A Comprehensive Guide to Premature EjaculationSex / Nov 19th 2018  at 03:46PM   /   0

Premature ejaculation (also known as unintentional or early ejaculation) is the most commonly cited male sexual issue. It’s been reported to affect 20-30% of the male population, however with most of those cases turning out to be "occasional" or "situational," current thinking puts the prevalence of treatment-worthy PE closer to 8-15%.

For those who have it (or whose partners are dealing with it) early ejaculation can be confounding and stress-inducing. On average, most couples engage in intercourse for five to six minutes. And while no set amount of time is innately adequate or inadequate, with PE it could be fifteen seconds or two minutes, at which point both parties agree something isn’t working. Left untreated, this can lead to guilt, shame, insecurity, and relationship conflict—all reason enough for a man to seek help. And yet most don’t, due to embarrassment, confusion, and/or lack of awareness about available treatment options. 

Sometimes the issue goes away on its own, sometimes it does not. It can be temporary or lifelong. For the latter group, PE occurs during puberty or their first sexual experience, then continues to throughout their life. While most men will actually experience it at least once in their life, treatment-worthy PE is a pattern of unintentional ejaculation, occurring sooner than intended, usually within the first few minutes of sexual activity or intercourse. Whether ten seconds or two minutes, the determining factors are that it's (1) an ongoing loss of control, and (2) significant enough to cause distress.

Most doctors do little more than prescribe antidepressants and sex therapy, before ushering the afflicted out the door. Progress for the patient becomes piecemeal, through trial and error, or bits of random information gleaned from online forums and Google Scholar. Surrogate Partners offer experiential therapy and have an excellent track record. Some intimacy coaches and somatic body-workers do too, yet helpful as they are, niche modalities aren’t available in every US city. Nor is PE a one-size fits all issue. PE’s causes are complex. It most often stems from a combination of factors.


The causes of premature ejaculation are varied. More research is needed (on men of every sexual orientation) but factors in play can be psychological, behavioral, cognitive, developmental, neurobiological, hormonal, genetic, and environmental. The following list is incomplete, but you get the gist.

  • Performance anxiety 
  • Pelvic Floor tension / hyper toned PFM
  • Hypersensitivity (of the glans)
  • Fear (of pregnancy, vulnerability, failure, etc.)
  • Catastrophizing (negative association, “failure spiral”)
  • Unconscious hostility (toward women)
  • Relationship conflicts (ongoing, even if subconscious)
  • Lack of sensory awareness (“he’s too much in his head")
  • Ingrained childhood habits (masturbates in a rush)
  • Disassociation, feeling detached or inauthentic
  • Neurotransmitter disorder (serotonin dysregulation, low dopamine or oxytocin)
  • Hyperthyroidism 
  • Genetic variations
  • Disease, injury, drugs, Rx, lifestyle factors 


There are four types of premature ejaculation: acquired, lifelong, subjective, variable. For the purposes of this discussion, listed below are the pertinent types (three only, because subjective PE isn’t actually PE) plus a few other broad / overlapping terms.

  • Acquired: begins after an extended period of normal sexual functioning (also called Secondary PE)
  • Lifelong: exists to some degree from the onset of sexual activity (also called Primary PE)
  • Variable / Situational: only occurs with specific person(s) or other specific factor
  • Generalized: occurs with different partners in a variety of environments; not situation specific
  • Occasional: (infrequent, affects most men at some point in life)

Acquired PE can have physiological or psychological causes. It should be checked out by a medical doctor as a first line of defense. Psychological issues, such as relational stress, trauma, or anxiety, can spark acquired PE at any age (though is more prevalent in younger men). Acquired PE can manifest as situational (variable) or generalized PE. It is treatable with a variety of modalities and techniques, many of which have excellent success rates. Lifelong PE has not been well understood in the past, yet new research suggests a strong genetic component, specifically certain issues having to do with serotonin receptors.


