Premature Ejaculation (PE) – A Complete Guide To Causes, Diagnosis and Treatment

What is Premature Ejaculation?

Premature ejaculation (PE) is one of the most common forms of male sexual dysfunction, where a man ejaculates sooner than he or his partner desires, often within 1 to 3 minutes of penetration. While occasional early climax is normal, consistent and uncontrollable early ejaculation that causes personal or relational distress may be diagnosed as PE.

This condition affects approximately 1 in 3 men globally at some point in their lives, including a large number of married men in Pakistan. It is not a disease or a result of “poor self-control”—instead, it can be caused by a variety of psychological or physical factors such as anxiety, relationship stress, hormonal imbalance, or medical conditions like diabetes or high blood pressure.

PE can be classified into

• Primary PE—present since the man’s first sexual experience
• Acquired PE—develops later due to medical, emotional, or situational changes

Men with PE often report stress, frustration, and avoidance of intimacy, which can impact both personal confidence and marital relationships.

The good news is that premature ejaculation is treatable. With proper diagnosis and support—from medications like Dapoxetine (Everlong tablets) to behavioral techniques and counseling—most men can regain sexual confidence and satisfaction.

If PE is causing distress, it’s important to consult a qualified healthcare provider. You are not alone, and effective help is available.

Symptoms of Premature Ejaculation

The main symptom of Premature Ejaculation (PE) is the inability to delay ejaculation for more than one to three minutes after vaginal penetration. However, it may also occur during other sexual activities, including masturbation.

PE can be categorized into two main types:

1. Lifelong PE: Present from the first sexual experience and occurs in nearly all situations.
2. Acquired PE: Develops after a period of normal sexual performance, often due to psychological or physical changes.

While occasional early ejaculation is common and usually not a cause for concern, PE is diagnosed when:

1. It happens consistently or almost always
2. You are unable to control or delay ejaculation
3. You feel distressed, frustrated, or avoid sexual intimacy

PE can also lead to:

• Low self-confidence and self-esteem
• Increased performance anxiety
• Strained marital or emotional relationships
• Emotional distress for the partner, especially in long-term relationships

If these symptoms persist and interfere with your relationship or mental health, seeking medical help is highly recommended.

Understanding the Ejaculation Process

Ejaculation is a natural reflex controlled by the brain, spinal cord, and nerves. It typically involves two phases:

• Emission: Sperm and semen move into the urethra.
• Ejection: Rhythmic muscle contractions push semen out through the penis.

Neurotransmitters like serotonin play a key role. High serotonin levels delay ejaculation, while low levels may lead to Premature Ejaculation (PE).

In PE, this natural timing is disrupted, either due to psychological stress or a physical imbalance.

Causes of Premature Ejaculation

The exact cause of Premature Ejaculation (PE) is not fully understood, but research shows it results from a combination of psychological, biological, and relational factors.

Psychological Causes

Emotional and mental health issues are among the most common triggers for PE, especially in acquired cases. These may include:

• Performance anxiety or fear of failure
• Depression or stress
• Poor body image or low self-confidence
• Guilt, especially due to religious or cultural pressures
• Relationship issues or communication problems
• Unrealistic expectations about sex
• Early sexual trauma or past sexual repression

A 2019 study of Chinese men with PE found a strong correlation between anxiety, depression, and poor sleep, further confirming the psychological impact.

Biological & Medical Causes

Some men may have underlying physical or neurological conditions contributing to PE:

• Low serotonin levels in the brain (affects ejaculation timing)
• Hormonal imbalances
• Swelling or infection of the prostate (prostatitis) or urethra
• Erectile Dysfunction (ED): Anxiety around maintaining an erection can lead to rushed climaxing
• Chronic illnesses like diabetes, High blood pressure, Thyroid disorders, Multiple Sclerosis, Alcohol or drug misuse, Genetic or inherited traits

Relationship Factors & Aging

PE can affect both partners emotionally, leading to frustration, reduced intimacy, or avoidance of sexual activity. Age is not a direct cause of PE, but older men may experience a faster climax due to reduced erection quality or sensitivity changes.

Diagnosis of Premature Ejaculation

Premature Ejaculation (PE) is usually diagnosed based on a man’s sexual history, symptoms, and emotional impact, rather than medical tests. If early ejaculation happens frequently and causes stress, frustration, or relationship issues, it’s time to see a qualified doctor, such as a urologist or general physician.

What to Expect During Diagnosis

Your doctor will ask detailed questions about your sexual experience, including:

• How long have you had this problem?
• Does it happen during every sexual activity or only sometimes?
• Does it occur with all partners or just one?
• Does it happen during masturbation as well?
• How long after penetration does ejaculation occur?
• How does PE affect your relationship and confidence?
• Do you also experience Erectile Dysfunction (ED)?
• Are you using any medications, herbal supplements, alcohol, or drugs?

