Family Medicine


I discuss all aspects of rejuvenation and wellness in this column. That includes skin rejuvenation, hair restoration, hormones, weight loss, as well as human sexuality and intimate wellness. Premature ejaculation is an important topic that must be addressed. It is, after all, one of the most common sexual disorders affecting men. It occurs when a man ejaculates sooner during sex than he or his partner would like. It is something that literally traumatizes not only men but also their partners. It is a complex issue, and I know that you have many questions about it. I am going to discuss premature ejaculation one question at a time but first, let’s discuss the bigger subject of the male orgasm and ejaculation. 

How does the male orgasm work?

An article titled “Review of Human Sexual Inadequacy” published in The Journal of Sex Research in 1970, outlined the four phases of male orgasm.

  1. Arousal Phase 

This phase leads to the release of nitric oxide into the arteries of the penis, which causes them to expand and quickly fill with blood. This leads to an erection. 

  1. Plateau Phase 

The time immediately before a man has an orgasm is called the plateau. This phase usually lasts between thirty seconds and two minutes. During this phase, several things happen all at once.

  • Heart rate increases 
  • Blood pressure and body temperature go up.
  • Pelvic thrusts become faster and harder, and border on involuntary.
  • Semen may leak from the urethra. This changes the pH of the urethra, and this means that the sperm has a better chance of survival.
  1. The Orgasm 

The orgasm phase is divided into two emission and ejaculation:

  • During emission, sperm move to the tip of the penis. At this point, ejaculation is inevitable.
  • During ejaculation, strong contractions of the penis and pelvic muscles help propel the semen out of the body.

At this point, the brain releases very large amounts of Oxytocin and Dopamine. Oxytocin promotes feelings of connection and bonding with a partner after orgasm. Dopamine is a “feel-good” neurotransmitter connected to the reward center of the brain.

  1. Resolution and Refraction Phase 

Resolution is when the penis starts to go soft. The man often feels relaxation or drowsiness at this point. 

The Refractory period is when a man is unable to achieve another erection even with adequate sexual stimulation. 

How common is premature ejaculation?

40-78% of men from all over the world suffer from premature ejaculation depending on which study you look at. Even if you go with 40%, that is a large number of men who are unable to last in the bedroom. For some it is a chronic issue that bothers them every single time they have sex, and for some it is sporadic.

How quick is too quick?

A study titled “A Multinational Population Survey of Intravaginal Ejaculation Latency Time” was published in The Journal of Sexual Medicine in 2005. This study covered 500 couples from five countries: the Netherlands, United Kingdom, Spain, Turkey, and the United States. The study participants were men aged 18 years or older, had a stable heterosexual relationship for at least 6 months, with regular sexual activity. 

Sexual events and stopwatch-timed intravaginal ejaculation latency time (IELTs) during a 4-week period were recorded, as well as circumcision status and condom use. Researchers found that the average duration men lasted was 5.4 minutes. 

Houston, we have a problem! Women want their men to last 25 minutes and 51 seconds but the average man only lasts 5.4 minutes. Women take a lot longer than men to orgasm, and so this becomes a big deal. Things aren’t looking good at baseline for the average man so when premature ejaculation happens, things become catastrophic. Severe premature ejaculation is when a man is only able to last a minute or less once he enters the vagina. For the most part, premature ejaculation is when a man goes from penetration to discharge in under 3 minutes.

What are the types of premature ejaculation?

Lifelong (primary): Lifelong premature ejaculation occurs in men who ejaculate too soon either 100% or almost 100% of the time beginning with their first sexual encounter.

Acquired (secondary): This is the case when you develop premature ejaculation without having suffered from it previously.

What causes premature ejaculation?

According to my alma mater the Cleveland Clinic, physical, chemical and emotional/psychological factors cause premature ejaculation.

Physical and chemical problems include:

  • An underlying erectile dysfunction diagnosis.
  • A hormonal problem with Oxytocin, Luteinizing Hormone (LH), Prolactin and Thyroid Stimulating Hormone (TSH), and of course the mighty Testosterone.
  • Low levels of Serotonin or Dopamine, the chemicals in the brain that are involved in sexual desire and excitement.
  • A penis that is overly sensitive to stimulation.

Emotional or psychological causes include:

  • Performance anxiety. This could be due to being with a new partner, having sex again after a long period of abstinence, lack of confidence, guilt, being overly excited or stimulated, and so on. 
  • Stress
  • Relationship problems
  • Depression
  • Men who come from cultures that view sex negatively as being dirty or sinful are also at risk for premature ejaculation.
  • Poor body image

Of note, premature ejaculation may be genetic in nature. A Dutch study tested 89 men who had experienced premature ejaculation since their first sexual encounter. In these men, Serotonin levels were far lower than the 92 men who were not suffering from it. The areas of the brain with lower Serotonin levels also controlled ejaculation. 

A 2011 study published in The Journal of Sexual Medicine studied the effect of Serotonin in rats and their ejaculation. This was a very different study but showed similar results. This has led researchers to believe that premature ejaculation may well have a genetic basis.

Do you require blood tests to diagnose premature ejaculation?

You don’t really need blood tests to diagnose premature ejaculation directly, but you can find abnormalities that are leading to it such as Thyroid and Testosterone issues by checking your blood levels.

Can you treat premature ejaculation?

The cause of premature ejaculation determines the treatment for it. For the most part, it is unclear what exactly causes premature ejaculation. So far, the three main categories of treatment include behavioral therapy, counseling and medications. Behavioral therapy and counseling are usually the first step in treating this condition.

