Premature, rapid or early ejaculation is defined by the DSM V as: a persistent or recurrent pattern of ejaculation occurring during partnered sex within 1 minute of vaginal penetration AND before the individual wishes it, for at least six months and present in 75-100% of sexual activities, causing significant distress, and is not due to other significant disorders/stressors in the individual’s life. Premature ejaculation (PE) can be lifelong or acquired. For the intents of this article, we will focus on acquired PE, which means the disturbance began after a period of relatively normative functioning sexually. While 20-30% of males report being concerned with their sexual longevity, only 1% qualify for the diagnosis.

Other factors to consider are if the PE happens every time or only sometimes. Acquired PE can occur due to any of the following: neurological, genetic, physical illness, drug side effect, psychological distress, relationship distress, or psychosexual deficit skills. While this list is not exhaustive, it is a start in considering where to begin when dealing with premature ejaculation.

When starting with a client that reports experiencing PE, I recommend having him visit his doctor and/or a urologist to rule out a biological/physiological component to the disorder. Once all medical options are ruled out (or diagnosed and treated concurrently), the client may still need to be assessed psychologically about his PE. How long it has been a problem, who defined it as a problem at the start, what his stroke/thrust number is (measured in strokes from entering the vagina until ejaculation; can also be measured in minutes), if any of this differs from when he masturbates, what is foreplay like for each partner, and what are the expectations that he has for his future sexual performance. A male struggling with PE may also be struggling with anxiety or depression, which can be addressed within the context of PE as well as life itself. How a male copes with stress, feeling down, or being anxious is telling.

Males are fed multiple myths that create the notion of these impossibly high standards that he must strive to meet as a man – especially sexually. No man is a 12-inch penis that stays perpetually hard and makes a woman orgasm solely from pounding into her repeatedly. First, the average sexual experience is around five and a half minutes, from entry to end (Journal of Sexual Medicine 2005). Most females come from clitoral stimulation, not vaginal. Sex is also not just a penis in a vagina. Sex has a multitude of definitions and ways to express sexual desire and intimacy. Males need to know that there are other things that can be done for the experience to be fulfilling for both partners. As for size, the average American male has a penis size of five inches erect, give or take.

Dr. Zilbergeld (1992) recommends that males spend time documenting these mistaken beliefs about sex and the negative flak he gives himself in response to not living up to fictional standards. Part of the process of treating such things like acquired PE require treating anxious or depressive feelings, debunking myths and educating the individual on the realities and functionalities of sex, and addressing the goals the man has for himself sexually. Low self esteem and/or negative self talk inhibit a man from physically achieving his goals. The mind’s thoughts help create how people perceive the world. If thoughts are similar/equal to reality, negativity will only perpetuate the problem.

Self love (masturbation) and partner love (sex) will also be critical components of treating PE. Be prepared: this conversation is very detailed. Things to consider are: stroke, direction, grip, the use of pornography, and use of lubrication. What about this is similar and different from sex with a partner? Learning about the variant levels of arousal and how quickly the penis goes from being soft to climax are vital pieces of information to pinpoint where to focus on learning how to extend those times/experiences. Using self pleasure on a one to ten scale, the goal is to keep sensation levels between the four to seven range until ready to climax. One will need to practice how to stay in that range before bringing his partner(s) into the treatment. However, while masturbating to learn to extend longevity, one can find various ways to keep his partner happy, including cuddling, mutual self pleasure, and manual and oral stimulation.

Consider what sex is like for you. What is foreplay like? Does either partner have fantasies that could be introduced to the repertoire? Start expanding sexual horizons. Maybe he has great oral sex skills. Perhaps the couple has sexual interests that have never been addressed that draw the focus away from the longevity of penetration and can bring them enjoyment in other ways, such as toys or kink. Also, find out what one’s refractory time is, or the time lapsed in between sex. Typically, males with PE have lower refractory periods and perform sexually soon after ejaculation.

This provides an overview of acquired PE, and is by no means meant to be a substitute for treatment. If you (or someone you know) may be suffering, encourage him to talk to a doctor or a sex therapist. If he is distressed, he does not have to live within those constraints forever. Treatment is available and can be quite beneficial. Check out aasect.org or psychologytoday.com for a list of therapists in your area that can be of assistance.