Sexual Health

Premature Ejaculation (PE): Symptoms, Causes, Treatments & More

Remember the proverb, “slow and steady wins the race”? Whether or not you actually heed this advice in your daily life, I’m sure you’ll agree that this proverb holds potent truth in bed. Indeed, coming too fast in bed often ruins the mood and can be extremely distressing for both you and your partner.

With 1 in every 3 men aged between 18 and 59 years old experiencing premature ejaculation (PE) at some point, PE is more common than you think.  

What is premature ejaculation (PE)?

Premature ejaculation occurs when:

  1. A man orgasms and ejaculates sooner than he or his partner would like.
  2. A man orgasms with very little stimulation.

How soon is too soon?

There is no clearly defined time period of what constitutes PE. The time frame can vary across individuals, depending on what he or his partner constitutes as “too soon”. International guidelines often cite that a man has PE if he ejaculates within 1 minute of entering your partner. Once again, this isn’t a hard-line definition, and it really depends on you and your partners’ preferences and feelings. 

What if it happens only occasionally?

It’s okay to have some disappointing nights, you can’t always have it all. However, if the problem occurs almost every time for more than 6 months and causes you significant distress, then you may have PE. 

Types of premature ejaculation

Also, did you know that not every PE is the same? Here, we break down the 2 different types of PE for you.

  • Lifelong PE (primary PE): These men have been experiencing PE ever since their first sexual encounter. 
  • Acquired PE (secondary PE): These men have previously had normal ejaculations, but later developed PE.

Lifelong PE is often caused by psychological factors, whereas acquired PE can be caused by a mixture of both psychological and biological factors. Moving on, let’s explore the different reasons for PE. 

Causes of premature ejaculation

PE may be due to psychological factors or physical factors, or a mixture of both. It’s good to know the common causes of PE so that you can identify which ones have led to your PE. 

Psychological factors

Anxiety is one of the leading factors of PE. This usually comes in the form of performance anxiety, where a man is concerned about his sexual performance. However, anxiety and stress about other aspects of life, such as work or relationship problems, can also play a part in PE. Other psychological factors that cause PE include depression, guilt, low self-confidence and unrealistic expectations about sex. 

Think back about your teenage years. If you recall masturbating hurriedly for fear of getting caught by your parents or others, that might have caused a lasting effect and led to your PE today. Besides that, traumatic sexual experiences at a young age or strict upbringing that frowns upon sex as shameful can lead to PE. 

Biological factors

Ever heard of serotonin, the happy hormone? Not only does serotonin boost your mood, but it is also the controller of your sexual desires and erection. The higher the serotonin levels in your brain, the longer it takes for you to ejaculate, allowing more satisfactory and happier sex. However, when serotonin levels are low, the time to ejaculation is shortened, causing PE. Not so happy anymore.

Besides serotonin imbalance, other medical conditions can also lead to PE. These include erectile dysfunction (ED), diabetes, an overactive thyroid and some prostate-related conditions. Genetics or simply an overly sensitive penis may even be at blame. 

Medical treatment for premature ejaculation

Oral medication

A common way to treat PE is using selective serotonin reuptake inhibitors (SSRIs). This is a class of drugs that increases the level of serotonin, hence prolonging the time it takes to ejaculate. They may also help increase your sense of control over ejaculation. If deemed medically appropriate, Arx can prescribe you an SSRI medication known as Priligy®, which contains dapoxetine. 

In men who have both PE and erectile dysfunction (ED), ED pills can help. These include sildenafil (Viagra®), also known as the blue pill, as well as avanafil (Spedra®) and tadalafil (Cialis®). These pills improve blood flow to the penis, which is necessary for an erection. 

Not sure if you have ED? Check out our previous blog article to learn more about ED.

Sprays and creams

Some men may find that local anaesthetic sprays and creams help reduce penile sensation, increasing the time to ejaculation. These sprays or creams should be applied onto the head of the penis up to 30 minutes before sex. You should wash the spray or cream off your penis 5 to 10 minutes before sex or put on a condom to prevent absorption of the spray or cream by your partner. Otherwise, it may cause vaginal numbness in your partner during vaginal sex. The condom also helps reduce your penile sensation, ultimately prolonging your time to ejaculation. 

