sexual Medicine 1 (2): 225–32. doi:10.1111/j.1743-6109.2004.04033.x. PMID 16429622.
60. ↑ Pearson, Catherine (2023-10-15). "8 Sex Myths That Experts Wish Would Go Away" (in en-US). The New York Times. ISSN 0362-4331. https://www.nytimes.com/2023/10/15/well/family/sex-myths.html.
61. ↑ Kalejaiye, Odunayo; Almekaty, Khaled; Blecher, Gideon; Minhas, Suks (2017-12-04). "Premature ejaculation: challenging new and the old concepts" (in en). F1000Research 6 (6:2084): 2084. doi:10.12688/f1000research.12150.1. PMID 29259775.
62. ↑ Wright, Karen (June 1, 1992). "Evolution of the Orgasm". Discover Magazine. http://discovermagazine.com/1992/jun/evolutionofthebi59.
63. ↑ Carufel, Francois de (2016). Premature Ejaculation: Theory, Evaluation and Therapeutic Treatment. Taylor & Francis. p. 6. ISBN 9781317280750. https://books.google.com/books?id=diMlDwAAQBAJ&pg=PA6.
64. ↑ Astbury-Ward, Edna (2002). "From Kama Sutra to dot.com: The history, myths and management of premature ejaculation" (in en). Sexual and Relationship Therapy 17 (4): 368. doi:10.1080/1468199021000017218. ISSN 1468-1994. http://www.tandfonline.com/doi/abs/10.1080/1468199021000017218.
65. ↑ Gajjala, Sukumar Reddy; Khalidi, Azheel (2014). "Premature ejaculation: A review". Indian Journal of Sexually Transmitted Diseases and AIDS 35 (2): 92–95. doi:10.4103/0253-7184.142391. ISSN 2589-0557. PMID 26396440.
66. ↑ Waldinger, Marcel D. (2013). "History of Premature Ejaculation". Premature Ejaculation. pp. 5–24. doi:10.1007/978-88-470-2646-9_2. ISBN 978-88-470-2645-2.
67. ↑ Kaplan (1974), p. 292
68. ↑ Puppo, Vincenzo; Puppo, Giulia (2016). "Comprehensive review of the anatomy and physiology of male ejaculation: Premature ejaculation is not a disease". Clinical Anatomy 29 (1): 111–119. doi:10.1002/ca.22655. PMID 26457680.
69. ↑ 69.0 69.1 Hart, Graham; Wellings, Kaye (2002-04-13). "Sexual behaviour and its medicalisation: in sickness and in health" (in en). BMJ 324 (7342): 896–900. doi:10.1136/bmj.324.7342.896. ISSN 0959-8138. PMID 11950742. PMC 1122837. https://www.bmj.com/content/324/7342/896.
70. ↑ 70.0 70.1 70.2 70.3 Grunt-Mejer, Katarzyna (2022-07-03). "The history of the medicalisation of rapid ejaculation—A reflection of the rising importance of female pleasure in a phallocentric world" (in en). Psychology & Sexuality 13 (3): 565–582. doi:10.1080/19419899.2021.1888312. ISSN 1941-9899. https://www.tandfonline.com/doi/full/10.1080/19419899.2021.1888312.
71. ↑ Grunt-Mejer, Katarzyna (2022-07-03). "The history of the medicalisation of rapid ejaculation—A reflection of the rising importance of female pleasure in a phallocentric world" (in en). Psychology & Sexuality 13 (3): 565–582. doi:10.1080/19419899.2021.1888312. ISSN 1941-9899. https://www.tandfonline.com/doi/full/10.1080/19419899.2021.1888312.
72. ↑ Kaplan, Helen Singer (1989). How to overcome premature ejaculation (2nd ed.). New York: Brunner/Mazel. p. 295. ISBN 9780876305423. OCLC 1008628084. https://books.google.com/books?id=EQI-TEM2fSoC.
73. ↑ 73.0 73.1 Grunt-Mejer, Katarzyna (2022-07-03). "The history of the medicalisation of rapid ejaculation—A reflection of the rising importance of female pleasure in a phallocentric world" (in en). Psychology & Sexuality 13 (3): 565–582. doi:10.1080/19419899.2021.1888312. ISSN 1941-9899. https://www.tandfonline.com/doi/full/10.1080/19419899.2021.1888312.
74. ↑ 74.0 74.1 Kaplan, Helen Singer (1974). The new sex therapy: active treatment of sexual dysfunctions. New York: Brunner/Mazel. p. 28. ISBN 9780876300831. OCLC 1015728698. https://books.google.com/books?id=AovC97CUny0C.
75. ↑ Stegenga, Jacob (2021-12-02). "Medicalization of Sexual Desire". European Journal of Analytic Philosophy 17 (2): 5–34. doi:10.31820/ejap.17.3.4. ISSN 1849-0514.

