Premature ejaculation

Premature ejaculation
International Classification (ICD) F52.-
Symptoms reduced quality of life, unsatisfactory sexuality, unsatisfactory intimacy
Possible causes Sexuality disorders
Possible risk factors Anxiety disorder, Steroid use, Medication, diabetes mellitus, previous urinary tract infections
Possible therapies Local anesthetics (local anesthesia), Squeeze technique, Psychotherapy, Medication
disease.indicated_substances Sildenafil


Premature ejaculation (ejaculatio praecox) is a common and poorly understood sexual disorder, often causing sufferers to avoid intimacy as well as sexuality. The term ejacuatio praecox comes from Latin and means "premature ejection".

According to the international ICD-10 disease classification, premature ejaculation is the inability to control ejaculation in a way that allows both partners to have satisfactory sexual intercourse. Ejaculation occurs before or during penetration in more than 75% of those affected.

The condition can be divided into a primary and a secondary form:

  1. Primary premature ejaculation has usually existed for a long time when it is first diagnosed by a urologist. It is congenital or the affected person has always had an intravaginal ejaculation time of less than one minute.

  2. The secondary form of the disease arises due to various causes such as hormonal changes or changes in the penis. This form is often accompanied by erection problems (erectile dysfunction).

Individual psychosexual well-being plays a major role in premature ejaculation. The average intravaginal ejaculation time of men across all age groups is 7 minutes.


Premature ejaculation can be both physical and psychological. Therefore, physical, medicinal and also psychotherapeutic treatment options should be considered for therapy.

Possible psychological causes of premature ejaculation:

  • Sexuality disorders

  • Anxiety disorders

  • Reflexes from the onset of sexuality in adolescence

  • A restrictive upbringing regarding sexuality as a child

  • Unrealistic expectations or ideas about sexuality

  • Sexual achievement thinking

The secondary form of premature ejaculation is often caused in men by steroid use (e.g., weight training). The excess testosterone causes hormonal changes and eventually premature ejaculation. Medications, such as opioids or sympathomimetics, can also cause premature ejaculation. Organic risk factors for the disease are urinary tract infections or diabetes mellitus.

Spermien (iStock / Christoph Burgstedt)

The physiological changes

Currently, premature ejaculation is understood to be a neurobiological problem caused by decreased serotonin neurotransmission. Likewise, decreased or even increased sensitivity of serotonin receptors may also play a role in the pathogenesis of the disease. The theory of receptor dysfunction also explains, for example, that premature ejaculation occurs more frequently in families.


Affected individuals often suffer from a reduced quality of life and unsatisfactory sexuality and intimacy. Premature ejaculation can put a strain on a partnership and lead to avoidance of sexual activity. Although the condition causes significant distress, few sufferers seek medical help.

Schamgefühl (iStock / peakSTOCK)


The diagnosis of premature ejaculation should be made by a urologist experienced in this field. Here the problem can be discussed sensitively and in detail. In addition, a detailed sexual, social and medication history is usually taken, since sometimes psychotropic drugs or blood pressure medication are responsible for premature ejaculation. During the confidential consultation, the patient is also asked how long it takes to ejaculate during sexual intercourse. Apart from a routine urological examination, no further examinations are usually necessary for the diagnosis.


There are various options for the treatment of premature ejaculation, whereby different treatments often have to be tried until an improvement is achieved. Initially, the urologist usually prescribes a cream containing a local anesthetic, which is applied before sexual intercourse. Local anesthetics such as lidocaine or prilocaine are active ingredients that numb the skin and reduce sensitivity on the penis. The use of this cream is based on the assumption that the tip of the penis of men with premature ejaculation is too sensitive.

The Squeeze Technique:

A mechanical therapy option for treating the condition is called the squeeze technique. Its application is intended to reduce the bloodiness in the corpus cavernosum by interrupting sexual intercourse and, on the other hand, by applying pressure on the glans. However, most of the time its application alone does not show satisfactory results.
Since premature often has a psychological component as its cause and triggers massive suffering, psychotherapy is an integral part of the therapy.

Psychotherapeutic procedures:

  • Sex therapy

  • Couples therapy

  • Cognitive behavioral therapy (KVT)

  • Family therapy

Drug therapy options:

Classic sexual enhancers such as phosphodiesterase V inhibitors (PDE-5 inhibitors) can also be used to treat premature ejaculation. Active ingredients of this group include sildenafil or tadalafil. Their use is currently "off-label", meaning that although an effect is being discussed, the drug is not officially approved for the indication of premature ejaculation. Currently, there are two different theories for the use of PDE-5 inhibitors in premature ejaculation:

  1. A central nervous mechanism of action, as it has been demonstrated that within the ejaculatory reflex, the PDE-5 enzyme is important in signal transduction.

  2. A peripheral mechanism of action, as smooth muscle cell relaxation results in delayed ejection of seminal fluid into the posterior urethra.

Selective serotonin reuptake inhibitors (SSRIs) such as sertraline or paroxetine, which are used to treat depression, also cause delayed ejaculation as a side effect. However, because they must be used long-term, short-acting SSRIs such as dapoxetine are more suitable for "off-label" treatment of the condition. However, the risk-benefit ratio is critically discussed.


The prognosis of premature ejaculation varies from individual to individual, with the secondary form being more treatable overall. In this case, the symptoms often improve rapidly after the cause has been eliminated (e.g. cessation of steroid use, opioid use or after treatment of penile changes).

(iStock / dima_sidelnikov)


The prognosis of premature ejaculation varies from individual to individual, with the secondary form being more treatable overall. In this case, the symptoms often improve rapidly after the cause has been eliminated (e.g. cessation of steroid use, opioid use or treatment of penile lesions). The treatment of primary premature ejaculation is often more difficult, with various treatment methods often having to be tried before lasting therapeutic success is achieved.

Editorial principles

All information used for the content comes from verified sources (recognised institutions, experts, studies by renowned universities). We attach great importance to the qualification of the authors and the scientific background of the information. Thus, we ensure that our research is based on scientific findings.
Dr. med. univ. Moritz Wieser

Dr. med. univ. Moritz Wieser

Moritz Wieser graduated in human medicine in Vienna and is currently studying dentistry. He primarily writes articles on the most common diseases. He is particularly interested in the topics of ophthalmology, internal medicine and dentistry.

Dr. med. univ. Bernhard Peuker, MSc

Dr. med. univ. Bernhard Peuker, MSc

Bernhard Peuker is a lecturer and medical advisor at Medikamio and works as a physician in Vienna. In his work, he incorporates his clinical knowledge, practical experience and scientific passion.

The content of this page is an automated and high-quality translation from DeepL. You can find the original content in German here.



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