Premature ejaculation: what it really is, why it happens, and how it's treated

It is, by a wide margin, the most common reason men come to see me. It's also the one most surrounded by silence, shame, and misinformation. Many arrive turning the same questions over in their minds: "Is this all in my head?", "Or is something wrong with my body?", "Can this be fixed, or do I just have to live with it?". These are completely legitimate concerns, and the good news is that they have answers.

Premature ejaculation has a medical explanation, it has concrete causes, and—above all—it has effective treatment. In this article I explain, without unnecessary jargon and without taboos, what it really is, why it happens, and what options you have today to resolve it.

What is premature ejaculation?

We speak of premature ejaculation when ejaculation persistently happens sooner than desired—usually within the first minute after penetration or even before—the person feels they have no control over that moment, and this causes distress, anxiety, or affects their sex life and relationship.

Three things in that definition are worth emphasizing:

• It's persistent and repeated. If it happens on an isolated occasion—after a long time without sexual activity, or during an especially arousing encounter—that is not a disorder: it's normal.
• It's defined by distress, not by the stopwatch. There is no "correct number" for how long it should last. What matters is the lack of control and the distress it causes, not reaching some magic number of minutes.
• It's not your fault, nor a flaw in your manhood. It's a sexual health issue as legitimate as any other, and it's treated as such.

It's more common than you think

If you're going through this, the first thing I want you to know is that you are not alone and you are not a rare case. Premature ejaculation is the most common male sexual dysfunction: it affects roughly one in three men at some point in their lives, regardless of age.

The problem is almost never how often it happens, but the silence that surrounds it. Many men live with this for years—sometimes decades—without seeking help, losing confidence and avoiding intimacy, when the solution is usually far more within reach than they imagine.

Two types worth distinguishing

Not all premature ejaculation is the same, and telling them apart helps guide treatment:

• Lifelong (primary): it has been present since the first sexual experiences. It tends to have a more pronounced biological component, related to sensitivity and the regulation of certain neurotransmitters, especially serotonin.
• Acquired (secondary): it appears after a period of satisfactory sex life. Here it's key to look for the trigger: performance anxiety, stress, relationship problems, associated erectile dysfunction, or thyroid or prostate issues, among others.

You don't make this distinction on your own: it's part of what we assess during the consultation to understand what's happening in your specific case.

Why does it happen? The real causes

For years it was said to be "purely psychological." Today we know that, although organic causes exist, in most cases—and very especially in younger men, under 40—the cause is predominantly psychological: the body is healthy, and what's altered is the way the sexual response is regulated.

Psychological and relationship factors (the most common)

• Performance anxiety (the fear of failing ends up causing the failure).
• Accumulated stress and fatigue.
• Early sexual experiences lived with rush or guilt.
• Communication difficulties within the couple.

Biological factors (less common, but worth ruling out)

• Serotonin regulation: altered levels or sensitivity in certain brain receptors speed up the ejaculatory reflex.
• Hypersensitivity of the glans.
• Hormonal imbalances (for example, of thyroid hormone).
• Inflammation of the prostate or urethra.
• Associated erectile dysfunction: the fear of losing the erection leads to "rushing" the encounter.

That's why a good approach never stops at just "a pill" or just "relax": it looks at the whole person.

Three myths worth dismantling

Myth 1: "It's just a matter of holding back or thinking about something else."

Distracting yourself doesn't train ejaculatory control; all it does is disconnect you from pleasure and increase anxiety. Real control is learned with specific techniques, not with willpower.

Myth 2: "If it happens, something must be wrong with me as a man."

Premature ejaculation says nothing about your manhood or your worth. It's a poorly regulated physiological reflex, just as a migraine or gastritis says nothing about your character.

Myth 3: "There's no solution; you just have to resign yourself."

It's one of the sexual dysfunctions that responds best to treatment. The vast majority of men who seek help improve significantly.

How it's treated (and why it really works)

Treatment is tailored to each person, according to the cause and the type. These are the tools we have, and they are often combined:

1. Behavioral techniques

They are the foundation and teach you to recognize and manage the "point of no return": the stop-start technique (identifying the sensation just before ejaculation, pausing stimulation, and resuming) and the squeeze technique. Properly guided, these exercises retrain the reflex and provide real, lasting control.

2. Pelvic floor training

Strengthening these muscles (yes, men have them too) has been shown to improve ejaculatory control.

3. Pharmacological support, when indicated

Topical anesthetics (creams or sprays) that reduce the hypersensitivity of the glans, or medications that act on serotonin and delay ejaculation—always with medical guidance and follow-up. Important: medication is not self-prescribed. It's evaluated, adjusted, and monitored.

4. Addressing anxiety and the relationship

When there's performance anxiety or tension in the relationship, working on communication and reducing pressure is an essential part of treatment. Here the partner is an ally, not a spectator.

When should you seek help?

I recommend seeking a professional evaluation if:

• It happens repeatedly and not just occasionally.
• It causes you anxiety or frustration, or you avoid intimacy because of it.
• It's affecting your relationship or your self-esteem.
• It appeared suddenly after a problem-free period (this always warrants a medical evaluation).

You don't have to wait for it to "fix itself" or live with it in silence. The sooner it's addressed, the faster and simpler the solution usually is.

One final thought

Premature ejaculation is not a character flaw or a sentence. It's a common, well-studied, and treatable reason for consultation. Talking about it with a professional doesn't make you less of a man: it makes you someone who chooses to take care of their sexual health, which is part of your health and your overall wellbeing.

This article is for informational and educational purposes and does not replace an individual medical consultation. Each case requires professional evaluation.