Answering honestly helps the doctor determine whether the PE is lifelong (primary) or acquired (secondary), and whether it’s linked to any emotional or physical health issues.

Are Lab Tests Needed?

In most cases, lab tests are not required. However, your doctor might recommend testing if they suspect:

1. Hormonal imbalance
2. Prostate infection
3. Neurological conditions
4. Other underlying medical problems

Risk Factors for Premature Ejaculation

Several factors can increase a man’s risk of developing Premature Ejaculation (PE). While PE can affect any man at any age, the following physical and emotional triggers make it more likely:

1. Erectile Dysfunction (ED)

Men who struggle with getting or maintaining an erection may unconsciously rush to climax out of fear of losing the erection. This creates a cycle where anxiety worsens both ED and PE over time.

2. Psychological Stress

High levels of stress—whether related to work, finances, or family life—can interfere with focus and emotional control during sex. Chronic stress also increases muscle tension and anxiety, making it harder to delay ejaculation.

3. Relationship Issues

Poor communication, unresolved conflicts, or emotional distance from a partner can contribute to PE. Lack of trust or intimacy may also lead to anxiety during sexual activity.

4. Anxiety Disorders

Men with generalized anxiety, performance anxiety, or social anxiety may be more prone to premature ejaculation. Constant overthinking disrupts relaxation and timing.

5. Lack of Experience or Confidence

Younger men or those with limited sexual experience may ejaculate early due to overexcitement, lack of control, or fear of disappointing their partner.

6. Hormonal or Neurochemical Imbalance

Low serotonin levels in the brain, abnormal hormone levels, or overly sensitive nerve pathways may predispose some men to early climax, even in the absence of psychological triggers.

Understanding these risk factors is the first step toward managing PE effectively. The good news is that most of them are treatable with proper medical guidance, lifestyle changes, or counseling.

Treatment for Premature Ejaculation (PE)

Treating Premature Ejaculation involves a combination of behavioral strategies, medications, topical therapies, and counseling. For many men, the most effective results come from combining more than one approach.

1. Behavioral Techniques

Simple lifestyle strategies and sexual techniques can help some men gain better control over ejaculation. These include:

• Masturbating before intercourse to reduce arousal levels
• Focusing on foreplay instead of intercourse
• Delaying penetration to reduce performance pressure

These techniques can be self-practiced or learned through guided sexual therapy.

2. Pelvic Floor Exercises (Kegels)

Weak pelvic floor muscles can reduce your ability to control ejaculation. Kegel exercises help strengthen these muscles.

How to perform:

• Identify the muscles used to stop urination or prevent gas.
• Squeeze and hold for 3–5 seconds, then relax.
• Do 3 sets of 10 reps daily.

These exercises improve control over ejaculation and enhance overall sexual function.

3. The Pause-Squeeze & Stop-Start Methods

• Pause-Squeeze: Stimulate the penis until near climax, then gently squeeze the shaft where the head meets the body until the urge passes.
• Stop-Start: Pause stimulation right before climax, wait until arousal subsides, then restart. Repeat multiple times before ejaculation.

Both methods can retrain your body and increase control over time.

4. Condoms & Numbing Agents

Thicker condoms or specially designed climax control condoms (e.g., Durex Prolong, Trojan Extended Pleasure) can reduce sensitivity.

Here are some affordable and popular condoms used for the treatment of Premature ejaculation:

• Durex Extended Pleasure Condom
• Durex Maxima Condom
• Josh Delay Condoms

Numbing creams and sprays (like lidocaine or benzocaine) are applied to the penis 10–15 minutes before intercourse. These reduce stimulation but must be washed off before penetration to avoid numbing the partner.

Here are some best numbing creams and sprays commonly used for the treatment of Premature Ejaculation:

1. Knight Rider Spray
2. Largo Cream
3. Largo Delay Spray
4. MAXMAN Delay Spray
5. Super Viga Spray

Use condoms to avoid transferring numbing agents to your partner.

5. Prescription Medications

Certain medications are used off-label to treat PE, often in daily or on-demand doses:

A. Selective Serotonin Reuptake Inhibitors (SSRIs)

Originally used for depression, these can delay orgasm:

• Paroxetine, Sertraline, Fluoxetine, Citalopram, Escitalopram
• Dapoxetine (the only SSRI developed specifically for PE; available in Pakistan, widely sold under the brand name EverLong tablets.

B. Tramadol

A pain reliever that delays ejaculation. Not used with SSRIs due to the risk of side effects like nausea or drowsiness. It can be habit-forming if used long-term.

C. Phosphodiesterase-5 Inhibitors (PDE-5 Inhibitors)

Phosphodiesterase-5 Inhibitors (PDE-5 Inhibitors) like Sildenafil (Viagra), Tadalafil (Cialis), and Vardenafil (Levitra) may help men who also have Erectile Dysfunction (ED). Often used alongside SSRIs.

Always consult a doctor before starting medication. Self-medication can be risky.

