Introduction to premature ejaculation

This topic describes management of premature ejaculation in individuals presumed male at birth. Healthcare providers are encouraged to use a sensitive approach that avoids assumptions about gender identity, sexual orientation or sexual practices.

For guidance on healthcare issues specific for people of diverse sexual orientation, see A guide to sensitive care for lesbian-gay-and bisexual people attending general practice at the Rainbow Health Victoria website. For resources on sexual health relating to gender-affirming treatment, see the TransHub website.

Premature ejaculation is an inability to control or delay ejaculation that causes significant personal distress. It is very common, affecting up to 31% of males. Like other sexual symptoms, which may be concurrent, such as erectile dysfunction and low libido, it is thought to be under-reported. See Screening and assessment for sexual difficulties for information on how to encourage discussion of sexual concerns.

Evidence-based definitions for premature ejaculation only describe vaginal intercourse. Premature ejaculation may be:

• lifelong—ejaculation always or nearly always occurs before or within 1 minute of vaginal penetration, and has occurred since the beginning of the person’s sexual experience
• acquired—ejaculation always or nearly always occurs before or within 3 minutes of vaginal penetration, and is secondary to other factors such as psychological and relationship problems, erectile difficulty, prostatitis, hyperthyroidism, and withdrawal from medication such as selective serotonin reuptake inhibitors (SSRIs).

Premature ejaculation can cause distress, frustration, and avoidance of sexual intimacy.

Premature ejaculation should not be diagnosed if rapid ejaculation only occurs occasionally or if the interval between penetration and ejaculation is more than 5 minutes (the median for this interval). It may reassure some people to know that this duration is not unusually short.