Behavioral therapy: Behavioral therapy is about learning to control your body and your emotions in order to delay orgasm. Methods include:

  • Distraction: The idea is to think about ordinary nonsexual things while you are being sexually stimulated. Think about mundane things like traffic or bills. It does not sound sexy but it will help you train your body to last longer.
  • Start and Stop (Edging): With this technique, you stop when you are close to orgasm. You take a break for 30 seconds until you are in control of your sexual response. This “start and stop” technique is repeated three or four times before you let yourself orgasm. Continue practicing this method until you have gained better control.
  • Squeeze therapy: With this technique, you get to the point where you are close to orgasm then gently squeeze the head of your penis for about 30 seconds so that you begin to lose your erection. Repeat this technique a few times before letting yourself orgasm.

Pelvic Floor Exercises (Kegels): These exercises can help strengthen the muscles in men with a weak pelvic floor. You see, weak pelvic floor muscles can make it harder to delay ejaculation. You have to do these exercises right for them to be effective at all. To begin with, you have to identify your pelvic floor. One way to do this is by stopping urination midstream. The muscles you clench are the ones you need to be exercising. To do pelvic floor exercises correctly, you should squeeze your pelvic floor muscles and hold that tight squeeze for 3 to 5 seconds, and do this several times in a row, a few times a day. Try to do at least 3 sets of 10 in a day. 

  • Condoms: They can help with premature ejaculation as well. They do this by reducing sensation. You can even buy condoms called climax control condoms which have a little numbing cream in them. (More on the topic further in this article).

Counseling/ Sex Therapy:

Whether the problem of premature ejaculation is causing you emotional anguish, or psychological, emotional or other issues are causing you to have premature ejaculation, counseling is a very important step towards improvement.

However, according to a 2019 study titled “Premature Ejaculation: Aetiology and Treatment Strategies,” behavioral or psychological therapy alone is usually not adequate to entirely manage and treat Premature Ejaculation. Despite showing high success rate of up to 65% for short-term management, the long-term success seems to be relatively poor, effectively managing only 25% of patients.

Medications: Several types of medications may be tried.

Oral Medications: Antidepressants, especially SSRIs or selective serotonin reuptake inhibitors can be very helpful for people suffering from this. SSRIs like citalopram (Celexa®), escitalopram (Lexapro®), fluoxetine (Prozac®), paroxetine (Paxil®) and sertraline (Zoloft®) or the tricyclic antidepressant clomipramine (Anafranil®), can help delay premature ejaculation. This is an off-label use because the medications are not approved by the Food and Drug Administration for this purpose. 

Erectile dysfunction medications such as Sildenafil (Viagra®), Tadalafil (Cialis®), Vardenafil (Levitra®) and Avanafil (Stendra®), have also been used to treat Premature Ejaculation, particularly in men with underlying Erectile Dysfunction. These medications, however, come with so many side effects and complications that they are not necessarily a good solution. My patients often tell me that these medications cause headaches, sinus congestion, flushing, blood pressure drop and more, and it makes complete sense based on their mechanism of action. 

Topical Medications: Numbing creams and sprays applied to the head and shaft of the penis is another way to delay ejaculation. In fact, I have my very own Dr. Sex Fairy brand delay spray that can really help you. If you would like to know how to get it, email me at [email protected] 

And last but certainly not least, let’s talk about my favorite treatment modalities in addition to our Dr. Sex Fairy brand delay spray.

I am seeing incredible results with acoustic wave therapy at my Boca Raton Florida practice Bawa Medical. Erections are, at their simplest, increased inflow and decreased outflow. As we get older, our blood vessels develop blockages be it in the heart or in the pelvic area. We use acoustic and shockwave therapy to safely break down those blockages and improve blood flow. This is leading to better erections and a major improvement in the cases of premature ejaculation in my practice. 

I am also a strong believer in P-Shots. This is where we take your blood like a regular blood draw and then spin it in our specialized centrifuge. This produces platelet rich plasma (PRP) which has growth factor that can stimulate your stem cells. We take it a step further at our practice and convert it into platelet rich fibrin matrix (PRFM) which is more concentrated and rejuvenates you even more. Acoustic or shockwave therapy and the P-Shot have a synergistic effect. 

If you go to my YouTube channel Dr. Sex Fairy, you can see videos where I talk to patients whose lives have been transformed by my treatment protocols. If you want to know more about these transformative treatments for both men and women at my practice, shoot me an email at [email protected]. Make sure you check out my podcast Dr. Sex Fairy which is among the top 10% around the world, and a top 30 US podcast. My TikTok account @drsexfairy is a worldwide hit as well with over 36 million views in just 4 months. I discuss this and many more topics such as penis enlargement, vaginal rejuvenation, orgasms, etc. that will be of great interest to you.

I hope that you are now better informed about the pandemic that is premature ejaculation and that you now have many tools that can help you overcome it.

How long does the average man last in bed? How can a man last longer? Let’s talk about early or premature ejaculation, and 2 ways to help you last longer.
Dr. Kanwal Bawa is America’s favorite sex doctor, and the host of America’s number one sex podcast, Dr. Sex Fairy. She is Cleveland Clinic trained, and a pioneer in the fields of sexual wellness, skin rejuvenation and hair restoration. She has a state-of-the-art practice in Boca Raton, Florida called Bawa Medical. She earned the moniker Dr. Sex Fairy due to her incredible advances in the field of intimate and sexual wellness.
Her patients fly to her from all over the world for vaginal rejuvenation, non-surgical labiaplasty, penis enlargement, Erectile Dysfunction treatments, better performance, increased libido, hormone replacement, and more. She also provides virtual consultations for those who are unable to travel to her for in-office treatments. Dr. Bawa also has her own line of Dr. Sex Fairy supplements which include a testosterone booster, a nitric oxide booster and a libido enhancer.

To schedule a virtual or in-office consultation:

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Ep. 77: Me Love You Long Time: Premature Ejaculation (

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