## Cited sources

* Kaplan, Helen S. (1974). The New Sex Therapy. Psychology Press. ISBN 9780876300831.
* Kaplan, Helen S. (1989). How to Overcome Premature Ejaculation. Routledge. ISBN 9780876305423.

## Further reading

* Hamblin, James (2012). "When Is Ejaculation 'Premature,' and When Should a Penis Be Made Numb?". The Atlantic. https://www.theatlantic.com/health/archive/2012/11/when-is-ejaculation-premature-and-when-should-a-penis-be-made-numb/265071/. Retrieved 6 March 2017. "According to [Dr. John Mulhall], when we talk casually about premature ejaculation ... we're usually talking about what the medical community would consider 'premature-ejaculatory-like syndrome,' or simply 'rapid ejaculation.' ... Mulhall says it comes down to whether the guy lasts long enough. If his partner is made wholly replete in 90 seconds, then a man who lasts 95 seconds can be fine. But if another guy lasts 15 minutes, and that's not cutting it, then it's a problem and can be considered rapid.".

## External links

Classification|

* ICD-10: F52.4
* ICD-9-CM: 302.75

|

External resources|

* MedlinePlus: 001524
* eMedicine: med/643

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Outline of human sexuality

Physiology and biology|

* Erection
* Insemination
* Intersex
* Libido
* Nocturnal emission
* Orgasm
* Female and male ejaculation
* Pelvic thrust
* Pre-ejaculate
* Pregnancy
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Religion and
sexuality|

* Buddhism
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* Islam
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Mental and behavioral disorders (F00–F99 & 290–319)

Adult personality and behavior

| Gender dysphoria|

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|

Other|

* Factitious disorder
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(developmental disabilities)|

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Neurological and symptomatic

| Autism spectrum|

* Autism
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Dementia|

* AIDS dementia complex
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Other|

* Delirium
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Neurotic, stress-related and somatoform

| Adjustment|

* Adjustment disorder with depressed mood

|

Anxiety|

| Phobia|

* Agoraphobia
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Other|

* Generalized anxiety disorder
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Dissociative|

* Depersonalization disorder
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Somatic symptom|

* Body dysmorphic disorder
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Physiological and physical behavior

| Eating|

* Anorexia nervosa
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Nonorganic
sleep|

* Hypersomnia
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Postnatal|

* Postpartum depression
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Sexual dysfunction|

| Arousal|

* Erectile dysfunction
* Female sexual arousal disorder

|

Desire|

* Hypersexuality
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Orgasm|

* Anorgasmia
* Delayed ejaculation
* Premature ejaculation
* Sexual anhedonia

Pain|

* Nonorganic dyspareunia
* Nonorganic vaginismus

Psychoactive substances, substance abuse and substance-related

* Drug overdose
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Schizophrenia, schizotypal and delusional

| Delusional|

* Delusional disorder
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|

Psychosis and
schizophrenia-like|

* Brief reactive psychosis
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Schizophrenia|

* Childhood schizophrenia
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Symptoms and uncategorized

* Catatonia
* False pregnancy
* Intermittent explosive disorder
* Klüver–Bucy syndrome
* Psychogenic non-epileptic seizures
* Psychomotor agitation
* Stereotypy

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