What is premature ejaculation?
Premature ejaculation means ejaculating much sooner than desired and without control, in a way that causes distress, anxiety or avoidance for the man or in the relationship. It is one of the most common sexual problems in men. Many men are reluctant to talk about it and delay seeking help; yet premature ejaculation is a condition that can be medically assessed and treated.
Lifelong and acquired premature ejaculation
The International Society for Sexual Medicine (ISSM) divides premature ejaculation into two main types:
- Lifelong (primary) premature ejaculation: Present from the first sexual experiences. Ejaculation always or nearly always occurs before penetration or within about 1 minute of penetration.
- Acquired (secondary) premature ejaculation: The time to ejaculation, previously normal, has become markedly shorter; it is usually about 3 minutes or less.
In both types, the inability to delay ejaculation and its negative personal consequences are an essential part of the diagnosis. Time alone is not enough for a diagnosis. Some men feel they ejaculate too early even though their time to ejaculation is within normal limits; in this case, information and counselling come first.
Causes of premature ejaculation
The causes of premature ejaculation are not fully understood, and several factors are often present together.
In lifelong premature ejaculation, a biological and inherited predisposition related to the serotonin system in the brain is thought to play a role.
In acquired premature ejaculation, the following causes are investigated:
- Erectile dysfunction: Fearing loss of the erection, a man may unconsciously speed up ejaculation.
- Prostate inflammation (prostatitis) and urinary tract infections
- Thyroid disorders, particularly an overactive thyroid
- Psychological factors: Performance anxiety, stress, depression
- Relationship problems and changes in how often sex takes place
The relationship between circumcision and premature ejaculation is also a subject of scientific debate. It was investigated in a study in which Op. Dr. Mücahit Kabar took part; overall, however, no clear cause-and-effect relationship has been established.
How is it diagnosed?
The diagnosis of premature ejaculation is based largely on a detailed sexual history. The doctor asks how long the problem has existed, whether it occurs with every intercourse or only in certain situations, how much control you feel over ejaculation, and the distress it causes you and your relationship.
- Questionnaires: Premature ejaculation questionnaires help determine the severity of the problem and monitor the response to treatment.
- Physical examination: The genital area and the prostate are assessed.
- Additional tests: Not needed for every patient. Depending on the history and examination, tests such as a urine test, thyroid hormones or testosterone may be requested.
- Assessment of erectile function: Whether there is also erectile dysfunction is always investigated.
Treatment options
Treatment is planned individually after the examination, according to the type of premature ejaculation, the underlying cause, the couple’s expectations and personal preference. Often, several methods are combined.
Behavioural techniques
- Stop-start technique: When the feeling of approaching ejaculation arises, stimulation is stopped and resumed once the feeling has subsided. This cycle is repeated several times.
- Squeeze technique: When the feeling of approaching ejaculation arises, the area just below the head of the penis is gently squeezed for a few seconds to delay the ejaculation reflex.
- Pelvic floor exercises: Strengthening the muscles of the pelvic floor can improve control over ejaculation in some patients.
These techniques take time and patience; they are more effective when practised with the partner’s support. They can be used on their own or together with medication.
Local anaesthetic creams and sprays
Local anaesthetic products applied to the head of the penis shortly before intercourse reduce sensitivity and delay ejaculation. To prevent numbness in the partner, using a condom or wiping the area before intercourse is recommended. The correct method of application should be explained by a doctor.
Oral medication
- Dapoxetine: A short-acting medication developed for premature ejaculation, taken a few hours before intercourse.
- Daily SSRIs: Low doses of certain antidepressants can be used in suitable patients because they delay ejaculation.
These medications can have side effects such as nausea, dizziness and, rarely, fainting, as well as interactions with other medications. For this reason, they should only be used after an examination, under medical supervision.
Treating accompanying erectile dysfunction
If premature ejaculation is accompanied by erectile dysfunction, the erectile dysfunction is treated first. In most patients, this treatment also improves the premature ejaculation. For details, see the erectile dysfunction page.
About surgery and other invasive methods
The effectiveness and safety of methods such as surgery on the nerves of the penis or filler injections into the head of the penis have not been demonstrated with sufficient evidence; current guidelines do not recommend them.
A couple-focused approach
Premature ejaculation is not just a man’s problem but a shared problem for the couple. Involving the partner reduces anxiety, increases the success of behavioural techniques and makes it easier to stick to treatment. Where psychological factors are prominent, sex therapy or couples therapy can be planned alongside medical treatment.
The treatment process and expectations
Treatment for premature ejaculation is usually not completed in a single consultation. At the first visit, the type of problem and its possible causes are identified, and then a starting treatment that suits the man and the couple is chosen. At follow-up appointments, the time to ejaculation, sense of control, side effects and satisfaction are assessed together; if needed, treatment is changed or methods are combined.
Knowing a few points helps set realistic expectations:
- When medication is stopped, the problem may return after a while; this is why learning behavioural techniques alongside medication brings long-term benefit.
- In acquired premature ejaculation, the problem may resolve permanently once the underlying cause is treated.
- “Delay” products sold online with unclear contents may pose health risks and should not be used.
When should you see a doctor?
It is advisable to see a urologist if lack of control over ejaculation has become recurrent, if it causes anxiety, embarrassment or avoidance of sex, or if it is affecting your relationship. In premature ejaculation that has appeared recently after previously having no problem, assessment should not be delayed if there are accompanying symptoms such as burning when passing urine, groin pain, erectile problems, palpitations or unexplained weight loss.
Premature ejaculation treatment in Bursa, Turkey
Op. Dr. Mücahit Kabar graduated from Uludağ University Faculty of Medicine and completed his urology residency at the Urology Clinic of Ankara Training and Research Hospital. He took part in a scientific study, published in an international peer-reviewed journal, investigating whether circumcision may be a risk factor for premature ejaculation. He sees men with premature ejaculation in Bursa (Nilüfer), with careful attention to privacy, at Özel Medicabil Nilüfer Hastanesi (weekdays 08:30–12:00) and Özel Jimer Hastanesi (weekdays 13:00–17:00).
Consultations are held in English or Turkish. The hospitals’ international patient departments can arrange interpreters for other languages and help with airport transfers and accommodation. If you are travelling from abroad, you can book your appointment in advance through the online booking page or appointment line of Özel Medicabil Nilüfer Hastanesi (weekdays 08:30–12:00, +90 444 8 112) or Özel Jimer Hastanesi (weekdays 13:00–17:00, +90 444 45 67). For questions before you travel, you can send a message via WhatsApp (+90 541 622 54 82). More information is available on the international patients page and the contact page.
