Premature ejaculation
ICD codes: F52.4 What are ICD codes?
If a man almost always reaches orgasm too soon, this is known as premature ejaculation. Exercises, medication or sex therapy can help.
At a glance
- Premature ejaculation means that a man almost always reaches orgasm either before penetration or shortly after, so that his sex life is significantly impaired.
- It takes an average of 5 to 7 minutes for a man to orgasm and ejaculate.
- Around 4 percent of men ejaculate very prematurely almost every time they have sex.
- Exercises to improve ejaculation control, medication or sex therapy can help.
Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.
What is premature ejaculation?
Inaccurate and exaggerated preconceptions about sex are widespread. A common misconception relates to how long it takes men to reach orgasm. This can fluctuate from one time to the next and depends on multiple factors.
It takes an average of 5 to 7 minutes for a man to orgasm and ejaculate. However, this period can differ greatly, ranging from less than a minute to more than half an hour.
Whether and the extent to which a comparatively early orgasm affects a man, his relationship and his sexual satisfaction varies greatly.
Studies show that men estimate the amount of time it takes before they ejaculate to be longer than it actually is – in some cases by as much as 25 or even 50 percent. It is therefore inadvisable to use what other men say for guidance.
Around 4 percent of men ejaculate very prematurely almost every time they have sex. This always or almost always occurs very quickly, i.e. even before or straight after penetration, for example.
Doctors class this as premature ejaculation (ejaculatio praecox) if rapid orgasm becomes a problem.
What causes premature ejaculation?
To date, little research has been conducted into what causes premature ejaculation. Some specialists believe that it is linked to biological factors, such as a hypersensitive penis or an altered interaction between hormones and nerves.
Others attribute it to psychological factors such as relationship problems or self-confidence issues. However, it is also possible that biological and psychological factors influence each other and have a combined effect.
Some men experience premature ejaculation from the very start of their sex life. Others only begin to experience it later on. In such cases, doctors refer to “acquired” or “secondary” premature ejaculation.
How is premature ejaculation diagnosed?
Anyone who feels they may be suffering from premature ejaculation can consult a general practitioner or urologist.
To make a diagnosis, the doctor will ask about the average time it takes the person to ejaculate. They will also ask how often he ejaculates too soon, how troubling the problem is and whether he can delay ejaculation.
Further investigations should only be carried out if the doctor believes there to be a medical problem.
Premature ejaculation is diagnosed if:
- the person almost always ejaculates unintentionally within a minute of penetration
- the person has ejaculated prematurely for more than 6 months
- the person is finding the premature ejaculations very problematic
- no other medical conditions are responsible for the situation
From a medical perspective, a person does not have premature ejaculation if:
- they only ejaculate prematurely on occasion
- they have not been sexually active for a long time – it is normal to initially reach orgasm sooner after a long break from sexual activity
- they feel that the time it takes to ejaculate is too short but it is in fact within the normal range
The consultation will also look at other possible causes that can influence how long it takes to ejaculate.
For example, it is thought that an inflamed prostate (prostatitis) can play a role. If the prostate is inflamed, this should therefore be treated first. Signs of this include frequent or painful urination.
How is premature ejaculation treated?
Whether and how a patient wants to be treated for premature ejaculation is a matter of personal choice. There are several options available:
- Certain exercises are designed to help men exert more control over their ejaculations and consciously delay them. One option is to repeatedly stimulate the penis until just before orgasm and then stop.
- Medication can slightly extend the time it takes to ejaculate. This can be taken orally or be in the form of anesthetics that are applied to the head of the penis (glans). However, both can have side effects.
- Sex therapies aim to give men or couples more self-confidence and remove fears of sexual inadequacy.
Important: Selective serotonin reuptake inhibitors (SSRI) are the most widely used type of medication for treating premature ejaculation. The only drug from this group to be approved for such treatment in Europe is dapoxetine. However, this only extends the time until ejaculation by an average of one to one-and-a-half minutes. Other SSRIs are far cheaper and also more effective. Doctors can prescribe these as an “off-label” treatment.
Regardless of whether or not it has been approved for this purpose, the cost of medication for treating premature ejaculation is not covered by statutory health insurance providers.
Further information, such as how to combat premature ejaculation, can be found at gesundheitsinformation.de.
What other useful information is there about premature ejaculation?
Their sex life plays an important role in many people’s self-confidence. Men who experience premature ejaculation may feel pressurized by inaccurate stereotypes about what constitutes “good” sex or by bragging or misguided words of wisdom. They should try not to let these things affect them – their issue doesn’t make them any less “manly” than other men.
If premature ejaculation becomes a problem and affects a man’s sex life, it becomes a bigger issue for him. Many men find it frustrating that they cannot control how long it takes them to orgasm.
Some men are afraid that they will not perform well enough in bed and will be unable to satisfy their partner. However, a couple’s love life does not have to revolve around sexual intercourse and how long it takes to ejaculate.
There are many other ways to experience one’s own sexuality, orgasm and enjoy intimacy. For many people, general satisfaction with their love life and relationship is more important than how long sexual intercourse lasts.
Some men tend to repress the topic and not speak openly about it. However, this can exacerbate the problem.
- Althof SE, McMahon CG, Waldinger MDet al. An Update of the International Society of Sexual Medicine's Guidelines for the Diagnosis and Treatment of Premature Ejaculation (PE). Sex Med 2014; 2(2): 60-90. doi: 10.1002/sm2.28.
- Cooper K, Martyn-St James M, Kaltenthaler E et al. Interventions to treat premature ejaculation: a systematic review short report. Health Technol Assess 2015; 19(21): 1-180, v-vi. doi: 10.3310/hta19210.
- Cooper K, Martyn-St James M, Kaltenthaler E et al. Behavioral Therapies for Management of Premature Ejaculation: A Systematic Review. Sex Med 2015; 3(3): 174-188. oi: 10.1002/sm2.65.
- Giuliano F, Patrick DL, Porst H et al. Premature ejaculation: results from a five-country European observational study. Eur Urol 2008; 53(5): 1048-1057. doi: 10.1016/j.eururo.2007.10.015.
- Sathianathen NJ, Hwang EC, Mian R et al. Selective serotonin re-uptake inhibitors for premature ejaculation in adult men. Cochrane Database Syst Rev. 2021 Mar 21;3(3):CD012799. doi: 10.1002/14651858.CD012799.pub2.
In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) (IQWiG).
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