Premature Ejaculation Q & A

How do I know if I have Premature Ejaculation (PE)?

If you usually ejaculate within a minute of penetration / before you really want to, and you feel you can’t control when you ejaculate, and you and/or your partner are upset about it, then you probably have PE.

What causes Premature Ejaculation? 

There are many possible causes. But most lifelong PE is simply the result of having a very low “ejaculation threshold.” Simply put, it doesn’t take much stimulation for you to climax. That’s just how you’re wired.

How common is PE?

PE is thought to affect 20-30% of American men.

Don’t most men just “grow out of” PE as they get older?

Many do, but a substantial number don’t. I see many men who still have serious PE in their 40’s, 50’s, and beyond.

How treatable is Premature Ejaculation?

Almost any man who is truly motivated can achieve better ejaculatory control. Men with milder PE often see results with simple behavioral techniques. More severe PE tends to require medication as well (see below).

How many sessions does PE treatment require?

Most men with PE can be treated in from 2 to 5 sessions.

What are the most common treatments for Premature Ejaculation?

Behavioral treatments for PE all tend to rely on some variant of what’s called “stop-start,” which basically means learning to sense the earliest signs of orgasms and stopping all stimulation until the feeling passes.

Medications for PE, on the other hand, work by actually raising your orgasm threshold, so you can enjoy more arousal without ejaculating. 

What are the most common medications for Premature Ejaculation?

All of the so-called serotonin reuptake inhibitors (SRI’s) will tend to raise your orgasmic threshold. These medications are all FDA-approved, though none of them has been FDA-approved for PE. However, doctors are free to prescribe them “off-label,” as long as the patient gives appropriate informed consent after a thorough discussion of risks, benefits, and other options.

What if I have PE but I’m single and don’t have a partner?

About half of the men who consult me or PE are single, so you’re in good company.  And many men with partners prefer to come in alone, which is fine.

What’s the most common mistake made by men with Premature Ejaculation?

Many men try to delay orgasm by dissociating themselves from the situation, for example by thinking of something unpleasant during sex. But that’s like trying to have bad sex.

What’s more, partners tend to hate it. “It’s like all he focuses on is not ejaculating,” says one partner. “It’s as if I’m not even there.”

What’s the most common mistake made by partners of men with PE?

Partners tend to think that because he got an orgasm and they didn’t, that he’s just being selfish. Nothing could be farther from the truth. Most men with PE want very much to please their partners.

Often a partner will say, “Well, he got his pleasure.” Not so. Usually, he’s miserable about it.

You might think of sex as like a meal -- appetizers, main course, dessert. Orgasm is dessert. A man with PE sits down to eat, has a few bites of salad, then they clear everything away and bring him dessert. Not very satisfying.

What’s distinctive about your treatment for PE?

As a sex therapist, I know the possibilities and limits of psychological treatments. As a medical doctor, I can prescribe medication for PE when behavioral treatments have failed. As a psychiatrist, I have extensive knowledge of the long-term risks and benefits of these medications. And as someone with decades of experience treating Premature Ejaculation, I can help you select options that are best for you.  

What can I expect from a first visit for PE?

You can expect a better understanding of why you have Premature Ejaculation, a list of specific things you can do right away to start getting more enjoyment from sex, and a knowledge of what your options are for the future.

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