As you can see, premature ejaculation is complicated—again though, also quite treatable. In order for treatment to be effective, determining the correct, most targeted approach for your individual issue(s) is obviously recommended. The average family doctor, or even your urologist, my not be up on the latest research, tests, and treatments. (I am continually disappointed by the myopic, incomplete, dismissive care clients receive in regard to their sexual health. Some MDs are woefully incapable of frank talk on sex entirely, and what they don’t know about the latest hormone replacement research could fill a football stadium.) I recommend finding a highly qualified, functional medicine specialist (I have a list for Austinites), then insist on most advanced, comprehensive tests available. The following is an incomplete list (I’ll be adding to it regularly), but a good sampling of available tests to consider. (Not every individual will benefit from everything on this list. Do your research and discuss with your highly-qualified doctor.)

  • Urinary issues, prostatitis
  • Thyroid hormone (TSH, T3, T4)
  • Cortisol (stress hormone)
  • Testosterone (free & total) and other hormones (SHBG, DHEA, DHT, E2)
  • Organic acids (for serotonin markers)
  • Pelvic Floor exam (by a physical therapist specializing in PFM)
  • Nervous system issues [more on this to come]
  • Family genetics (inquire among male relatives, for men with lifelong PE issues)


There are many ways to address premature ejaculation. Among the most basic has always been a reduction in the man's level of pleasurable sexual sensation. 

Think about that for a minute. Should this really be our go-to approach?

Yeah... I didn't think so either. It not only requires tremendous restraint on his part, but the results are inconsistent at best. Counterintuitive as it seems, increasing one's capacity for pleasure is a far more effective approach. Not the same thing as pleasurable sensation, his “capacity for pleasure” can be expanded gradually, through a series of exercises during which the client learns to accept, feel, embrace, and enjoy a higher degree of bodily pleasure overall. Acquired PE tends to respond well to this, especially when due to psychological issues. Men with lifelong PE can benefit from this type of embodiment practice as well, although APE and LPE generally require type-specific, highly-individualized protocols. The goal is overcome PE by healing, repairing, and otherwise addressing the (myriad of) emotional and physical issues causing it...not to disguise it or temporarily override it (which is the only thing most past methods really do).

Some older treatment methods that have fallen out of favor (for good reason): 

  • Stop/Start method
  • Squeeze technique
  • Mental distractions (baseball, grandma, etc.)

Other methods are effective only in the short term, as mere stop-gap measures that don’t address the core issue, and can actually worsen it in the longterm:

  • Condoms, one or more (to minimize sensation) 
  • Numbing sprays (same reason as above)
  • Antidepressants (which have side effects and are challenging to discontinue)
  • SSRIs (among their many downsides is the potential to impair fertility and erectile function)
  • Limiting sex positions, such as to woman on top (again, to minimize sensation for the man)
  • Pre-sex / pre-date masturbation (yet another sacrifice of sensation for him)

More effective, comprehensive approaches have come to light, resulting in sustained improvement, and in some cases complete eradication of PE issues:

  • Masturbation practice (mindful masturbation, peaking exercises)
  • Successive Approximation (shaping behavior gradually, incrementally)
  • Pelvic floor therapy
  • Kegels and Reverse Kegels [more on this in a future post]
  • Yoga and other stretching techniques
  • TheraWand prostate massager, when hypertonic (nonrelaxing) pelvic floor muscles are indicated
  • Breathing techniques (to stimulate the parasympathetic nervous system)
  • Mindfulness meditations, embodiment exercises
  • Acupuncture (scientifically proven success rate)
  • Chinese herbs 
  • Endocrine therapies, Bio-identical hormone therapy
  • OTC supplementation (probiotics, 5-HTP, various neurotransmitter formulations)
  • Sex therapy / couples therapy
  • Intimacy coaching and other experiential modalities

For more info on any of the above, please contact me through my Intro form or email address (found at the top of my Pricing page).

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