Premature Ejaculation: Causes, Diagnosis & Treatment

What is premature ejaculation?

Premature ejaculation (PE) means ejaculating sooner than you or your partner would like, with little control over the timing, and feeling distressed or frustrated by it.

It is the most common sexual problem in men – more common than erectile dysfunction – and it can happen at any age. Yet very few men ask for help, often because of embarrassment or a belief that nothing can be done. In fact, PE is very treatable.

What counts as "premature"?

There is no "normal" stopwatch time for sex, but as a guide:

• The average time from penetration to ejaculation in men is around 5–6 minutes

• Doctors talk about lifelong PE when ejaculation has always (or nearly always) happened within about 1 minute of penetration, from the first sexual experiences

• Acquired PE is when a man who previously had good control develops a clear reduction in time – often to around 3 minutes or less

Just as important as time is:

• Feeling unable to delay ejaculation

• Distress, frustration or avoiding sex because of it

Many men also go through phases of faster ejaculation – with a new partner, after a long gap, or when stressed. This is normal and usually settles.

What causes premature ejaculation?

Lifelong PE

• Thought to be largely biological – related to the brain chemical serotonin, which helps control the ejaculation reflex

• It may run in families

Acquired PE – common causes

• Erectile dysfunction – a very common hidden cause. Men who worry about losing their erection often (unconsciously) rush to ejaculate before it fades

• Anxiety, stress and performance worries

• Relationship difficulties

• Inflammation of the prostate (prostatitis)

• An overactive thyroid gland

• Stopping certain medicines or recreational drugs

How is it diagnosed?

Diagnosis is mainly based on a careful, confidential conversation about:

• When the problem started, and whether it has always been present

• How long you usually last, and how much control you feel

• Whether it happens with every partner and with masturbation

• Erection quality – to check for hidden ED

• Urinary symptoms or pain that might suggest prostatitis

• The effect on you and your relationship

You may be asked to complete a short questionnaire (such as the PEDT) and have a brief examination. Tests are only needed in some men – for example a urine test if prostatitis is suspected, or thyroid blood tests.

Treatment options

Treatment works best when it combines more than one approach.

1. Behavioural techniques

These help you learn to recognise the "point of no return" and improve control:

• Stop-start technique – stimulation is stopped just before you feel close to ejaculation, then restarted once the urge settles; repeated several times

• Squeeze technique – the partner gently squeezes the head of the penis to reduce the urge

• Pelvic floor exercises – strengthening these muscles can improve control in some men

• Simple measures such as thicker condoms, or masturbating a few hours before sex

These techniques are free and safe, and work best with an understanding partner. Results take practice.

2. Numbing sprays and creams

• Fortacin is a licensed spray containing two local anaesthetics (lidocaine and prilocaine)

• It is sprayed onto the head of the penis about 5 minutes before sex, to reduce sensitivity

• It can increase time to ejaculation several-fold in many men

• Possible side-effects: numbness or reduced pleasure for you or your partner; using it as directed keeps this to a minimum

3. Tablets

• Dapoxetine (Priligy) – the only tablet specifically licensed for PE in the UK. Taken 1–3 hours before sex. Possible side-effects include nausea, dizziness and headache, and rarely fainting – avoid alcohol and do not combine it with antidepressants. It is not suitable for men with certain heart conditions

• Daily low-dose medicines – some antidepressants (for example sertraline or paroxetine), taken every day, delay ejaculation as a side-effect. This is an "off-label" use, chosen for men who need a more consistent effect. They take 1–2 weeks to work, and should not be stopped suddenly

• ED tablets (sildenafil, tadalafil) – very helpful when PE is linked to erection problems, and sometimes useful in combination with other treatments

4. Treating the underlying cause

• Treating erectile dysfunction often resolves acquired PE completely

• Treating prostatitis or thyroid problems where present

5. Psychosexual therapy

Counselling with a specialist psychosexual therapist – alone or with your partner – helps with anxiety, confidence and communication, and works well alongside medical treatment.

What about surgery or "permanent cures"?

You may see online advertisements for operations, nerve-cutting procedures or penile filler injections for PE. These are not recommended in European urology guidelines, because of limited evidence and the risk of permanent loss of sensation. Circumcision is not a treatment for PE.

What can you expect?

With the right combination of treatment, most men see a significant improvement in control and satisfaction. Mr Keskin will assess you fully, look for and treat any hidden cause such as erection problems, and agree a practical, step-by-step plan that suits you and your partner.