Other tips and tricks to combat premature ejaculation

There are several natural ways to combat premature ejaculation. These include behavioural therapy, psychological therapy, lifestyle changes and even switching up your sex positions and techniques. We’ll save those for the next blog post, so do keep a close lookout for it!

Our final tip to all men with PE is to talk to your partner and seek treatment. Keep in mind that PE does not only affect you, but it can also lead to frustration and feelings of hurt from your partner. This may, of course, be a difficult topic to approach. However, your partner can be a great pillar of emotional support, and an open discussion with your partner will help to pave the way for mutual understanding. 

Lastly, remember that PE can be easily treated. That’s fortunate, but it means nothing if you shun away from seeking treatment. We know that visiting the clinic for treatment can be embarrassing and daunting, and that’s where we step in to help you. At Arx, simply fill up a questionnaire to answer the awkward questions and connect with one of our doctors for a video consultation, all from the comfort and privacy of your own home. 


  • What are the DSM-5 diagnostic criteria for premature ejaculation (PE)? Latest Medical News, Clinical Trials, Guidelines – Today on Medscape. (2021, June 4). 
  • Nazario, B. (2020, July 7). Premature Ejaculation: Symptoms, Causes, Treatment, & Prevention. WebMD. 
  • NHS. (2019, July 24). Ejaculation problems. NHS Choices. 
  • Premature Ejaculation. Premature Ejaculation: Causes & Treatment – Urology Care Foundation. (2020, July 16). 
  • Lowy, M. (2018). Premature Ejaculation Fact Sheet. Healthy Male (Andrology Australia). 
  • Urology Care Foundation. (2020). Premature Ejaculation Patient Guide
Sexual Health

Erectile Dysfunction (ED): Symptoms, Causes, Treatments & More

Are your erections, or rather, lack thereof, causing disappointing nights for you? We’ve got you covered! Here’s a comprehensive guide on everything you need to know about erectile dysfunction.

What is erectile dysfunction?

Erectile dysfunction (ED), sometimes known as impotence, refers to the inability to get or sustain an erection that is firm enough for sex. It is one of the most common sexual problems that men encounter. In fact, a study published by the Singapore Medical Journal has revealed that among Singaporean men above the age of 30, about 1 in 2 of them have had ED at some point in their lives. 

Symptoms of erectile dysfunction

If your penis fails to perk up very occasionally, chances are it is completely normal, especially if you’re recently feeling a little stressed out. However, if you routinely have difficulty getting or maintaining your erection, you might want to get it checked out – it may be ED. Some men also find themselves losing interest in sexual activities or having lower self-esteem about their erections. These psychological factors may ultimately result in ED.

The mechanics of erectile dysfunction

Imagine someone filling up a balloon with water. The balloon expands in size and becomes more turgid. Likewise, when a man is sexually aroused, your brain sends signals which cause blood to flow into your penis. Blood fills up spongy tissues, known as corpora cavernosa, causing the penis to become more rigid.

Now, imagine if the tap that you are using to fill the balloon is faulty. Water flows out so slowly that there isn’t enough force to stretch and fill up the balloon. That’s exactly how ED works. When blood flow to your penis is blocked or slowed down, your penis remains flaccid. Other causes of ED may be a disruption in brain signals arising from depression, anxiety or stress. 

Causes of erectile dysfunction

You might have heard that ED is “all in your head”. For many years, experts believed that emotional and psychological problems were the sole causes of ED. Well, this is partially correct and partially wrong. Here’s the truth – ED can be caused by a multitude of factors, including emotional, physical, lifestyle factors and many more. 

Psychological and emotional causes of erectile dysfunction

Your brain plays a key role in a good erection. It is responsible for feelings of sexual excitement, as well as transmitting nerve signals to allow blood flow to your penis. The common psychological culprits of poor erection include: 

  • Depression
  • Anxiety
  • Stress
  • Low self-esteem
  • Guilt
  • Performance anxiety
  • Relationship conflicts

Physical causes of erectile dysfunction

Contrary to popular beliefs, ED is not “all in your head”. Any chronic disease that decreases blood flow can result in ED. If you have any chronic diseases, it is important to keep it under control. Common diseases include:

  • Diabetes
  • High blood pressure
  • High cholesterol

Besides those mentioned above, there are also other less common, albeit more serious diseases that can contribute to ED. These include: 

  • Hormonal imbalance
  • Parkinson’s disease
  • Alzheimer’s disease
  • Benign prostate hyperplasia (BPH)

Does old age cause erectile dysfunction?

