Most men don't seek medical help for this problem—partially because they may be embarrassed or perhaps because they are unaware that effective treatments are available. But premature ejaculation (PE) is a common male sexual disorder that often affects the sexual satisfaction of the man, his partner or both. It may also diminish his self-confidence and cause him anxiety and depression.
At the same time, many men have concerns about the condition even when their ejaculation time falls in the normal range of around 3 to 6 minutes. While the time varies, a study of about 500 men found that the median time was 5.4 minutes. (That figure varied with age, from 6.5 minutes among men 18 to 30 to 4.3 minutes for men older than 51.) Moreover, many men experience variations within the normal range.
In contrast, PE occurs when a man always (or nearly always) experiences ejaculation within a minute or less during sexual activity. It can also be defined as the inability to regularly delay ejaculation and reacting with distress or avoidance of sexual intimacy. Premature ejaculation may be "lifelong," beginning when the man first becomes sexually active and occurring with nearly every partner. Or it may be "acquired," occurring after having normal ejaculation times up until then.
Traditionally, the only options for men with PE were psychotherapy and behavioral therapy. But some men explore medical options, including low doses of the antidepressants known as selective serotonin reuptake inhibitors (SSRIs). These drugs are FDA-approved for the treatment of depression, and some are approved for other health conditions. But others have increasingly become first-choice drugs—although used "off-label" for PE—which may be related, in part, to lower levels of serotonin, a chemical in the brain that has a delaying effect in ejaculation. SSRIs increase the production of serotonin, and a side effect, first noted in the treatment of depression, is prolonging the time it takes to reach ejaculation. (Doctors can legally prescribe any medication for conditions other than those approved by the FDA.)
"Most men with premature ejaculation respond to daily treatment with SSRIs, and some respond really well," says Ira Sharlip, M.D., a clinical professor of urology at the University of California, San Francisco, and a spokesman for the American Urological Association. "But there are significant side effects that, while not harmful, are unpleasant for the patients who experience them."