Premature Ejaculation

Options include behavioural techniques, topical anaesthetic products, and prescribed treatment such as short-acting SSRIs where appropriate.

Book if

• You ejaculate sooner than you would like and it is causing distress
• It has developed recently — worth investigating rather than accepting
• It is affecting your relationship or your confidence

Worth knowing

This is the commonest male sexual complaint and among the least discussed. It is also one of the more treatable.

Important safety point

SSRIs used for this must not be combined with certain antidepressants or migraine treatments — the risk is serotonin syndrome. Tell the GP about everything you take, including anything bought over the counter or online.

1. Establish the pattern

Lifelong or acquired? Acquired premature ejaculation often has an identifiable cause — erectile dysfunction, thyroid disease, prostatitis or anxiety — and treating that resolves it.

2. Start with what is free

Behavioural techniques such as stop-start and the squeeze method are genuinely effective and involve no medication. They are worth trying first.

3. Medication if needed

Topical anaesthetics, or a short-acting SSRI taken before intercourse. Both work; they suit different people.

4. Review

Dose and timing frequently need adjusting.

Give the behavioural approaches a proper run

Stop-start and the squeeze technique genuinely work, and they cost nothing — but they take several weeks of practice and most men abandon them in the first fortnight.

• Practise alone first, then with a partner. That order matters
• Six to eight weeks before judging whether they are helping
• Progress is not linear. A bad occasion after a good run is normal and not a relapse

Reviewing medication

• Timing is what usually needs adjusting. A short-acting SSRI taken 1–3 hours before is the standard approach; daily SSRIs work differently and take one to two weeks to build up
• Topical anaesthetics need the right contact time — too little does nothing, too much causes numbness. A condom reduces transfer to your partner, which is the commonest complaint about them
• Dose and preparation frequently need changing at least once. That is normal

Review at four to six weeks

• What has changed, in practical terms rather than in stopwatch seconds
• Side effects — nausea, headache and dizziness are common early and usually settle
• Whether reduced libido or delayed orgasm has become the new problem, which can happen and is worth saying
• Whether erections are also affected. Where erectile dysfunction coexists, it should generally be treated first
• Mood. Any new low mood or thoughts of self-harm on an SSRI must be reported promptly

The safety point that matters most

SSRIs used for this must not be combined with certain antidepressants, migraine treatments, tramadol, lithium or St John's Wort — the risk is serotonin syndrome, which can be life-threatening.

Agitation, confusion, sweating, shivering, muscle twitching, a racing heart or fever needs urgent assessment. Tell the GP everything you take, including anything bought online.

Stopping

Do not stop a daily SSRI abruptly — taper it. On-demand dosing can simply be stopped.

Many men use medication for a period while behavioural techniques are established, then reduce it. That is a reasonable plan and worth discussing at the outset.

Start with what is free

Behavioural techniques are genuinely effective, cost nothing, and are consistently skipped over.

• Stop-start — pausing at the point of high arousal, learning to recognise where that point is
• The squeeze technique
• Pelvic floor exercises, which have reasonable evidence and are free
• Thicker condoms, or two thin ones — simple, effective for some men, and available today

They take six to eight weeks of practice. The commonest reason they "fail" is being abandoned in week two.

Topical anaesthetics

Sprays and creams, several available over the counter, applied 5–15 minutes before. Effective, cheap, and no systemic side effects.

The drawback is numbness — for both partners. A condom largely solves the transfer problem.

Where medication fits

Dapoxetine, a short-acting SSRI licensed for this and taken on demand. Other SSRIs are used off-licence, taken daily, and are often more effective for men who want a consistent effect rather than planning around occasions.

Treat the cause where there is one

Acquired premature ejaculation — where it developed rather than always being present — usually has an identifiable cause, and treating that resolves it.

• Erectile dysfunction — rushing to finish before losing an erection. Treat the ED first; the PE often follows
• Thyroid disease, which is worth excluding with a simple blood test
• Prostatitis or urinary infection
• Anxiety, relationship difficulty, and life stress

Psychosexual therapy

Good evidence, particularly where anxiety or relationship factors are involved, and it addresses the cause rather than delaying the symptom. Relate and the College of Sexual and Relationship Therapists both list qualified therapists.

