THE COACH: ARTICLES

Sex Ends Way Too Soon?

MALE HEALTH
How Long Does Sex Need to Last?

Ever wonder how you compare in terms of friends' sexual performance? Average, above average, or (God forbid) below average? We get it — it’s a weird, probably uncomfortable question. Not too many people muster the courage to seek to ask.a

The Journal of Sexual Medicine published a study in 2001 in which researchers asked a group of sex therapists how long sex (penetrative vaginal sex, specifically) should last. The results? Well, 1-2 minutes was “too short”; 3-7 minutes, “adequate”; and 10-30 minutes, “too long.” The study also pegged the duration of desirable sex between 7 and 13 minutes.

And in case you were wondering, the study didn’t include foreplay.

So now, on to the verdict: Where in that spectrum do you fall? If you’re on the shorter — err, quicker — side and are wondering whether Premature Ejaculation (PE) is something you have to contend with, read on…

What Is Premature Ejaculation?


More often than not, Premature Ejaculation entails ejaculating within the first minute of penetration. It also means you can’t control when you ejaculate, thus leading to distress and unsatisfactory sex.

PE has become one of the most common forms of sexual dysfunction. According to the American Urological Society, one in every three men aged 18 to 59 years lives with the condition.

Incidentally, Premature Ejaculation shouldn’t be confused with Erectile Dysfunction (ED), which involves difficulty having or sustaining an erection. ED is also characterized by a noticeably reduced sex drive. 

What Are the Types of PE?

Premature Ejaculation is broadly divided into two categories: lifelong PE and acquired PE. The former is characterized by premature ejaculation in all or almost all sexual activities — ever since sexual maturity. The latter is exhibited by men who previously had an average ejaculatory duration and control, but then later developed PE.

The two major types of PE differ from another type of PE, called natural variable PE. This is shown in men who usually have an average ejaculation time, but who may experience occasionally PE. The natural variable PE is considered a normal variation of sexual performance, and so is not a sexual dysfunction.

How Can You Determine If You Have PE?

It’s worth mentioning that how long sex “should” last also depends on you. And your dissatisfaction with the length of time you can spend in bed with your partner doesn’t automatically mean that you have clinical PE.

Consider the three factors that the International Society for Sexual Medicine (ISSM) says you should look out for to determine if you have PE:

  • Do you always, or almost always, ejaculate within the first minute of penetration (for individuals with lifelong PE), or three minutes into penetration (for individuals with acquired PE)?

  • Do you suffer from an inability to control or delay ejaculation during sexual activities all or nearly all of the time?

  • Do you feel distressed or frustrated in regard to sexual intimacy, and/or do you avoid it?

Your answers to these questions can determine whether or not you suffer from PE. Of course, for accurate diagnosis, definitely pay your doctor a visit for a physical exam and a proper discussion of your sexual difficulties.

What Are the Causes of Premature Ejaculation?


While PE is undoubtedly a menacing problem, there’s no known, clear-cut explanation for it. A wide range of psychological and biological theories abound.

The following are psychological factors that may contribute to PE:

  • Anxiety, including sexual-performance anxiety
  • Decreased sex drive
  • Depression (caused by a previous incidence of PE)
  • Guilt
  • History of sexual abuse or sexual repression
  • Low self-esteem
  • Phobias (e.g., fear of not measuring up, reaching climax too early)
  • Relationship problems
  • Stress

And as for biological factors, these may contribute to PE:

  • Testosterone imbalance. According to the National Institutes of Health, testosterone is the most important male sex hormone. So, it comes as no surprise why low testosterone levels have been associated with PE.

  • Imbalances in certain neurotransmitters, like dopamine, serotonin, and oxytocin. Increased serotonin delays ejaculation, while low levels shorten the time to ejaculation. Anywhere from 2%-5% of cases of lifelong PE is said to be caused by an imbalance in serotonin levels. And while dopamine and oxytocin have been shown to also play a role in ejaculation, they haven’t been as thoroughly studied as serotonin.

  • Prostate gland Inflammation (Prostatitis). While it’s unclear as to how prostatitis causes PE, 26%–77% of men who suffer from Prostatitis also have PE.

  • Imbalances in thyroid hormone. Some patients with thyroid hormone imbalances also display PE. Again, the mechanism isn’t fully understood. 

  • Drug withdrawal. Individuals who rely on recreational and even prescribed medications to improve sexual performance often state that withdrawal from these drugs affect their sexual performance.

  • Hypersensitivity of the head of the penis.

It’s worth noting that age is another factor that can contribute to PE. It’s natural for older men to take longer to get an erection, and erections are harder to maintain. And as for younger men, some might find themselves reaching climax sooner than they’d like.

And one final point of interest is that treating certain underlying medical conditions can improve the duration of ejaculation for some men.

Treatment for Premature Ejaculation


The good news is that according to the American Urological Association, approximately 95% of men who undergo proper treatment will recover from PE. If either you or your partner has PE or even just suspects it, schedule a visit with a healthcare provider for the best treatment plan.

#1. Medical Management

Just as there’s no known definite cause for PE, there’s also no specifically FDA-approved treatment. However, several medications are commonly prescribed:

  • Erectile dysfunction medications. Phosphodiesterase-5 inhibitors (PDE5i) like sildenafil, tadalafil, and vardenafil used in treating ED have also been proven to be effective in treating PE. However, the mechanism, again, is unclear. 

  • Antidepressants. Two groups of antidepressants — selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) — have been shown to delay ejaculation in some men. SSRIs include paroxetine, sertraline, and dapoxetine; while TCAs include amitriptyline and clomipramine.

  • Pain killers. Pain medication like Tramadol affects serotonin and can delay ejaculation. However, due to the potential of drug addiction and abuse, it should be avoided except when prescribed by a doctor.

  • Numbing creams, sprays, and wipes. Numbing medications like lidocaine, benzocaine, and prilocaine decrease penile sensation.

#2. Natural Remedies

Zinc and magnesium have been shown to play an essential role in male sexual health. In a 2001 study, researchers from Kuwait University’s Department of Obstetrics and Gynaecology found that the men who suffered from PE had lower levels of magnesium in their sperm than their healthier peers.

An easy remedy might be to simply increase dietary intake of zinc and magnesium. Supplements for both minerals are also good options. Note that excess magnesium can be dangerous, however, so be sure to talk to your healthcare provider about your diet and mineral needs.

#3. Behavioral Therapy

A behavioral approach to treating PE might involve activities you can practice at home to improve ejaculation time. The stop-start method, the squeeze technique, and pelvic floor exercises are the three most commonly used therapies for PE.

The first two methods are designed to make you feel more aware of mid-range levels of excitement and the sensations leading up to climax. These help you control and delay ejaculation. The last method helps strengthen the muscles activated during ejaculation.

#4. Psychological Therapy

Psychological therapy can involve sex counseling to address performance anxiety and to improve self-confidence in the bedroom. 

Having your partner involved in your treatment plan can be beneficial, as that would allow you to talk about the reasons for your poor performance. And for an even more effective treatment plan, you might consider combining behavioral and psychological therapies. 

In a Nutshell

While premature ejaculation may seem like a severe problem, it’s not the end of the world. PE is a highly treatable condition with an excellent recovery rate. But successful treatment first hinges on having an honest, open discussion regarding your sexual difficulties. So, talk with your partner and schedule that appointment with the doctor. There’s no reason to delay.

Disclaimer: This information isn’t a substitute for professional medical advice, diagnosis, or treatment. You should never rely upon this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.