Premature Ejaculation

Premature ejaculation (PE), also called early ejaculation, rapid ejaculation, or finishing too quickly, occurs when a man ejaculates sooner than he wants and has difficulty delaying ejaculation. It may happen before penetration, shortly afterward, or simply sooner than desired.

Common signs include:

• Finishing sooner than desired
• Ejaculating with little warning
• Rushing as arousal increases
• Anxiety or reduced confidence during sex
• Avoiding intimacy because of performance concerns
• A noticeable change from how long you previously lasted

Occasionally finishing sooner than expected is common. When the pattern is persistent or starts affecting confidence, satisfaction, or your relationship, it is worth evaluating.

Premature ejaculation is generally described as lifelong or acquired. Distinguishing between them matters because the contributing factors and treatment strategy may be different.

Lifelong premature ejaculation

Lifelong PE has been present since a man’s earliest sexual experiences and occurs during most or nearly all encounters. It is commonly associated with ejaculation before or within about one minute of penetration, difficulty delaying ejaculation, reduced control, and distress. Lifelong PE may involve differences in nervous-system signaling, sensitivity, arousal processing, genetics, and regulation of the ejaculation reflex. [4]

Acquired premature ejaculation

Acquired PE begins after a man previously had more control or lasted significantly longer. It generally involves a meaningful and bothersome reduction from his previous ejaculation time, often to about three minutes or less. [4] Erectile dysfunction, performance anxiety, prostate or pelvic conditions, thyroid dysfunction, diabetes, medication changes, relationship stress, and other changes in health may contribute. A new loss of ejaculatory control should be evaluated rather than dismissed.

PE rarely has just one cause. Biological, physical, medical, and emotional factors can overlap, especially in acquired PE. The goal is to determine what is driving the problem rather than assume every man needs the same treatment.

Nervous-system signaling and sensitivity

Ejaculation depends on communication between the brain, spinal cord, nerves, pelvic muscles, and reproductive organs. Some men experience increased sensitivity, a rapid rise in arousal, difficulty recognizing when ejaculation is approaching, or a very short interval between manageable arousal and the point when ejaculation becomes difficult to stop. These factors may be particularly important in lifelong PE.

Erectile dysfunction

Some men with erectile dysfunction rush because they are afraid they will lose their erection. They may increase stimulation, move faster, or try to finish before the erection changes. Research has found that men with PE have nearly four times the odds of also experiencing ED. [2] When the conditions occur together, both should be evaluated rather than treating ejaculation timing alone.

Pelvic-floor function

The pelvic floor participates in erections, ejaculation, orgasm, and urinary control. Weakness, excessive tension, poor coordination, or difficulty relaxing may affect ejaculatory control in some men. This is why more Kegel exercises is never the answer. Some men need strengthening; others need relaxation and better coordination. Pelvic-floor muscle training may help selected men with PE, although there is no single ideal program for everyone. [7]

Medical, hormonal, medication, and lifestyle factors

Acquired PE can appear alongside prostate inflammation, pelvic discomfort, urinary symptoms, thyroid dysfunction, diabetes, neurological conditions, changes in erection quality, medication changes, or substance use. Low testosterone is not considered the primary cause of most PE, but hormone imbalance can affect libido, energy, mood, erection quality, and overall sexual function.

Stress, poor sleep, depression, relationship conflict, smoking, vaping, excessive alcohol use, inactivity, and performance pressure may also worsen the problem. For many men, several factors are present at the same time.

Erectile dysfunction, premature ejaculation, and performance anxiety are separate problems, but they frequently overlap. A man with ED may rush because he is afraid of losing his erection. Rushing can contribute to PE. After several difficult experiences, fear of finishing too quickly or losing the erection may create even more pressure and make both problems worse.

The overlap is significant: a systematic review and meta-analysis found that men with PE had approximately 3.68 times the odds of also experiencing erectile dysfunction. [2] The emotional impact can be substantial as well; in one observational study, 64% of men with PE reported “quite a bit” or “extreme” personal distress. [3]

When these concerns occur together, treatment may need to address erection reliability, ejaculatory control, confidence, and anxiety at the same time. Treating only one part of the cycle may leave another contributor unchanged.

At Bawa Medical, Dr. Bawa treats premature ejaculation based on why it is happening rather than using a one-size-fits-all approach. PE may be lifelong or acquired and may overlap with erectile dysfunction, sensitivity, pelvic-floor dysfunction, hormone or metabolic issues, performance anxiety, or other changes in health. The Bawa Method is designed to improve ejaculatory control while also supporting erection quality, confidence, pleasure, and long-term sexual function.

Treatment is personalized after a private virtual or in-office consultation with Dr. Bawa. Men travel to Bawa Medical in Boca Raton from across the United States and internationally for her proprietary treatments and personalized combination protocols, while DSF.me® supplements can be ordered from anywhere in the world. Depending on what is contributing to your PE, treatment may include:

• BawaWave®
• BawaRF®
• BawaShot®
• DSF.me® Supplements
• Testosterone and Hormone Optimization

Topical anesthetics and serotonin-based medications are recognized PE treatment options, but they are not the complete answer for every man. [5] They may change ejaculation timing without identifying why the problem is occurring, which is why Dr. Bawa looks at the broader sexual and medical picture.

