Premature Ejaculation

What premature ejaculation is

Premature ejaculation (PE) is one of the most common male sexual health concerns. It is usually described as ejaculation that consistently occurs sooner than the man or couple would like, with a sense of lack of control, and causes personal distress or difficulty in the relationship.¹

PE can be lifelong (present since the first sexual experiences) or acquired (developed later in life after a period of normal function). The underlying causes and the best treatment approach can differ between the two.¹

Contributing factors

Premature ejaculation is usually a mix of biological, psychological, and relationship factors. Common contributors include:

• Anxiety, stress, or performance pressure.
• Relationship or communication difficulties.
• Erectile dysfunction (sometimes men rush to ejaculate before losing the erection).
• Thyroid disorders or other hormonal factors.
• Prostatitis or other local genitourinary conditions.

Assessment

Assessment is mainly based on a careful history, including how long PE has been present, whether it happens in every situation, its impact on wellbeing and on the partner, and any coexisting erectile difficulty. A physical examination and, where relevant, blood tests (for example thyroid function or hormones) may be arranged. Addressing any coexisting erectile dysfunction is often an important part of the plan.

Treatment options

There is no single cure for PE, but several treatments can help. In many men, a combination works better than any one approach alone.¹ An individualised plan is developed with Dr Kooner and, where relevant, the men's health pharmacist.

Behavioural and psychological strategies

• Techniques such as the stop-start and squeeze methods, aimed at developing better ejaculatory control.¹
• Pelvic floor training.
• Sex therapy or counselling, particularly where anxiety or relationship factors are prominent.

Topical treatments

• Topical anaesthetic creams or sprays applied to the head of the penis can reduce sensitivity and prolong time to ejaculation.¹ Transfer to the partner should be minimised by using a condom or wiping off before intercourse.

Oral medications

• Selective serotonin reuptake inhibitors (SSRIs) taken on demand or daily can prolong ejaculation latency. Side effects include nausea, headache, reduced libido, and others; the choice and schedule are individualised.¹
• In men who also have erectile dysfunction, a PDE5 inhibitor may be combined with behavioural or pharmacological PE treatment.¹

Combined approach

Evidence generally supports combining a behavioural or psychological approach with a medical treatment, particularly in acquired PE.¹

Involving the partner

Where the patient is in a relationship, involving the partner in the conversation – with the patient's agreement – often improves outcomes, reduces performance pressure, and helps with behavioural strategies.

How to access care

• Contact Urology NSW to arrange a consultation.
• Request a second opinion if you have already been assessed elsewhere.
• Call the rooms on 02 8382 6980.