What is premature ejaculation and how common is it?

Sex: the thing that takes up the least amount of time and causes the most amount of trouble.John Barrymore

Some men last longer at sex than others. Some men finish within a few minutes, others can go for an hour or more. We fast-forward through porn for this very reason.

There are men who find it impossibly difficult to last any longer than a few seconds. And there are men who think they don’t last long enough, no matter how long they last. These are the nuances of a problem called premature ejaculation.

What is premature ejaculation?

With science, research and years of studies with stopwatches on our side, it’s time for some definitive answers. Firstly, let’s consider why lasting longer is such a big deal.

Why do men feel under pressure?

For us non-sexual-athletes, truly satisfying sex presents unique challenges:

• Sex is a multi-step activity (seduction, foreplay, intercourse, post-coital glow), with each phase calling for timing and initiative. This is a source of pressure.
• We have sex entangled with someone else. Their needs and desires need to be balanced with our own. If we disappoint, we fear they might leave us. This is another source of pressure.
• Sex requires maintaining arousal and relaxation at the same time. That’s pressure, right there.
• Strategically planned sex is not fun sex. So we put ourselves under pressure to be spontaneous.
• We are bombarded with portrayals of others having amazing, effortless sex. This is not helpful.

When we make a habit of finishing too soon, we call this premature ejaculation (or PE for easy convenience). But how soon is too soon?

Medical definition of premature ejaculation

In 2014, the International Society for Sexual Medicine assembled a select panel of premature ejaculation experts. They decided that it occurs when a man always (or nearly always) ejaculates less than one minute after penetration.

Interestingly, one minute is quite a long time compared to earlier medical estimates. In 1994, experts described PE as occurring before or within 15 seconds of the beginning of intercourse ¹. Earlier definitions were based on the number of pelvic thrusts rather than duration, with 15 or fewer thrusts qualifying as a problem. We clearly have higher expectations these days.

What about men who don’t get as far as penetration?

This is considered the most extreme form of premature ejaculation, for obvious reasons. Shooting prior to vaginal penetration is called anteportal ejaculation. It presents a significant block for couples who are trying to conceive children, natch.

How long do most men last?

For comparison, a 2005 multinational survey found that the average duration of penis-in-vagina action is 5.4 minutes. This was a comprehensive piece of research. 500 couples were closely monitored over a 4-week period and yes, stopwatches were used.

Do men always have premature ejaculation, or can they develop it?

The answer is that both are possible. We might notice a significant reduction in our sexual stamina, gradually over time or seemingly out of the blue. If we previously lasted longer, this is known as acquired premature ejaculation. If we have always experienced the problem, right from our first sexual experiences, then this is considered to be lifelong premature ejaculation.

To reflect this, the ISSM guidelines extend the definition of premature ejaculation to include men who have experienced a significant reduction in intercourse duration, often to around 3 minutes or less.

What about men who last longer, but they (or their partners) still aren’t satisfied?

One of the reasons why premature ejaculation has always proved tricky to define is its subjective nature. Men tend to think they don’t last long enough, regardless of their actual timings. They might enjoy intercourse for longer than the average 5.4 minutes but if their partner doesn’t reach orgasm, they cast themselves as having a problem. In one Australian survey, nearly a quarter of men said they “came to orgasm too quickly”.

Then there are men who ejaculate relatively quickly and don’t see it as an issue. Their partners may be perfectly satisfied, due to their own needs and sexual expectations.

Most men will experience natural variation in their own ability to delay orgasm. Some sexual encounters last longer than others, for a whole variety of reasons. For example, we tend to come quicker if we haven’t had sex for a while or are experiencing the excitement and novelty of a new partner. Tiredness levels and environment also make a big difference.

Also note that medical definitions, and the research behind them, are fixated on the duration of penis-in-vagina intercourse. This doesn’t take the full curve of sexual arousal into account, as the penis becomes erect much earlier in the process. In fact, the build of sexual excitement begins in the central nervous system before the penis even notices. There is much more to this than boners and orgasms, as we’ll discuss in the section on causes.

Is premature ejaculation bad for mental health?

Yes, it certainly can be. Every time we struggle to make sex last, we tell ourselves that we must do better next time. For men who struggle with lifelong premature ejaculation, this presents a constant cycle of pressure, disappointment and frustration. The only apparent way out is to avoid sexual relationships altogether.

The 2014 ISSM definition acknowledges this. As well as always experiencing an “intervaginal ejaculatory latency time” of one minute or less (or a significant reduction), a man has premature ejaculation if:

a) he experiences an inability to delay his ejaculation (i.e. he’s not just being lazy) and
b) he experiences negative personal consequences such as distress, bother, frustration and/or the avoidance of sexual intimacy

The ISSM guidelines highlight the fact that premature ejaculation causes significant personal and interpersonal distress to the man, his partner and the couple.

How severe is the psychological impact?

It is inevitable that negative associations around our sexual function will affect us at some level. The potential for mental distress depends on our individual circumstances, emotional outlook and support from our partners. Sex is a deeply integral part of our identity, the fundamental connection with our partners and the genesis of new life, after all.

Men who experience intermittent PE might accept that this is how they function, and the impact on their confidence and self-esteem is relatively minimal. A positive perspective can go a long way, understanding that millions of men experience the same frustration on occasion and still enjoy satisfying relationships. Men with this mindset tend to find sexual workarounds and foreplay techniques that compensate for any shortcomings (no pun intended).

For others, however, the inability to last in bed has a devastating effect on their confidence, self-esteem and life experience. Unable to enjoy their sexuality, their innate needs for intimacy and connection are compromised. If they are in a relationship, the prospect of intimacy makes them edgy. Their PE anxiety is ever-present in the bedroom. Research has identified a clear link between premature ejaculation and depression.