Is age just a number in the onset and progression of ED? Well, maybe, maybe not. Although ED becomes more common with age, growing old does not always cause ED. Some men remain sexually functional, even in their 80s. On the other hand, younger men, including teenagers, can have ED due to their lifestyle factors such as drinking, smoking and overall health.

Treatments for erectile dysfunction

Depending on what caused your ED, you may be recommended for different treatment options. Most ED pills belong to a class of medication known as “phosphodiesterase type 5 inhibitors (PDE5 inhibitors)”. To put their mechanism of action in simple terms, these pills cause your blood vessels to relax, increasing the blood flow to the penis. 

Different pills follow different treatment schedules. Generally, ED pills can be categorised into two groups: the as-needed pills and the daily pills. 

As-needed pills

These pills are taken prior to any sexual activity. They are recommended for men who are able to predict when they have sex or men who do not wish to take pills daily. 

  • Viagra® (Sildenafil), also known as the blue pill. These pills have a long history and were the first FDA-approved oral treatment for ED. 
  • Generic Sildenafil. These pills contain the same ingredient and work exactly the same as its branded option, Viagra®. In comparison with Viagra®, generic sildenafil is much more affordable and wouldn’t burn a hole in your wallet. Generic sildenafil is also the most popular treatment option at Arx.
  • Spedra® (Avanafil). These pills are great for men who prefer spontaneity. They are fast-acting and are effective just 15 minutes after taking them.
  • Cialis® (Tadalafil)*. These pills are long-lasting and are effective for up to 36 hours after taking them. 
  • Levitra® (Vardenafil). These pills are the branded alternatives to Viagra®, the blue pill.

Daily pills

These ED pills are to be taken every day. They work best for men who don’t like to plan ahead and want to be ready around the clock.

  • Cialis® (Tadalafil)*. These pills are for daily use and provide greater flexibility in terms of sexual activity schedule. 

*Cialis® (Tadalafil) may come in the form of both as-needed pills or daily pills, depending on the strength of the pills.

Other treatment options

Other options include testosterone therapy if you have low testosterone, penile injections, vacuum erection devices, intraurethral medications, penile implants or even surgery. 

Lifestyle changes for better performance

Keeping a healthy lifestyle not only boosts your overall health, but also your sexual health. Here are some tips that you can follow: 

  • Keep a heart-healthy diet: A poor diet that is full of fats and sugars can lead to clogged arteries, diabetes and heart disease, which eventually spirals into ED. Reduce fats and sugars while incorporating more vegetables and fruits into your diet. 
  • Stay within your healthy weight range: If you are overweight, it’s best that you shake off that excess weight.
  • Exercise regularly: Not only does exercise promote blood circulation, it is also amazing at alleviating stress. In short, exercise targets both root causes of ED. Having 30 minutes of exercise for at least 5 days a week is bound to boost your health and energy, both in and out of the bedroom.
  • Quit smoking and drinking: As both smoking and drinking increases your risk of ED, we recommend that you sever your ties with them. Trust us, your body and penis will thank you. 

Finding the best treatment for erectile dysfunction

There is no one-size-fits-all treatment for ED. To choose the best treatment option for yourself, take into account your lifestyle, preferences, medical history and affordability. If you’re experiencing ED, it’s a good idea to speak to a doctor at Arx. They’ll help you find the solution that’s right for you, and potentially catch other health problems before they become severe.


  • Tan, J. K., Hong, C. Y., Png, D. J., Liew, L. C., & Wong, M. L. (2003). Erectile dysfunction in Singapore: prevalence and its associated factors – a population-based study. Singapore medical journal, 44(1), 20–26.
  • Lakin, M., & Wood, H. (2018, June). Erectile Dysfunction. 
  • Urology Care Foundation. (n.d.). Erectile Dysfunction (ED). Erectile Dysfunction (ED): Symptoms, Diagnosis & Treatment. 
  • Bandukwala, N. Q. (2019, June 10). A Visual Guide to Erectile Dysfunction. WebMD. 
  • Santos-Longhurst, A. (2017, December 29). Lifestyle Changes and Natural Treatments for Erectile Dysfunction. Healthline.