6. Counseling & Psychological Therapy

For many men, performance anxiety, past trauma, relationship stress, or low confidence contribute to PE. Working with a psychologist or sex therapist can help you:

• Manage anxiety
• Improve relationship communication
• Reduce guilt or unrealistic expectations
• Increase sexual confidence

Therapy is especially effective when combined with medication or exercises.

7. Future Treatments

Ongoing research is exploring newer treatments, including:

• Modafinil (a wakefulness-promoting drug)
• Silodosin (used for enlarged prostate)
• Botox injections into pelvic muscles

These are still under clinical investigation and are not yet standard treatments.

8. Success Rate & Ongoing Management

With proper treatment, up to 95% of men experience improvement. However, PE may return if therapy is stopped. Staying consistent and open with your doctor is key.

Frequently Asked Questions (FAQs)

Here are some frequently asked questions about premature Ejaculation:

Why do I ejaculate too early?

Premature ejaculation can result from a mix of psychological and physical factors. Common causes include:

• Performance anxiety or stress
• Low serotonin levels in the brain
• Erectile dysfunction
• Medical issues like diabetes or thyroid imbalance
• Excessive alcohol or recreational drug use

Consulting a doctor is important to identify the root cause and begin appropriate treatment.

Can premature ejaculation be cured?

Yes. Premature ejaculation is a treatable condition. Most men benefit from one or a combination of the following:

• Prescription medications like Dapoxetine (EverLong Tablets)
• Numbing sprays or creams
• Behavioral methods such as the stop-start or pause-squeeze techniques
• Kegel (pelvic floor) exercises
• Counseling or sex therapy

Many men see significant improvement with consistent treatment.

Does Everlong (Dapoxetine) really work for premature ejaculation?

Yes, Everlong, which contains Dapoxetine, is a clinically approved medication for the treatment of premature ejaculation (PE) in men. It works by increasing the time to ejaculation and improving control during sexual activity.

According to a 2019 meta-analysis published in the journal Sexual Medicine Reviews, 30 mg to 60 mg doses of Dapoxetine were well-tolerated and effective in most patients with lifelong or acquired PE.

Everlong is a brand name version of Dapoxetine available in Pakistan and widely used in clinical practice. Patient feedback generally supports its effectiveness when taken 1–3 hours before intercourse.

Does premature ejaculation cause infertility?

No, PE does not directly cause infertility. However, if ejaculation happens before penetration, it may reduce the chances of pregnancy. Proper timing or treatment can improve fertility outcomes.

Can wearing a condom help with premature ejaculation?

Yes. Condoms reduce penis sensitivity, which can help delay ejaculation. Special condoms with numbing agents like benzocaine or lidocaine are also available to enhance control.

What’s the difference between erectile dysfunction & premature ejaculation?

• Erectile Dysfunction (ED) is the inability to get or maintain an erection.
• Premature Ejaculation (PE) is when ejaculation happens too early despite having an erection.

ED can sometimes contribute to PE, especially if anxiety about losing the erection causes men to climax too soon. A healthcare provider can evaluate and treat both conditions together.

Can drinking alcohol delay ejaculation?

While alcohol might delay orgasm, it is not a safe or recommended treatment for PE. Long-term alcohol use can cause more harm to sexual performance and overall health.

How do I stop ejaculating early?

The best approach is to identify and treat the underlying cause. Whether it’s stress, a hormone imbalance, or ED, solutions include medication, exercises, behavioral techniques, and therapy. A doctor or urologist can guide you toward the right combination for your needs.

Can masturbation cause premature ejaculation?

Masturbation itself does not directly cause premature ejaculation. However, certain habits—such as rushing to climax, using excessive pressure, or frequent stimulation without control—can condition the body to ejaculate quickly. Practicing controlled, slower techniques during masturbation can help improve endurance over time.

What is the meaning of premature ejaculation in Urdu?

Premature ejaculation is called “قبل از وقت انزال” in Urdu. It refers to a condition where a man ejaculates earlier than desired during sex, often causing dissatisfaction for both partners.

Are PDE5 inhibitors (like Cialis or Tadalafil) good for premature ejaculation?

PDE5 inhibitors such as Tadalafil (Cialis) or Sildenafil (Viagra) are primarily used to treat erectile dysfunction, but some studies suggest they may also help with premature ejaculation, especially when PE is linked to performance anxiety or weak erections.

They work by improving blood flow and reducing anxiety during sex, which can indirectly improve ejaculatory control. However, they are not FDA-approved specifically for PE, and results may vary.

Conclusion

Premature ejaculation is a common but manageable sexual health condition. Whether caused by psychological stress, medical issues, or performance anxiety, effective treatments are available. With the right combination of medication, behavioral techniques, and emotional support, most men can improve their control and confidence in the bedroom. If PE is affecting your quality of life or relationship, don’t hesitate to seek help from a qualified healthcare provider.