Topical numbing products

Products containing lidocaine, prilocaine, or benzocaine reduce penile sensation. That may help some men last longer during a particular sexual experience, but reduced sensation is not the same as improved ejaculatory control. Potential drawbacks include excessive numbness, reduced pleasure or orgasmic sensation, erection difficulty, irritation, and transfer of the product to a partner.

Topical products may be useful in selected circumstances, but they do not correct erectile dysfunction, pelvic-floor problems, performance anxiety, hormonal or metabolic concerns, prostate or pelvic symptoms, or other contributors to acquired PE.

Antidepressants and serotonin-based medications

Certain SSRIs, including paroxetine, sertraline, fluoxetine, citalopram, and escitalopram, may delay ejaculation. Clomipramine and dapoxetine, where available, are also used in some treatment plans. [5] Many of these medications are prescribed off-label for PE.

The trade-off is that medications used to delay ejaculation can also affect other parts of sexual function. Possible side effects include reduced libido, erection problems, delayed or absent orgasm, reduced genital sensation, and lower sexual satisfaction. Men should not start, adjust, or stop an antidepressant without medical supervision.

At Bawa Medical, selected medications may be incorporated when appropriate, but the goal is broader than simply making ejaculation take longer. Treatment should support control, erection quality, sensation, pleasure, confidence, intimacy, and overall sexual wellness.

1. Porst H, Montorsi F, Rosen RC, Gaynor L, Grupe S, Alexander J. The Premature Ejaculation Prevalence and Attitudes Survey: Prevalence, Comorbidities, and Professional Help-Seeking. European Urology. 2007;51(3):816–823; discussion 824. doi:10.1016/j.eururo.2006.07.004.

2. Corona G, Rastrelli G, Limoncin E, Sforza A, Jannini EA, Maggi M. Interplay Between Premature Ejaculation and Erectile Dysfunction: A Systematic Review and Meta-Analysis. The Journal of Sexual Medicine. 2015;12(12):2291–2300. doi:10.1111/jsm.13041.

3. Patrick DL, Althof SE, Pryor JL, Rosen R, Rowland DL, Ho KF, McNulty P, Rothman M, Jamieson C. Premature Ejaculation: An Observational Study of Men and Their Partners. The Journal of Sexual Medicine. 2005;2(3):358–367. doi:10.1111/j.1743-6109.2005.20353.x.

4. Serefoglu EC, McMahon CG, Waldinger MD, et al. 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. The Journal of Sexual Medicine. 2014;11(6):1423–1441. doi:10.1111/jsm.12524.

5. Shindel AW, Althof SE, Carrier S, et al. Disorders of Ejaculation: An AUA/SMSNA Guideline. The Journal of Urology. 2022;207(3):504–512. doi:10.1097/JU.0000000000002392.

6. Waldinger MD, Quinn P, Dilleen M, Mundayat R, Schweitzer DH, Boolell M. A Multinational Population Survey of Intravaginal Ejaculation Latency Time. The Journal of Sexual Medicine. 2005;2(4):492–497. doi:10.1111/j.1743-6109.2005.00070.x.

7. Myers C, Smith M. Pelvic Floor Muscle Training Improves Erectile Dysfunction and Premature Ejaculation: A Systematic Review. Physiotherapy. 2019;105(2):235–243. doi:10.1016/j.physio.2019.01.002.

8. Martyn-St James M, Cooper K, Ren K, et al. Topical Anaesthetics for Premature Ejaculation: A Systematic Review and Meta-Analysis. Sexual Health. 2016;13(2):114–123. doi:10.1071/SH15042.

9. Montejo AL, Llorca G, Izquierdo JA, Rico-Villademoros F; Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction. Incidence of Sexual Dysfunction Associated With Antidepressant Agents: A Prospective Multicenter Study of 1,022 Outpatients. The Journal of Clinical Psychiatry. 2001;62(Suppl 3):10–21.

10. Morris BJ, Krieger JN. Does Male Circumcision Affect Sexual Function, Sensitivity, or Satisfaction? A Systematic Review. The Journal of Sexual Medicine. 2013;10(11):2644–2657. doi:10.1111/jsm.12293.

11. U.S. Food and Drug Administration. Cialis®—Tadalafil Prescribing Information. Section 5.11: Combination With Other PDE5 Inhibitors or Erectile Dysfunction Therapies. Also: Burnett AL, Nehra A, Breau RH, et al. Erectile Dysfunction: AUA Guideline. The Journal of Urology. 2018;200(3):633–641. doi:10.1016/j.juro.2018.05.004.

12. Bhat GS, Shastry A. Time to Orgasm in Women in a Monogamous Stable Heterosexual Relationship. The Journal of Sexual Medicine. 2020;17(4):749–760. doi:10.1016/j.jsxm.2020.01.005.