Premature Ejaculation
Premature ejaculation is ejaculation that consistently happens sooner than a man or his partner would like, causing distress. The AUA/SMSNA Disorders of Ejaculation Guideline generally uses about 2 minutes from penetration as a practical marker, though the defining feature is a lack of control and resulting distress, not the clock alone.
Symptoms
Ejaculation occurring sooner than desired, minimal ability to delay it, and frustration or avoidance of intimacy as a result.
Causes and risk
Serotonin signaling, genetics, thyroid disease, prostatitis, and anxiety are all associated; circumcision status does not affect timing, despite a common assumption otherwise.
How it is evaluated
Diagnosis is based on history alone -- there's no test required, and the AUA/SMSNA guideline emphasizes a straightforward conversation about timing, control, and distress over any lab workup.
Treatment
Behavioral techniques (start-stop, squeeze) and topical anesthetics have the strongest supporting evidence per a Cochrane review. SSRIs are used off-label in the U.S. (paroxetine has the most data); dapoxetine, a fast-acting on-demand option, is available in some countries but is not FDA-approved. Combination behavioral-plus-medication therapy outperforms either alone.
When to seek care
Premature ejaculation itself is not an emergency. Severe mood symptoms, medication side effects, or signs of infection (pain, discharge, fever) are the things that would warrant prompt attention.