Premature ejaculation

What it is

Premature ejaculation (PE) is one of the most common male sexual health concerns. It usually means ejaculation that consistently happens sooner than the man or couple would like, with a feeling of not being in control, and that causes distress.

PE can be:

• Lifelong - present since the very first sexual experiences.
• Acquired - developed later in life, after a period of normal function.

Things that can play a part

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

• Anxiety, stress or performance pressure.
• Relationship or communication difficulties.
• Erectile dysfunction (some men try to ejaculate quickly before losing the erection).
• Thyroid problems or other hormone issues.
• Prostatitis or other local conditions.

How it is assessed

Assessment is mainly based on a careful history. Key questions are how long PE has been happening, whether it happens every time, how much it is affecting your life, and whether there is also any difficulty with erections. A physical examination and, where useful, blood tests may also be arranged.

The main treatment options

There is no single cure for PE. For many men, a combination of approaches works better than any one alone.

Behavioural and psychological strategies

• Techniques such as the stop-start and squeeze methods, to build better control.
• Pelvic floor training.
• Sex therapy or counselling, especially when anxiety or relationship factors are prominent.

Topical treatments

• Anaesthetic creams or sprays applied to the head of the penis can reduce sensitivity and lengthen the time to ejaculation.
• A condom or wiping the cream off before intercourse helps stop transfer to the partner.

Tablets

• Some antidepressant medications (SSRIs) taken either on demand or daily can lengthen the time to ejaculation. Side effects can include nausea, headache, and lower libido.
• If there is also erectile dysfunction, an ED tablet may be combined with PE treatment.

Combined approach

The strongest results are usually seen when behavioural strategies are combined with a medication, especially in acquired PE.

Involving the partner

If you are in a relationship, involving the partner in the conversation (with your agreement) often improves outcomes, reduces performance pressure, and helps with the behavioural strategies.