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Premature
Ejaculation

What's behind it — and what really helps

Premature ejaculation is the most common male sexual dysfunction — more common than erectile dysfunction. It is estimated that one in three men is affected, and even more at a young age.

And yet it is hardly ever talked about, hardly ever raised with a doctor, hardly ever treated. Yet premature ejaculation is well understood — and in most cases readily treatable.

This page explains what lies behind the phenomenon, which types exist, how the diagnosis works — and which treatment options really help.

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What is premature ejaculation — the definition

The medical technical term is Ejaculatio praecox (Latin: praecox = premature) or in English Premature Ejaculation (PE). The current definition of the International Society for Sexual Medicine (ISSM) describes three core features:

Definition: Ejaculatio praecox (ISSM 2014)

① Timing: Ejaculation always or almost always occurs before or within approximately 1 minute of penetration.

② Control: The man is unable to delay ejaculation or has no control over it.

③ Distress: The situation causes negative consequences — frustration, avoidance behaviour, strain on the relationship.

All three criteria must be met. Occasional rapid ejaculation without distress is not a medical condition.

The IELT value: What is 'normal'?

IELT stands for Intravaginal Ejaculatory Latency Time — the time between penetration and ejaculation. Studies show a wide variation: the median is approximately 5–6 minutes, with the range extending from under 1 minute to over 30 minutes. What counts as 'too fast' does not depend on figures alone — the deciding factor is whether the man and his partner are satisfied with it.

An IELT of under 1 minute, combined with distress, is considered clinically relevant. An IELT of 2–3 minutes may already be experienced as subjectively too fast — this too is legitimate and treatable.

The four types of premature ejaculation

Not all rapid ejaculations are the same. Distinguishing between types is important — because the cause and treatment depend on it:

Type

Description

Frequency

Distinctive features

Lifelong (primary)

Present since the first sexual contact, consistently < 1 min.

approx. 1–3 % of all men

Probably neurobiological — serotonergic dysregulation

Acquired (secondary)

Previously normal control, now deteriorated

approx. 3–5 % of all men

Often triggered by ED, prostatitis, stress, a new relationship

Subjective (variable)

Objectively normal IELT, subjectively experienced as too fast

Common, often undertreated

Predominantly psychological component, often pressure to be perfect

Natural variability

Fluctuating, situation-dependent — sometimes faster, sometimes longer

Very common

Not a medical condition — but worth a consultation if there is distress

Causes: What lies behind premature ejaculation

Premature ejaculation rarely has a single cause. Biological, psychological and experience-related factors usually work together — and reinforce one another if the problem is not addressed.

Cause category

Common factors & mechanisms

Neurobiological

Increased sensitivity of the penis · low serotonin levels in the central nervous system (serotonin slows the ejaculation reflex) · genetic predisposition in primary PE

Psychological

Performance anxiety and fear of failure · flooding of arousal · early sexual experiences under time pressure · unrealistic expectations from pornography · general stress

Hormonal

Elevated thyroid hormone levels (hyperthyroidism) · prolactin level too low · testosterone level — the connection is under discussion

Urological / inflammatory

Chronic prostatitis · urethritis · hypersensitivity of the glans in cases of phimosis

Learned pattern

Rapid ejaculation trained in adolescence (secrecy, fear of being discovered) · a conditioned response that has become firmly ingrained

Together with erectile dysfunction (ED)

A very common combination: fear of losing the erection leads to unconscious acceleration — PE and ED reinforce one another

Important: it is precisely this last point — PE as a reaction to ED anxiety — that is often overlooked. Those who have erection problems unconsciously accelerate in order to 'use the erection while it lasts'. The specialist always assesses both dimensions.

How is premature ejaculation diagnosed?

The diagnosis is based primarily on the medical history — an open, structured conversation. Laboratory tests play a secondary role, but are important for ruling out organic causes.

The medical consultation — what is asked:

  • How long has the problem existed — since the first time (primary) or newly occurred (secondary)?
  • How long does it typically take from penetration to ejaculation?
  • Does the problem always occur, or only in certain situations or with certain partners?
  • Is there a simultaneous erectile dysfunction or loss of libido?
  • How great is the distress — for you and, where applicable, within the relationship?
  • Pre-existing conditions, medications, prostate problems, thyroid?

Laboratory findings that are useful in PE:

  • TSH (thyroid) — hyperthyroidism is a frequently overlooked PE trigger
  • Testosterone and SHBG — overall hormonal picture
  • Prolactin — in cases of combined libido disorder
  • PSA and inflammatory markers — if prostatitis is suspected

Preliminary medical history form at the AndroKlinik

  • As with all initial consultations, after booking you will receive a structured medical history form via link.
  • This contains specific questions on ejaculation time, distress, relationship situation and medical history.
  • This way the doctor is already fully informed during the first video consultation — no time spent on basics, more time for solutions.

Premature ejaculation — finally get it clarified

Discreet, specialist, without waiting time. Medical history form in advance — your doctor is prepared.

Book a consultation now

Treatment options: What helps with premature ejaculation?

The good news: premature ejaculation is very treatable today — with a broad spectrum of options. The optimal approach depends on the type, the cause and the individual level of distress.

