Premature Ejaculation: Your Questions Answered

Search for help with finishing too soon and you'll find pills, sprays, creams, exercises, and a lot of confident advice from people who have never sat with a man going through it.

These are the questions I hear most often, answered as honestly as I can. I'm a sex coach, not a doctor. Where a question is medical, I'll say so, and I'll tell you what coaching can add.

For the full picture of how I teach control, start with my complete guide to premature ejaculation.

The basics

What causes premature ejaculation?

In my experience, most of the time it's the link between arousal and anxiety. As arousal climbs, anxiety climbs with it, the body tightens, and everything speeds up. Habits play a part too, especially years of fast masturbation.

Physical causes are less common, but they're real. Thyroid problems, prostate problems, and recreational drugs can all play a role. A doctor can rule those out.

How do I know if it's "really" PE?

The clinical definitions are strict. For lifelong PE, they usually mean finishing within about a minute of penetration, nearly every time, with real distress about it.

Most men who come to me last longer than that and still finish before they want to. That's worth working on too. I go into the difference in Is It Normal to Finish Quickly?

How long should sex last?

One survey of sex therapists put "adequate" intercourse at 3 to 7 minutes and "desirable" at 7 to 13.

I share that mostly to take the pressure off: it's shorter than most men imagine. But I'd rather you aim for a feeling than a number. What you want is control, the sense that you choose when.

Is premature ejaculation permanent?

No. For most men I've worked with, control is a learnable skill. It takes practice, not willpower.

How long does it take to learn control?

In my practice, I've seen anywhere from a couple of weeks to more than a year. It depends on how long it's been going on, how quickly you finish now, and how consistently you practice.

Think of it like learning the piano. Nobody sits down once and expects to play well. Men who give up early usually expected a trick, not a skill.

What you can do right now

What can I do tonight?

While you're learning the longer-term skills, a few things can help:

• Breathe slowly and low, from start to finish.
• Try positions other than missionary. Holding yourself up in a plank tenses your whole body. Many men find more control with their partner on top, spooning, or from behind, where they can relax.
• Masturbate an hour or two beforehand.
• Use a thicker condom. It lowers sensation, so think of it as a short-term support.
• Make pleasure the goal, not duration. If your partner wants to, help them come first, in whatever way they enjoy most.
• Tell your partner. Something like: "I sometimes finish sooner than I want, and I'd love for us to take our time. Can we slow down tonight?"

Does the start-stop or squeeze method work?

It can help some men delay. If it works for you, use it.

My reservation: it teaches you to stop when arousal gets high, not to relax into it. I'd rather teach your body to hold more arousal with less tension, so you're not slamming on the brakes every few minutes.

Do kegels help?

Not the way most people think. Kegels have been the go-to advice for years, but most men I work with are already over-clenching. We want the whole body, especially the pelvic floor, to relax and release.

Where kegels are useful is as a check. If you're not sure whether your pelvic floor is relaxed, tighten and release it a few times. Now you know what letting go feels like.

My erection comes and goes during long sex. Is something wrong?

Probably not. In my experience, erections often ebb and flow, and plenty of men lose some firmness after being hard for a long stretch without finishing.

If you keep breathing, stay connected to your body and your partner, and go after what you want, it often comes back. The trouble starts when you get stuck in your head monitoring how hard you are. That pulls you away from the pleasure.

If getting or keeping an erection is a regular struggle, see a doctor.

Medical questions

When should I see a doctor?

If it started suddenly, if there's pain or urinary symptoms, if you're also having trouble with erections, if it began after starting or stopping a medication, or if you simply want to rule out a medical cause: go, and sooner rather than later.

What can doctors prescribe for premature ejaculation?

The most common option is a class of antidepressants called SSRIs, which can delay ejaculation as a side effect. In the US, no medicine is approved for this, so they're prescribed off-label.

Dapoxetine is a short-acting SSRI made to be taken before sex. It's licensed in the UK but not approved in the US. It isn't suitable for everyone, can interact with other medications, and can cause headaches, dizziness, or nausea.

These are decisions to make with a doctor. What coaching adds: medication can buy you time, but it doesn't teach your body to stay relaxed while arousal builds. Some men use both, with medication as a bridge while they practice, under a doctor's guidance.

Can Viagra help with premature ejaculation?

Sildenafil (Viagra) and similar drugs are made to treat erections, not ejaculation. Research reviews haven't found strong evidence that they help with premature ejaculation, except in men who also have erection problems.

If you also struggle with erections, or you rush because you're afraid of losing your erection, a doctor may suggest one. That's a conversation for your doctor.

What about numbing creams and sprays?

They contain a local anesthetic, such as lidocaine, prilocaine, or benzocaine, applied before sex to reduce sensation. Without a condom, they can numb your partner too.

A few years ago K-Y contacted me to interview me about the men who come to me for help with ejaculation. At the end, they told me what they were launching: a product with lidocaine in it. Would I recommend it to my clients? My answer was no.

Numbing yourself so you can't feel is like putting a bandage on an injury that needs stitches. My whole approach is about learning to let pleasure into the body, not numbing it out.

Does premature ejaculation affect sperm count or fertility?

Sperm count and fertility are questions for a doctor, not a coach. If ejaculation consistently happens before penetration and you're trying to conceive, talk to a doctor or a fertility specialist.

The bigger questions

How often is it normal to ejaculate?

There's a wide normal range, from more than once a day to once a week or less. It depends on age, desire, health, stress, and what you believe about sex.

Some traditions, Taoist practice among them, recommend ejaculating rarely. That's a philosophy, not a health requirement. I write more about it in Delaying Ejaculation: Pleasure, Pressure, and What You Want.

If I ejaculate twice a day, is that a sex addiction?

Frequency alone doesn't tell you. The better question is whether it's costing you. Are you missing work, canceling plans, taking risks, or feeling unable to stop when you want to?

If yes, a licensed therapist is a good next step. If not, you probably just have a strong sex drive.

I feel self-conscious naked. Does that matter?

It does. It's hard to let pleasure in while you're judging your body.

I once worked with a man who had been badly bullied for not growing much facial hair. Years later, he'd stopped looking in the mirror. The bullies were long gone, but he was still doing the same thing to himself every day. As we looked in the mirror together and talked about it, he softened, and for a moment he felt something like compassion for himself.

It's a process, not a switch. Here's where to start. Undress in front of a mirror and take a long look at your whole body. Work up to it if you need to. Then ask yourself:

• What do I see?
• What do I like?
• What do I hate?
• What's hard to look at, and what's easy?

For the hard parts, ask whose words you're hearing. Often they're someone else's, or the media's. See if you can offer that part of your body a little kindness. Your body never tried to hurt you.

Can I work with you directly?

Yes. I work one-on-one with men, and with couples. If you'd rather start on your own, my 30-minute PE audio course is a lower-commitment way in.

If finishing sooner than you want has become a worry, my PE Mastery video course takes you through the full practice, step by step and at your own pace.