PE in Men: What Causes It & How to Treat It

Throughout a man’s life, there will probably be times when he’ll go through a challenging period in his sexual health.

While PE in men can feel isolating, it’s actually incredibly common. One in three American men aged 18-59 experience premature ejaculation regularly. So, if you’re struggling with premature ejaculation disorder, you’re not alone.

What Is PE In Men?

Premature ejaculation, also known as PE, is when ejaculation occurs during sex sooner than a man or his partner would like. Whilst PE isn’t considered a health condition, it can impact relationships. For some, it will be a one-off or an occasional incident. But if it starts to become a recurring problem, PE in men can lead to feelings of distress, embarrassment, insecurity, anxiety, and even depression.

What Causes Male PE?

The cause of premature ejaculation isn’t completely understood, but it’s thought that serotonin plays a role. Serotonin is an essential hormone that stabilizes our mood, wellbeing, and happiness. Serotonin also enables our brain cells and nervous system cells to communicate and helps with sleeping, eating, memory, and digestion.

Too little serotonin in the body can cause a host of issues, including:

• Mental health symptoms such as depression and anxiety
• Memory issues
• Changes in sleep patterns
• Trouble focusing
• Digestive issues

In our sexual health, serotonin can also increase the length of time to orgasm. If you’re deficient in serotonin, then you may experience premature ejaculation.

PE in men may also be linked to underlying psychological causes and can be impacted by feelings of stress and anxiety in other areas of your life. For example, a high-pressure job or financial struggles could lead to PE in men… Over the last few years, there has been a massive recognition of PE in men and a better understanding of the problems that can stem from it. It’s important to remember that you’re not alone in suffering from PE, and worrying about your condition can increase your emotional stress and anxiety, therefore worsening your PE.

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How Do You Treat Male PE?

So, the big question: Is there treatment for premature ejaculation? Yes.

For many men suffering from premature ejaculation disorder, there’s often a psychological cause. Your doctor may suggest psychological, behavioral, or medical treatments for PE. If they believe there are a few factors at play, they may prescribe a combination of treatments.

Psychological Treatment For Premature Ejaculation

If PE occurs at the beginning of a new sexual relationship, it often resolves as the relationship develops. However, if PE persists, your doctor may recommend counseling from a therapist that specializes in couples therapy.

Behavioral Therapy For PE In Men

Alternatively, they may recommend behavioral therapy, which uses exercises to ‘train’ your body. There are two main techniques used to treat PE in men, which aim to build control over your ejaculation:

• The Squeeze Method is where you or your partner squeeze the head of your penis as you feel that you’re about to ejaculate. Over time, you’ll build more control.
• The Stop-Start Methods works by stopping sex or reducing stimulation when you feel like you’re about to ejaculate. This works similarly to the squeeze technique. And the more you practice, the more control you’ll have over your ejaculation.

Medical Treatment For PE

Currently, there are no medications specifically approved to treat PE in men. However, many doctors use selective serotonin reuptake inhibitors (SSRIs), which have “off-label” abilities to treat PE in men. SSRIs are commonly used to treat depression because they raise serotonin levels in the brain. As previously discussed, serotonin delays ejaculation, so SSRIs can also help to treat PE in men. However, it’s important to be aware that SSRIs may have unpleasant side effects.

Alternative Ways To Treat PE In Men

Some men find that applying a numbing cream or spray directly to their penis can help with PE. You can buy a range of creams and sprays to delay ejaculation at the pharmacy.

Alternatively, you might find that wearing a condom helps you combat PE. Many men will already be aware that a condom dulls some sensation; if you suffer from premature ejaculation, that dulled sensation could help you build control during sex.

Topical Anesthetics for Premature Ejaculation

Lidocaine does help with premature ejaculation in controlled trials. A topical anesthetic numbs the head of the penis, which lowers sensation and can delay ejaculation.¹ A 2013 meta-analysis pooled eight randomized trials.² Topical anesthetics lengthened intravaginal ejaculatory latency time (the time from penetration to ejaculation) more than placebo did (P < .00001).² A 2016 review found that lidocaine gel outperformed placebo, sildenafil and paroxetine in individual trials.³ Seven of the nine trials in that review were of unclear methodological quality.³

The largest trials tested a lidocaine-prilocaine spray. A European phase III trial enrolled 300 men with lifelong premature ejaculation.⁴ Geometric mean latency rose from 0.6 minutes to 3.8 minutes on the spray, compared with 1.1 minutes on placebo.⁴ Men using the spray also reported better ejaculatory control and sexual satisfaction.⁴ A metered-dose version of this spray is approved in Europe for premature ejaculation.⁵

Side effects stay mostly local. The 2013 meta-analysis found more adverse events with topical anesthetics than with placebo, and nearly all of them were mild and transient.² Excess numbness can work against you. In one cream trial, men who left the cream on longer before sex lost their erections because of numbness.⁶ A 2012 review lists numbness in the man or his partner among the drawbacks of off-label topical products.¹ In the European spray trial, localized side effects were reported by 2.6% of men and 3.1% of partners.⁴

In two early lidocaine-prilocaine cream studies, men covered the penis with a condom after applying the cream.^6,7 One over-the-counter lidocaine desensitizer label tells you to wash the product off after intercourse and to stop if you or your partner develop a rash or irritation.⁸ The same label states that premature ejaculation may be due to a condition requiring medical supervision.⁸

If you want to try a topical anesthetic, a physician can help you choose a product and decide how it fits with the behavioral techniques above. The European Association of Urology lists medication as first-line treatment for lifelong premature ejaculation.⁹ For acquired premature ejaculation, which starts after a period of normal control, the EAU guideline makes treating the underlying cause the first goal.⁹ Your evaluation shows which of those two situations applies to you, and your plan follows from it.

If PE is harming your mental health and relationships, consider speaking with a men’s health doctor. Here at Opt Health, we have specialized men’s health doctors who can provide treatment from the comfort of your own home. However, we can help with so much more than providing treatment for premature ejaculation. We also offer preventative medicine to increase men’s vitality and testosterone replacement therapy for men.

The Opt Take on Premature Ejaculation

PE is common and treatable, and the right approach depends on what is driving it for you. Your physician looks at your history, your medications and your goals before recommending behavioral methods, a topical anesthetic or a prescription.

Opt Health begins with a panel of 55+ biomarkers, covering hormones, inflammation and cardiovascular risk, and a 1:1 consultation with an Opt Health physician. Your existing conditions and current medications are reviewed before a plan is set. Labs and a physician consultation repeat every 3 to 4 months, so your plan changes with your results. You can see the full process on the How Opt Health Works page.

Consultations happen by video on a HIPAA-compliant platform, and your care team is reachable by chat in the Opt app 7 days a week. Sexual health often ties back to sleep, stress and hormones, which are three of the six pillars Opt Health builds your care around.

Get started: Begin with Opt Health, where a physician reads your labs, builds your plan, and adjusts it over the loop.

Available in the GetOPT store: Sildenafil and Lidocaine Gel.

This content is for informational purposes and does not replace evaluation, diagnosis, or treatment by a qualified medical professional.