With a natural tendency to problem-solve rather than problem-discuss, men are less likely to seek help or consult their doctors. We tell ourselves to man-up, fix our own issues, tough it out. This especially applies when the problem is so personal and embarrassing.

Unfortunately, this attitude leads to men being locked in a loop of frustration and failed attempts to fix themselves. The wealth of misguided advice on the internet doesn’t help. Trying to fix our own PE problem can also become an obsession, as evidenced in the online communities of men sharing elaborate kegel and edging routines. Self-help and discussion can make a positive difference, but obsession and over-thinking risks making matters worse.

Is the term ‘premature ejaculation’ unhelpful?

Some experts suggest that this clinical term pathologises the problem, making it sound like a disease or permanent affliction. It also doesn’t convey the subjective nature of the issue. As mentioned above, ‘premature’ means different things to different men. The term ‘early ejaculation’ is sometimes used, but this has similar connotations.

A more positive label might be ‘difficulty with prolonging intercourse’. This has a less judgemental ring to it, and acknowledges that a difficulty can be managed and overcome with self-compassion and strategy.

For reasons of convenience and searchability, I stick to the generally accepted term in my website and writings. In my therapy work, I always explain these distinctions. It gives us a head-start in understanding the problem and setting a positive expectation for treatment.

How common is premature ejaculation?

In a nutshell: more common than most of us realise.

There’s no absolute statistic, mainly due to the sensitive nature of the issue. Surveys have suggested that 66% of men ejaculate soon after intercourse commences ². Other studies are more conservative, estimating that between 20% and 30% of men regularly experience the problem. A UK study of a random sample of men on GP waiting lists put the figure at 31% ³.

Experts report that premature ejaculation is the most common sexual complaint among men of all ages. Renowned sex counsellor and psychotherapist Ian Kerner agrees with this claim. He suggests that the percentage of men who struggle is higher than 30%, especially among men under 40 years of age ⁴.

It is also estimated that between 5% and 20% of men with lifelong premature ejaculation suffer from anteportal ejaculation, or the inability to penetrate their partners without coming. So the prevalence of this most challenging form of the problem is also higher than most of us would predict.

How frequently do men experience premature ejaculation?

There is insufficient data on this, but the ISSM guidelines suggest that the prevalence of lifelong premature ejaculation is unlikely to exceed 4% of men. This is using the definition of lifelong premature ejaculation as always (or on most occasions) coming within a minute of intercourse.

In an online survey of men in the Middle East, 82% of participants reported some degree of difficulty in making sex last. 15% of participants reported that they ‘always’ ejaculated before they wished, while 21% described themselves as ‘mostly’ ejaculating before they wanted. ⁵ In a similar US study, 78% of men reported some degree of difficulty, with 14% stating that this was ‘always’ the case.

These statistics suggest that the majority of men who struggle to make sex last are experiencing situational or acquired premature ejaculation. However, the numbers of men who experience lifelong PE are most probably higher than the 4% ISSM estimate.

Does premature ejaculation get better as men get older?

Although the issue is reported across all age groups, younger guys may be less affected by their inability to last long. If a man has a short refractory period, his partner doesn’t need to stay sexually aroused for long before he can commence round two.

For men under the age of 30, their refractory periods are typically less than 10 minutes. It’s common for young men to deliberately use the strategy of rapid stimulation and ejaculation, then a session of foreplay before gaining another, often longer-lasting, erection. They can rely on their bodies’ ability to keep going.

As men age, however, their refractory periods inevitably get longer. One ejaculation per sex session definitely becomes the norm, and some men take a couple of days to fully recover and feel horny again. Along with the increased possibility of erectile dysfunction, this means that older guys are more inclined to rush sex while the going is good.

It is a myth that premature ejaculation goes away as men grow out of it. Younger guys may be less likely to identify with the problem, but they certainly experience it. In surveys, older men are more likely to report PE difficulties for the reasons described above ⁶.

Do gay men experience premature ejaculation as much as straight men?

Studies suggest that the problem is just as common for gay men as it is for straight men ⁷. Regardless of sexuality, we all experience the same pressures and expectations in the bedroom.

Is it true that overweight men last longer than slim men?

Interestingly, there is evidence to suggest that overweight men really do last longer. In one study, researchers noted that overweight men had an average advantage of 60 seconds.

A possible explanation is that overweight men have higher levels of the female sex hormone estradiol and lower levels of testosterone. They have elevated levels of prolactin, a hormone that also decreases testosterone. This can inhibit the process of orgasm and ejaculation. In fact, overweight men are more likely to report problems reaching orgasm.

How reliable are the surveys?

Due to the stigma and embarrassment surrounding PE, men are certainly less likely to volunteer information about their experiences. Even when they approach their doctors in full confidentiality, men with premature ejaculation are inclined to downplay the symptoms.

As noted previously, some men are more distressed about their inability to delay ejaculation than others. They might answer yes to a straightforward question on a research survey, but not actually experience enough distress or bother to seek any kind of treatment. According to the full ISSM definition of premature ejaculation, they don’t meet the criteria ⁸.

Inevitably, this affects the reliability of survey-based research and how accurately it represents the real picture. However, when we combine insights from surveys and research with the popularity of self-help articles, forums and media attention, it’s clear that premature ejaculation is a widespread source of personal distress. Whatever our own experience of the problem may be, we are certainly not alone.

Coming up in Part 2: what causes PE? Is it our genetics, all in our minds – or are we doing something wrong?

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