Combining therapy with medication works better than either alone for many men.

What to avoid

"Delay" sprays and supplements sold online without ingredient lists. Some contain undeclared anaesthetics at unpredictable concentrations, and some contain nothing at all.

What you pay us

• £40 for the consultation — twenty confidential minutes, which is more than this subject usually gets
• £40 for review, where timing and dose are adjusted
• Blood tests only where genuinely indicated, quoted first

What you pay the pharmacy

SSRIs are inexpensive as generics. Dapoxetine, being licensed specifically for this, costs more than the off-licence alternatives.

We earn nothing from what is prescribed. Ring around before handing the prescription over.

The cheapest options are the ones we start with

• Behavioural techniques cost nothing, and they are the first-line approach rather than a fallback
• Thicker condoms cost a few pounds
• Topical anaesthetic sprays are available over the counter without any prescription at all

If one of those is the right answer for you, we will say so — and you will have spent £40 on being told what to do rather than on a prescription you did not need. That is a legitimate outcome.

What we will not sell you

No supplements, no "performance" products, no subscription packages. We sell nothing.

Be wary of online men's health services bundling this into a monthly plan — it creates a financial interest in your staying on treatment, when the goal for many men is to need it less over time.

Free help worth knowing about

NHS sexual health services can advise, and NHS talking therapies take self-referrals where anxiety is a significant part of the picture. Both are free.

Is this actually common?

It is the commonest male sexual complaint — and among the least discussed, which is why so many men assume they are unusual.

It is also one of the more treatable.

Is there a definition, or is it just how I feel about it?

Both matter, and distress is the part that counts. Clinical definitions use around a minute for lifelong PE and a marked reduction from previous for acquired.

But if it is causing you or your partner distress, that is reason enough to treat it — nobody needs to hit a threshold to be helped.

Has it always been like this, or did it start?

The single most useful question, because it changes the approach entirely.

Lifelong PE — present since first sexual experiences — responds well to behavioural techniques and medication.

Acquired PE — a change from how things were — usually has a cause worth finding: erectile dysfunction, thyroid disease, prostatitis, anxiety or relationship strain. Treating that often resolves it without long-term medication.

Do the behavioural techniques actually work?

Yes, genuinely — and they cost nothing. Stop-start and the squeeze technique both work, and pelvic floor exercises have reasonable evidence.

They take six to eight weeks of practice, and the commonest reason they fail is being abandoned after a fortnight. Practise alone first, then with a partner.

Which medication is used?

Dapoxetine, a short-acting SSRI licensed for this and taken 1–3 hours beforehand. Other SSRIs taken daily, used off-licence, which suit men who prefer not to plan around occasions.

Topical anaesthetics — sprays and creams, several over the counter, applied shortly before.

What is the serious risk with SSRIs here?

Serotonin syndrome, if combined with certain other medicines — some antidepressants, triptans for migraine, tramadol, lithium and St John's Wort. It can be life-threatening.

Tell the GP every single thing you take, including anything bought over the counter or online. This is the reason buying these tablets from a website is a poor idea.

Will the spray numb my partner too?

It can, and it is the commonest complaint about them. Wearing a condom after application largely solves it, and washing the area before sex helps.

Getting the contact time right matters — too little does nothing, too much causes numbness for you as well.

Could my erections be the real problem?

Quite possibly, and it is frequently missed. Men with erectile dysfunction often rush to finish before losing the erection, which looks exactly like PE.

Where both are present, the ED is treated first — and the PE commonly resolves with it.

Should my partner be involved?

It helps considerably where they are willing. The behavioural techniques involve both of you, and the distress is usually shared.

They are welcome to join the consultation — and equally, you do not have to bring anyone.

Will I need medication forever?

Often not. Many men use it for a period while behavioural techniques become established, then reduce or stop it.

If you are on a daily SSRI, taper rather than stopping abruptly. On-demand dosing can simply be stopped.

Is it caused by anxiety?

Anxiety is very often part of it, and it becomes self-reinforcing — worrying about it makes it more likely, which gives you more to worry about.

That is why the combination of treatment and psychosexual therapy works better than either alone, and why medication can be useful for breaking the cycle even when the cause is psychological.