Treatment option

How it works

Particularly suitable for

Behavioural techniques

The start-stop method and the squeeze technique train conscious control over the ejaculation reflex — classic sex therapy methods

Mild to moderate PE, predominantly psychological component, as a supplement to other therapies

Topical anaesthetics

Local anaesthetics (lidocaine/prilocaine) as a spray or cream reduce the sensitivity of the glans — simple, immediately effective

Primary PE with high penile sensitivity, when rapid relief is desired

SSRIs (daily or as needed)

Serotonin reuptake inhibitors delay ejaculation as a side effect — dapoxetine is specifically approved for PE (as needed)

Primary PE, lifelong form, when a biological cause is likely

EjaNova® procedure

Surgical procedure: selective denervation of the dorsal penile nerves permanently reduces hypersensitivity — minimally invasive, outpatient

Primary PE with proven hypersensitivity, when conservative therapy has been exhausted

Psychosexual therapy

Cognitive behavioural therapy, sensate focus, couples therapy — resolves performance anxiety, thoughts of failure and conditioned patterns

Secondary PE, predominantly psychological cause, combination with relationship problems

Treatment of the underlying cause

Treat prostatitis, adjust the thyroid, treat ED specifically — when an organic cause is present

Secondary PE with an identified organic cause

EjaNova®: The surgical procedure for severe primary PE

The EjaNova® procedure is a minimally invasive intervention developed specifically for men with primary, lifelong PE and proven hypersensitivity of the glans. It involves a selective denervation of the dorsal penile nerves — the nerve fibres responsible for the hypersensitivity are specifically interrupted.

EjaNova® at the AndroKlinik

  • The EjaNova® procedure is carried out personally by Dr. Spanholtz at the AndroKlinik.
  • Prerequisite: complete diagnostics, including biothesiometry and the exclusion of other causes.
Learn more: Treatment of Premature Ejaculation

How the procedure works:

  • Preoperative diagnostics:
    Measurement of penile sensitivity (biothesiometry) to confirm the hypersensitivity
  • Outpatient procedure:
    Procedure under local anaesthesia or light sedation, approx. 60–90 minutes
  • Selective interruption:
    Interruption of specific sensory nerve fibres without affecting erectile function
  • No complete numbness:
    The aim is a normalised, pleasant sensitivity

Results and aftercare:

In published studies, patients show a marked prolongation of IELT after EjaNova®. Full recovery after approximately 4–6 weeks. Important: the procedure is only suitable for carefully selected patients — a detailed preliminary examination and consultation with the specialist is absolutely essential.

PE and ED: When both occur together

PE and ED frequently occur together — and reinforce one another. A man with the onset of erectile weakness unconsciously accelerates in order to 'use' the moment. Conversely, chronic PE can lead to fear of failure, which impairs the erection.

At the AndroKlinik, both problems are evaluated and treated together — an isolated focus on just one aspect often leads to unsatisfactory results. The initial consultation systematically covers both dimensions.

Combined treatment of PE + ED:

When PE and ED are present simultaneously, an integrated therapy is recommended:

  • ED treatment first (e.g. PDE-5 inhibitors or the P-Shot) → reduces time pressure and anxiety
  • In parallel: behavioural therapy techniques for PE control
  • For primary PE with ED: EjaNova® + ED therapy in a coordinated sequence
  • The therapy plan is discussed individually — there is no one-size-fits-all answer here.

Not two separate problems — one conversation

PE, ED or both: the specialist assesses everything together and draws up an integrated plan.
Book a consultation now

Frequently asked questions about premature ejaculation

How long should sexual intercourse last?

There is no 'correct' duration. The median from studies is 5–6 minutes from penetration to ejaculation — but the range is enormous and depends heavily on the situation, partner, arousal and other factors. What matters is not the clock, but whether both partners are satisfied with the situation. .

Can I train against premature ejaculation myself?
Yes — behavioural therapy methods such as the start-stop technique or the squeeze technique can be learned and practised by yourself. They require patience and regular training, but can be very effective in cases of milder PE. In cases of primary PE, or when self-training is not sufficient, specialist support is more advisable.
Do condoms help against premature ejaculation?
Condoms slightly reduce penile sensitivity and can prolong the ejaculation time in some men. There are also thicker condoms designed specifically for this purpose, or ones with a slightly anaesthetic inner coating. This is not a medical approach, but a pragmatic first measure for some men.
Is EjaNova® painful?
The procedure is carried out under local anaesthesia or light sedation and is not painful during the procedure. In the first few days afterwards, a feeling of pressure or slight sensitivity may occur. Most patients return to normal activity within a week, and sexual intercourse is possible again after 4–6 weeks.
Does the treatment affect my erectile function?
With conservative methods (behavioural therapy, medications, topical agents), no. With the EjaNova® procedure, the selective denervation is designed so that the nerves responsible for the erection are not affected. Erectile function is preserved — this is a central criterion in patient selection.
What do the assessment and treatment cost?
The initial consultation and laboratory diagnostics are billed according to the GOÄ as a self-pay service. Guideline prices can be found on our services page. The EjaNova® procedure is a surgical private service — the exact costs are discussed after the preliminary examination. Reimbursement by the statutory health insurance (GKV) for PE treatments is generally not provided.

All treatment options for premature ejaculation

You now have an overview of causes and diagnosis — on the next page you will find all treatment options in detail, including the EjaNova® procedure.
Continue to: Treatment of Premature Ejaculation

Take the first step now

PE is common — and readily treatable. A discreet conversation with the andrologist is enough as

About the author

Dr. med. Timo A. Spanholtz
Specialist in Plastic and Aesthetic Surgery - Specialist in Men's Health and Intimate Surgery

Dr. med. Timo A. Spanholtz
Dr. Spanholtz is the founder and chief physician of the AndroKlinik. With many years of clinical experience in men's health, andrology and reconstructive urology, he supports patients from across the entire German-speaking region.
Learn more

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