In this episode, we discuss premature ejaculation, a problem faced by 30-40% of men at some point in their lives.
*But what defines premature ejaculation and, for that matter, what is considered a normal time to ejaculation?
*10 minutes? 5 minutes? 1 minute?
*What causes premature ejaculation in men?
*Do all men experience premature ejaculation for the same reasons?
*And what, if anything, can be done to help men increase the time to ejaculation?
Understanding Premature Ejaculation: Expert Insights from Dr. Helen Bernie
Premature ejaculation (PE) is a common concern, affecting 30–40% of men at some point in their lives. While often a source of embarrassment or a blow to self-esteem, for some men it can have a significant impact on relationships and overall well-being. In a recent episode of Better Man Clinics, Dr. Helen Bernie, a board-certified urologist and Director of Sexual and Reproductive Medicine at Indiana University, offered a comprehensive look at PE-what it is, what causes it, and how it can be managed.
What Is Premature Ejaculation?
PE is defined by both the timing of ejaculation and the level of distress it causes. There are two main types:
Lifelong PE: Present from a man's first sexual experiences, typically characterized by ejaculation within about one minute of penetration and a lack of control.
Acquired PE: Develops later, often defined as ejaculation within about three minutes, and is also associated with a lack of control and distress for the individual or their partner.
Crucially, Dr. Bernie emphasizes that PE is only considered a problem if it causes distress-if neither the man nor his partner is bothered, it may not require intervention.
What Is “Normal” Ejaculation Timing?
The average time to ejaculation (ejaculatory latency time) is about 5–6 minutes, but there is a wide range considered normal. Some men may last much longer, while others may ejaculate sooner, and both can be normal depending on individual and partner satisfaction.
Causes of Premature Ejaculation
PE can result from a combination of psychological, behavioral, and biological factors:
Psychological: Anxiety, stress, relationship issues, or past trauma.
Behavioral: Infrequent sexual activity or high arousal with a new partner.
Biological: Differences in neurotransmitter levels, prostate or bladder function, and sometimes anatomical sensitivity.
Despite advances in understanding, the full mechanisms behind ejaculation and orgasm remain complex and not fully understood.
At-Home Strategies and When to Seek Help
Men experiencing PE can try several self-directed strategies:
Maintain a healthy lifestyle (diet, exercise, managing chronic conditions).
Increase frequency of sexual activity or self-stimulation before intercourse.
Open communication with partners to address relationship dynamics.
If these approaches are not effective or the problem persists, Dr. Bernie recommends seeking medical advice for a thorough evaluation.
Diagnosis and What to Expect at the Doctor’s Office
A diagnosis of PE is primarily based on a detailed medical, sexual, and relationship history. Physical exams and validated questionnaires may be used, but invasive tests are rarely needed. The focus is on understanding the timing, context, and impact of the issue.
Treatment Options
Treatment for PE is tailored to the individual and may include:
Behavioral and Psychological Therapy: Techniques like the start-stop or squeeze method, psychotherapy, and couples counseling can be effective, especially when combined with other treatments. Improvement typically takes about three months of consistent effort.
Pharmacotherapy: Medications such as selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, topical anesthetics, and, in some cases, tramadol or alpha-blockers. Most SSRIs must be taken daily and can take two weeks to show effects. Side effects are generally mild but should be discussed with a healthcare provider.
Combination Therapy: Using behavioral and pharmacological approaches together often yields the best results, though improvements are typically in the range of three- to six-fold increases in time to ejaculation.
Other Treatments: Procedures like hyaluronic acid injections or dorsal neurectomy are considered experimental and not recommended outside clinical trials due to limited evidence and potential risks.
Common Myths Addressed
Frequency of Sex: While infrequent sex can sometimes lead to shorter latency times, it is not a primary cause of PE.
Circumcision and Sensitivity: There is no evidence that circumcision status significantly affects PE risk.
Viagra and PE: PDE5 inhibitors like Viagra are only helpful if erectile dysfunction is also present; they do not treat PE directly.
Alternative Therapies
Acupuncture and certain herbal remedies have limited evidence for effectiveness in PE, with only minor improvements seen in small studies.
Setting Expectations
Most treatments, whether behavioral or medical, result in modest improvements (e.g., from 30 seconds to 2–3 minutes). The goal is to reduce distress and improve satisfaction, not necessarily to achieve dramatically prolonged intercourse.
Final Thoughts: Living Your Best Life
Dr. Bernie concludes by encouraging men to value their own health and well-being, emphasizing that taking care of oneself is essential not just for personal benefit but also for the people around them.
To answer these questions and many more we turned to a true expert.
Dr. Helen Bernie is a board-certified, fellowship-trained urologist and the Director of Sexual and Reproductive Medicine at Indiana University. She is also an Assistant Professor of Urology at the Indiana University School of Medicine where she teaches medical students. Dr. Bernie completed her residency in Urology at the University of Rochester Medical Center and went on to complete a two-year fellowship in Sexual and Reproductive Medicine at Memorial Sloan Kettering Cancer Center and New York Presbyterian/Weill Cornell Medical College. She is an active member of the Sexual Medicine Society of North America and a member of the American Society for Reproductive Medicine.
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