Private premature ejaculation clinic in London, same-day men's health.

What counts

Clinically, PE means ejaculation occurring sooner than desired, usually within about a minute of penetration for lifelong PE or a marked reduction from previous timing for acquired PE, with an inability to delay it and resulting distress. All three parts matter — particularly the distress. If it does not trouble you or your partner, it does not require treatment.

• Lifelong PE — present since first sexual experiences. More likely to have a neurobiological basis, and responds well to medication.
• Acquired PE — developing after a period of normal function. More likely to have a specific cause worth finding.
• Variable — occasional early ejaculation, which is normal and not a disorder.

Causes worth excluding

• Erectile dysfunction — men who fear losing an erection often rush, producing secondary PE. Treat the ED first; the PE frequently resolves with it.
• Prostatitis or chronic pelvic pain
• An overactive thyroid — a simple blood test
• Performance anxiety, relationship difficulty, or a long gap without sex
• Alcohol and recreational drug use, and withdrawal from certain medicines

Behavioural techniques

These work, they are free, and they are more durable than medication because they build actual control. They need practice over weeks, ideally with a partner.

1. Stop-start. Stimulate to just before the point of no return, stop completely until the sensation subsides, then resume. Repeat three times before allowing ejaculation.
2. The squeeze technique. As above, but firm pressure applied just below the head of the penis for several seconds to reduce arousal.
3. Pelvic floor training. Strengthening the pelvic floor has good trial evidence in PE, and a physiotherapist can teach it properly — most men do it wrong unsupervised.
4. Reduce the pressure. Sensate focus exercises, which remove intercourse from the equation for a period, break the anxiety cycle that maintains the problem.
5. Practise alone first, then with a partner, building tolerance gradually.

Medication and topical treatment

• Topical anaesthetic sprays or creams applied 10 to 15 minutes beforehand reduce sensitivity. Use a condom or wash it off before intercourse to avoid numbing your partner.
• Dapoxetine is licensed specifically for PE and taken on demand, one to three hours before sex.
• Daily SSRIs are used off-label and are highly effective, delaying ejaculation substantially. They take one to two weeks to work.
• Where ED coexists, a PDE5 inhibitor may be used, often alongside.
• Thicker condoms help some men. Combining medication with behavioural work gives the best long-term results.