Premature Ejaculation – Causes and Treatment Methods

Premature ejaculation, also known as rapid ejaculation, is one of the most common and frustrating sexual performance disorders in men. When it occurs, it disrupts the sense of control and self-esteem, and can significantly affect a relationship. The good news is that it is a treatable condition, and the better one understands the combination of underlying factors, the easier it becomes to find an accurate, personalized solution.

The Physiological Basis – How Does Ejaculation Occur?

To understand what premature ejaculation is, it is important first to know the ejaculation process itself.

Ejaculation is a complex reflex process controlled by the central and peripheral nervous systems. It can be divided into two main consecutive stages – the emission phase and the expulsion phase. Understanding these stages helps identify where the premature ejaculation issue occurs.

1. Emission Phase

This stage begins when sexual stimulation reaches its peak and is managed by the sympathetic nervous system (responsible for involuntary responses like increased heart rate).

Sperm and fluid collection – a series of involuntary contractions occur in several areas. The testes, epididymis, and vas deferens contract, moving sperm cells into the posterior urethra. Simultaneously, the prostate gland and seminal vesicles release fluids that make up most of the semen volume.

The "point of no return" – as the fluid accumulates in the posterior urethra, bladder neck muscles contract and close tightly. This prevents semen from flowing backward into the bladder (retrograde ejaculation) and ensures that all fluid moves forward. This is when a man feels the "point of no return" – from this moment, ejaculation becomes inevitable.

2. Expulsion Phase

This stage follows immediately after the emission phase and is uncontrollable once it starts.

Muscle contractions – this reflex is triggered by the central nervous system. Strong rhythmic contractions occur in the pelvic floor muscles around the base of the penis.

Semen expulsion – these contractions push the collected semen outward through the urethral opening.

Orgasm – the expulsion phase is accompanied by orgasm, the physical and emotional peak of sexual pleasure.

What Is Premature Ejaculation?

Premature ejaculation is characterized by a consistent inability to control the timing of ejaculation, which occurs sooner than desired by either partner. The standard definition refers to ejaculation that happens very quickly—often within one to three minutes after penetration, or even before it—leading to frustration, distress, and reduced sexual satisfaction. The exact duration may vary based on the couple's expectations and cultural or personal context. Some studies define varying time ranges according to medical criteria such as those of the International Society for Sexual Medicine (ISSM).

What Causes Rapid Ejaculation?

Premature ejaculation doesn't result from a single cause but rather a combination of biological, physiological, psychological, and relational factors. Understanding all of these factors is key to building an effective, personalized treatment plan. In recent years, awareness of personalized treatment has grown significantly compared to general, one-size-fits-all approaches.

1. Biological And Physiological Factors

Chemical imbalance in the brain – the mechanism controlling ejaculation involves neurotransmitters in the brain. Irregular levels or imbalances of these chemicals can affect the ejaculation reflex and make it occur faster.

Increased sensitivity – heightened sensitivity in the penis, especially at the glans, can cause rapid arousal and early ejaculation.

Health conditions – thyroid disorders, prostate or urethral inflammation, and chronic illnesses such as diabetes or nerve damage can contribute to the problem.

Genetic factors – there is evidence suggesting a hereditary component in lifelong (primary) premature ejaculation.

2. Psychological And Emotional Factors

Performance anxiety – fear of failure or inability to satisfy a partner creates tension that accelerates ejaculation.

Previous sexual experiences – habits developed in early experiences, such as rushed masturbation due to fear of being caught, can establish a lasting pattern of rapid climax.

Stress, pressure, and depression – mental strain and high stress levels interfere with relaxation and control over sexual response.

Associated erectile dysfunction – men who fear losing their erection may rush the act, perpetuating a cycle of anxiety and premature ejaculation.

Treatment Methods And Regaining Control

Treatment for premature ejaculation is multidisciplinary but must be tailored to the identified cause. In many cases, combining different approaches produces the best results.

1. Behavioral Therapy And Control Techniques

This approach forms the foundation of treatment, focusing on developing physical and mental control over the ejaculation reflex. The goal is to gradually extend the time before ejaculation through structured training methods.

Start-Stop Technique – the man learns to recognize his arousal level. Stimulation continues until reaching the 'point of no return,' then stops completely for about 30 seconds until arousal subsides. Repeating this process trains the nervous system to recalibrate control.

Squeeze Technique – similar to the start-stop method, but when arousal peaks, the partner gently squeezes the base of the glans (the head of the penis) for a few seconds. This reduces arousal and allows continuation.

Pelvic Floor Exercises (Kegels) – strengthening the pelvic muscles, which play a direct role in ejaculation, can significantly improve control.

Distraction and Relaxation Techniques – learning to shift focus or use breathing relaxation at moments of high arousal can moderate the response. Positions that reduce the man's physical activity (e.g., lying on his back) can also help decrease tension.

2. Medication (With Doctor's Approval)

There are medical treatments prescribed by doctors that target the biological causes of premature ejaculation.

Topical products – sprays or creams containing mild anesthetic agents reduce skin sensitivity in the penis and help extend control time.

Oral medications – certain drugs originally developed for emotional disorders affect specific neurotransmitter levels in the brain, delaying the ejaculation reflex. These are prescribed by urologists or sexual medicine specialists in personalized doses, for daily or on-demand use before intercourse.

SKCURE offers advanced telemedicine solutions for premature ejaculation.

Treatment is customized after a detailed medical questionnaire and professional diagnosis by experts, then discreetly shipped to your home.

Note: The decision to begin, adjust, or stop medication must be made solely by a doctor after a thorough diagnosis and personalization. Never start, change, or stop medical treatment without explicit medical supervision.

3. Psychological And Couples Therapy

Reducing mental stress and improving relationship intimacy are essential components of successful treatment.

Sex therapy – focuses on reshaping negative thought patterns about sexuality, rebuilding sexual confidence, and enhancing partner communication.

Couples therapy – addresses relational conflicts, mutual performance anxiety, and teaches ways to create closeness and non-performance-focused intimacy.

Practical exercises may include gradual exposure techniques that emphasize non-sexual touch (sensate focus) and intimacy, or guided conversations to improve communication about needs and expectations. This approach helps create a safe emotional space where both partners feel understood and supported, reducing tension associated with premature ejaculation.

Enhance Your Sexual Function With SKCURE

At SKCURE, we understand the importance of personalized and discreet support in your journey to overcome premature ejaculation. We are committed to creating a comprehensive, tailored treatment plan just for you. This process includes a detailed medical assessment via a doctor-reviewed questionnaire, followed by a targeted solution designed specifically for your needs. As a result, you can avoid unnecessary trial and error with multiple products — instead, you receive one effective, concentrated treatment discreetly and quickly delivered right to your door.

Authored By - Dr. Shlomo Sadoun

A pioneering pharma entrepreneur with over two decades of experience in the health and biotechnology sectors. Operating at the intersection of science, innovation, and a global vision, leading the development of advanced medical solutions with a real impact on patients’ lives.