Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

The etiology and management of premature ejaculation

Nature Clinical Practice Urology volume 2, pages 426–433 (2005)Cite this article

Abstract

Premature ejaculation (PE) is a common male sexual disorder. Normative data suggest that men with an intravaginal ejaculatory latency time of less than 1 min have 'definite' premature ejaculation, while men with intravaginal ejaculatory latency times of between 1 and 1.5 min have 'probable' premature ejaculation. Although there is insufficient empirical evidence to identify the etiology of PE, there is correlational evidence to suggest that men with PE have high levels of sexual anxiety and altered sensitivity of central 5-hydroxytryptamine receptors. Pharmacological modulation of the ejaculatory threshold using daily or on-demand selective serotonin reuptake inhibitors offers patients a high likelihood of achieving improved ejaculatory control within a few days of initiating treatment, leads to improvements in sexual desire and other sexual domains, and is well tolerated.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Treatment with selective serotonin reuptake inhibitors in men with premature ejaculation results in ejaculatory delay within 5–10 days.10
Figure 2: Algorithm for the management of premature ejaculation.
Figure 3: Regulation of synaptic cleft 5-HT and 5-HT neurotransmission and effects of acute and chronic administration of SSRIs on 5-HT neurotransmission and 5-HT receptors.

Similar content being viewed by others

References

  1. Laumann EO et al. (1999) Sexual dysfunction in the United States: prevalence and predictors. JAMA 281: 537–544

    CAS  PubMed  Google Scholar 

  2. Rosen RC et al. (2004) The premature ejaculation, prevalence and attitudes (PEPA) survey—A multinational survey [abstract # O92]. J Sex Med 1 (Suppl 1): aS57–aS58

    Google Scholar 

  3. Waldinger MD et al. (2005) A Multinational Population Survey of Intravaginal Ejaculation Latency Time. J Sex Med 2: 492–497

    PubMed  Google Scholar 

  4. Waldinger MD et al. (2005) Proposal for a Definition of Lifelong Premature Ejaculation Based on Epidemiological Stopwatch Data. J Sex Med 2: 498–507

    PubMed  Google Scholar 

  5. Schapiro B (1943) Premature ejaculation: a review of 1130 cases. J Urol 50: 374–379

    Google Scholar 

  6. Masters W and Johnson V (1966) Human Sexual Response. Boston: Little Brown

    Google Scholar 

  7. McMahon CG (2002) Long term results of treatment of premature ejaculation with selective serotonin re-uptake inhibitors. Int J Imp Res 14 (Suppl 3): S19

    Google Scholar 

  8. Fasolo CB et al. (2005) Premature Ejaculation: Prevalence and Associated Conditions in a Sample of 12,558 Men Attending the Andrology Prevention Week 2001—A Study of the Italian Society of Andrology (SIA). J Sex Med 2: 376–382

    Google Scholar 

  9. Perelman M et al. (2004) The impact of self-reported premature ejaculation on other aspects of sexual function [abstract #O98]. J Sex Med 1 (Suppl 1): aS59

    Google Scholar 

  10. Waldinger MD et al. (1998) Effect of SSRI antidepressants on ejaculation: a double-blind, randomized, placebo controlled study. J Clin Psychopharmacol 18: 274–281

    CAS  PubMed  Google Scholar 

  11. McMahon CG and Touma K (1999) Treatment of premature ejaculation with paroxetine hydrochloride as needed: 2 single-blind placebo controlled crossover studies. J Urol 161: 1826–1830

    CAS  PubMed  Google Scholar 

  12. Waldinger MD and Hengeveld MW (2000) Neuroseksuologie en seksuele psychofarmacologie. Tijdschr Psychiatr 8: 585

    Google Scholar 

  13. Olivier B et al. (1998) Serotonin, serotonergic receptors, selective serotonin reuptake inhibitors and sexual behaviour. Int Clin Psychopharmacol 13 (Suppl 6): S9–S14

    PubMed  Google Scholar 

  14. Waldinger M and Olivier B (2001) Hersenonderzoek en farmacologie: serotonine, seks en agressie. In Het Brein Belicht: Opstellen over Niet-Aangeboren Hersenletsel, 55–63 (Eds Wolters-Schweitzer MHJ and Beuger Utrecht CL) Meppel: Uitgeverij Lemma

    Google Scholar 

  15. Waldinger MD et al. (1998) Familial occurrence of primary premature ejaculation. Psychiatr Genet 8: 37–40

    CAS  PubMed  Google Scholar 

  16. Ahlenius S et al. (1981) Effects of a new type of 5-HT receptor agonist on male rat sexual behavior. Pharmacol Biochem Behav 15: 785–792

    CAS  PubMed  Google Scholar 

  17. Waldinger MD et al. (1998) Premature ejaculation and serotonergic antidepressants-induced inhibited ejaculation: the involvement of the serotonergic system. Behav Brain Res 92: 111–118

    CAS  PubMed  Google Scholar 

  18. Rowland DL et al. (2001) Defining early ejaculation for experimental and clinical investigations. Arch Sex Behav 30: 235–253

    CAS  PubMed  Google Scholar 

  19. McMahon CG et al. (2004) Disorders of Orgasm and Ejaculation in Men. In Sexual Medicine: Sexual Dysfunctions in Men and Women (2nd International Consultation on Sexual Dysfunctions), 409–468 (Eds Lue T et al.) Paris: Health Publications.

