The review, published in February 2023 in Trends in Urology & Men's Health, included 54 studies on premature ejaculation with data from nearly 3,500 participants. Researchers examined the literature to compare the effects of alternative treatments, including exercise, with pharmaceuticals.
They concluded that physical activity running—and pelvic floor workouts were two examples—was as beneficial for treating PE as standard medications, without the side effects.
In the report, researchers noted that estimates of premature ejaculation's prevalence vary along with the definition. Studies suggest it affects as many as 30 percent to 83 percent of men.
"It's generally thought of as the most common male sexual health problem," said Joshua Gonzalez, M.D., a urologist in Los Angeles and a sexual health advisor at Astroglide, a lubricant manufacturer.
Gonzalez defined premature ejaculation as semen leaving the body within a minute of sexual activity. Mayo Clinic's definition extends the time to three minutes.
Another way to define it is "ejaculating sooner than you would like, at a speed and/or frequency that is bothersome to you and/or your partner," said Martin Gross, M.D., a urologist at Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire, and an assistant professor of surgery at Dartmouth College's Geisel School of Medicine.
"I think establishing the degree of patient and partner bother is vital. It is also important to clarify if this is a lifelong issue or a problem that has worsened over time," Gross said. "I also try to make sure that patients understand the difference between orgasm and ejaculation when we have these discussions."
Occasional premature ejaculation isn't a cause for concern, but a routine occurrence might indicate an underlying problem, according to Mayo Clinic.
The condition produces more than fleeting disappointment, explained Lee Smith, Ph.D., a professor of public health at Anglia Ruskin University in Cambridge, England, and the 2023 review's lead author.
He said PE can contribute to or exacerbate multiple issues, including:
Yet despite PE's prevalence and impact, it's under-researched and often neglected in academic literature.
"Few pharmacological treatments for premature ejaculation are available and [they] have unwanted side effects," Smith said in an email interview. "We, therefore, wanted to explore nonpharmacological treatment options to support health practitioners in disseminating advice and those who suffer from this dysfunction."
Treatment options for premature ejaculation are limited and varied depending on the suspected cause. Several factors can contribute to PE, but it's generally thought to result from biological and psychological influences, according to Gonzalez.
Biological factors can include imbalances in hormones or neurotransmitters, underlying pelvic floor dysfunction and problems with ED, he said.
"Psychological factors that we generally consider would be depression, anxiety, low self-esteem or issues with body image, [along with,] obviously, a history of sexual assault or trauma, or even sometimes sociocultural factors like religious upbringing or familial ideas around sex," Gonzalez said.
In some parts of the world, including the United Kingdom and Australia, one medication, a selective serotonin reuptake inhibitor (SSRI) called dapoxetine, has been approved to treat premature ejaculation.
The U.S. Food and Drug Administration (FDA) has not approved this drug or any other medication to treat premature ejaculation, Gonzalez said.
Doctors can prescribe treatments off-label, however. The American Urological Association (AUA) recommends antidepressants such as SSRIs and local anesthetics such as lidocaine spray to manage PE.
Tramadol, a pain medication, is sometimes used, but it has not been extensively studied concerning premature ejaculation.
"The exact mechanism of action for these treatments is unknown, but both are probably reducing neurological input from the penis to the brain," Gross said. "The local anesthetics reduce how much sensory information leaves the penis, while the SSRIs reduce how much sensory information gets to the brain."
He added that alcohol probably acts similarly to SSRIs after a few drinks.
The AUA also recommends treating premature ejaculation with ED drugs. Gross said many studies indicate a benefit of using such treatments, particularly PDE5 inhibitors, for premature ejaculation in addition to ED. The reason is unknown.
Pharmaceutical treatments can be effective, but they're often associated with adverse side effects, said James J. Elist, M.D., a urologist in Beverly Hills, California, who specializes in impotence and male sexual dysfunction.
With SSRIs and pain medications, these side effects can include decreased libido, ED and long-term dependency. With lidocaine sprays, the numbing sensation may spread to the partner.
PDE5 (phosphodiesterase type 5) inhibitors can cause headaches, nasal and throat congestion, dyspepsia and, rarely, prolonged erections that last more than four hours (priapism), according to a report published in Pharmacy and Therapeutics. Priapism is a medical emergency that requires a visit to the emergency room.
Medications can also interact negatively with other medicines and health conditions, which may preclude some people from taking them.
In one of the studies included in the 2023 review, researchers found that running for 30 minutes five times a week was as effective in treating premature ejaculation as dapoxetine.
The study involved 105 participants who were separated into three groups. Researchers instructed the control group not to walk for more than 30 minutes a day for 30 days. The second group ran for at least 30 minutes five days a week, and the third group took dapoxetine.
Both running and dapoxetine substantially improved participants' symptoms to about the same degree. This finding may result from running's mental health benefits, Smith and Elist said.
"Running may relieve stress via stimulating the production of feel-good chemicals, [such as] endorphins, in the brain," Smith said. "This is also true for other forms of physical activity, and thus, similar benefits may be observed with other types of exercise, but future research is needed to confirm or refute this."
Gonzalez theorized that running might help because it requires holding tension in the pelvis. Over time, this might improve control of the pelvic floor muscles, which would be consistent with another of the study's findings: yoga and pelvic floor exercises were also beneficial.
A small study included in the review had 26 participants perform 12 weeks of yoga. By the end, the average time the participants took to ejaculate had increased from just less than 26 seconds to nearly 90 seconds on average.
Another study Smith and his cohorts reviewed found that engaging in pelvic floor exercises three times a day for three months increased participants' median ejaculation time from one to three minutes.
Gonzalez said he has seen patients make significant improvements through pelvic floor physical therapy.
"Ultimately, men with stronger pelvic floor muscle control may be able to delay ejaculation by relaxing their perineal muscles," Elist said. "Conversely, men with an overactive or overly tightened pelvic floor might be unable to relax these muscles, which can contribute to premature ejaculation."
More research is needed, Smith noted, but the systematic review's results indicate that physical activity could be beneficial in the prevention and treatment of premature ejaculation.
Overall, Gonzalez said the most interesting aspect of the review is that it opens the door to looking at alternative approaches.
"In medicine, we're often hardwired to try to find a medication that can help people. As I mentioned, pelvic floor physical therapy can be incredibly important at helping men get better ejaculatory control," he said.
Gonzalez thinks a lot of people overlook physical activity because medical professionals generally try to find the quickest, easiest medical therapy possible.
"So I think it would be interesting if more studies like this looked at specific types of physical activity to try to figure out what, specifically, about those activities is causing an improvement in ejaculatory control," he concluded.