    Google Scholar 

  20. Spiess WF et al. (1984) Premature ejaculation: investigation of factors in ejaculatory latency. J Abnorm Psychol 93: 242–245

    CAS  PubMed  Google Scholar 

  21. Strassberg DS et al. (1987) The psychophysiological nature of premature ejaculation. Arch Sex Behav 16: 327–336

    CAS  PubMed  Google Scholar 

  22. Kilmann PR and Auerbach R (1979) Treatments of premature ejaculation and psychogenic impotence: a critical review of the literature. Arch Sex Behav 8: 81–100

    CAS  PubMed  Google Scholar 

  23. Schover L et al. (1982) Multiaxial problem-oriented system for sexual dysfunctions. Arch Gen Psychiat 39: 614–619

    CAS  PubMed  Google Scholar 

  24. Gebhard PH (1966) Factors in marital orgasm. J Soc Issues 22: 88–95

    Google Scholar 

  25. Waldinger M et al. (1998) An empirical operationalization of DSM-IV diagnostic criteria for early ejaculation. Int J Psychiatry Clin Pract 2: 287–293

    CAS  PubMed  Google Scholar 

  26. Patrick DL et al. (2005) Premature Ejaculation: An Observational Study of Men and Their Partners. J Sex Med 2: 358–367

    PubMed  Google Scholar 

  27. Masters W and Johnson V (1970) Human Sexual Inadequacy. Boston: Little Brown

    Google Scholar 

  28. Heiman JR and LoPiccolo J (1988) Becoming orgasmic: a sexual and personal growth program for women. New York: Simon & Schuster

    Google Scholar 

  29. Rowland D et al. (2004) Ratings of factors contributing to overall sexual satisfaction in men with and without self-reported premature ejaculation [abstract # O94]. J Sex Med 1 (Suppl 1): aS58

    Google Scholar 

  30. Kaplan HS et al. (1974) Group treatment of premature ejaculation. Arch Sex Behav 3: 443–452

    CAS  PubMed  Google Scholar 

  31. McCarthy B (1988) Cognitive-behavioural strategies and techniques in the treatment of early ejaculation. In Principles and Practices of Sex Therapy: Update for the 1990's, 141–167 (Eds Leiblum S and Rosen R) New York: Guilford Press

    Google Scholar 

  32. Vandereycken W (1986) Towards a better delineation of ejaculatory disorders. Acta Psychiatr Belg 86: 57–63

    CAS  PubMed  Google Scholar 

  33. Zilbergeld B (1978) Male Sexuality. Toronto: Bantam

    Google Scholar 

  34. Grenier G and Byers ES (1997) The relationships among ejaculatory control, ejaculatory latency, and attempts to prolong heterosexual intercourse. Arch Sex Behav 26: 27–47

    CAS  PubMed  Google Scholar 

  35. Montague DK et al. (2004) AUA guideline on the pharmacologic management of premature ejaculation. J Urol 172: 290–294

    PubMed  Google Scholar 

  36. American Psychiatric Association (1994) Diagnostic And Statistical Manual of Mental Disorders, DSM-IV, edn 4, 509–511. Washington DC: American Psychiatric Association

  37. Waldinger MD (2002) The neurobiological approach to premature ejaculation. J Urol 168: 2359–2367

    PubMed  Google Scholar 

  38. Williams W (1984) Secondary premature ejaculation. Aust N Z J Psychiatry 18: 333–340

    CAS  PubMed  Google Scholar 

  39. Screponi E et al. (2001) Prevalence of chronic prostatitis in men with premature ejaculation. Urology 58: 198–202

    CAS  PubMed  Google Scholar 

  40. Laumann EO et al. (2005) Sexual problems among women and men aged 40–80 y: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors. Int J Impot Res 17: 39–57

    CAS  PubMed  Google Scholar 

  41. Semans JH (1956) Premature ejaculation: new approach. South Med J 49: 358–358

    Google Scholar 

  42. De Amicis LA et al. (1985) Clinical follow-up of couples treated for sexual dysfunction. Arch Sex Behav 14: 467–489

    CAS  PubMed  Google Scholar 

  43. Hawton K et al. (1986) Long-term outcome of sex therapy. Behav Res Ther 24: 665–675

    CAS  PubMed  Google Scholar 

  44. Waldinger MD (2003) Towards evidenced based drug treatment research on early ejaculation: a critical evaluation of methodology. Int J Impo Res 15: 309–313

    CAS  Google Scholar 

  45. Strassberg DS et al. (1999) Clomipramine in the treatment of rapid (premature) ejaculation. J Sex Marital Ther 25: 89–101

    CAS  PubMed  Google Scholar 

  46. Kim SW and Paick JS (1999) Short-term analysis of the effects of as needed use of sertraline at 5 PM for the treatment of premature ejaculation. Urology 54: 544–547

    CAS  PubMed  Google Scholar 

  47. Hellstrom W et al. (2004) Dapoxetine HCl for the treatment of premature ejaculation: A Phase II, randomised, double-blind, placebo controlled study [abstract # O97]. J Sex Med 1 (Suppl 1): aS59

    Google Scholar 

  48. Pryor JL et al. (2005) Efficacy and Tolerability of Dapoxetine in the Treatment of Premature Ejaculation [abstract #740]. J Urol 173: a201

    Google Scholar 

  49. Berkovitch M et al. (1995) Efficacy of prilocaine-lidocaine cream in the treatment of early ejaculation. J Urol 154: 1360–1361

    CAS  PubMed  Google Scholar 

  50. Xin ZC et al. (1997) Efficacy of a topical agent SS-cream in the treatment of premature ejaculation: preliminary clinical studies. Yonsei Med J 38: 91–95

    CAS  PubMed  Google Scholar 

  51. Busato W and Galindo CC (2004) Topical anaesthetic use for treating premature ejaculation: a double-blind, randomised, placebo-controlled study. BJU Int 93: 1018–1021

    CAS  PubMed  Google Scholar 

  52. Dawson TM and Snyder SH (1994) Gases as biological messengers: nitric oxide carbon monoxide in the brain. J Neurosci 14: 5147–5159

    CAS  PubMed  Google Scholar 

  53. Sato Y et al. (1998) Effect of the nitric oxide level in the medial preoptic area on male copulatory behavior in rats. Am J Physiol 274: R243–R247

    CAS  PubMed  Google Scholar 

  54. Lorrain DS and Hull EM (1993) Nitric oxide increases dopamine and serotonin release in the medial preoptic area. Neuroreport 5: 87–89

    CAS  PubMed  Google Scholar 

  55. Lorrain DS et al. (1996) Nitric oxide promotes medial preoptic dopamine release during male rat copulation. Neuroreport 8: 31–34

    CAS  PubMed  Google Scholar 

  56. Abdel-Hamid IA et al. (2001) Assessment of as-needed use of pharmacotherapy and the pause-squeeze technique in premature ejaculation. Int J Impot Res 13: 41–45

    CAS  PubMed  Google Scholar 

  57. Salonia A et al. (2002) A prospective study comparing paroxetine alone versus paroxetine plus sildenafil in patients with premature ejaculation. J Urol 168: 2486–2489

    CAS  PubMed  Google Scholar 

  58. Chen J et al. (2003) Efficacy of sildenafil as adjuvant therapy to selective serotonin reuptake inhibitor in alleviating premature ejaculation. Urology 61: 197–200

    PubMed  Google Scholar 

  59. Sommer F et al. (2005) Treatment of premature ejaculation: a comparative Vardenafil and SSRI crossover study [abstract #741]. J Urol 173: a202

    Google Scholar 

  60. Mattos RM and Lucon AM (2005) Tadalafil and slow-release fluoxetine in premature ejaculation—a prospective study [abstract #880]. J Urol 173: a239

    Google Scholar 

  61. McMahon C et al. (2005) Efficacy of Viagra (Sildenafil Citrate) in Men With Premature Ejaculation. J Sex Med 2: 368–376

    CAS  PubMed  Google Scholar 

  62. Kim JJ et al. (2004) Effects of glans penis augmentation using hyaluronic acid gel for premature ejaculation. Int J Impot Res 16: 547–551

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Australian Centre for Sexual Health, Sydney, Australia

    Chris G McMahon

  2. World Health Organization's second Consultation on Sexual Dysfunction Committee of Male Ejaculatory Dysfunction,

    Chris G McMahon

Authors
  1. Chris G McMahon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chris G McMahon.

Ethics declarations

Competing interests

Chris McMahon is a paid consultant, investigator and member of the speakers' panel for Pfizer and Johnson & Johnson.

Rights and permissions

Reprints and permissions

About this article

Cite this article

McMahon, C. The etiology and management of premature ejaculation. Nat Rev Urol 2, 426–433 (2005). https://doi.org/10.1038/ncpuro0293

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpuro0293

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing