Patient information · Men's health
Premature ejaculation
the most common male sexual difficulty, and among the most treatable
Premature ejaculation affects a large minority of men at some point and is the commonest male sexual complaint. It is also the one most likely to go unmentioned, and the one where the gap between how treatable it is and how many men are treated is widest.
Arrange assessment rather than self-treating if there is
- a sudden change in a man who previously had no difficulty
- PE alongside erectile dysfunction — the order of treatment matters
- pain on ejaculation, or blood in the semen
- significant relationship distress, low mood or anxiety
- symptoms alongside urinary problems or pelvic pain
Acquired PE — a change from a previously normal pattern — more often has an identifiable and treatable cause, including thyroid disease, prostatitis and erectile dysfunction. If you are struggling with your mood, Samaritans are free on 116 123 at any hour.
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.
- 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.
- The squeeze technique. As above, but firm pressure applied just below the head of the penis for several seconds to reduce arousal.
- 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.
- Reduce the pressure. Sensate focus exercises, which remove intercourse from the equation for a period, break the anxiety cycle that maintains the problem.
- 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.
Talk to your partner
Men frequently conceal this, avoid sex, and let a partner conclude they are no longer attracted to them — which causes far more relationship damage than the problem itself. Partners are usually more concerned about the withdrawal than the timing. Involving them in treatment substantially improves outcomes.
Why come to us. This is straightforward to treat and very rarely raised. We offer discreet men's health appointments seven days a week, with no referral needed and online booking if you would rather not discuss it at reception. We assess and treat the causes underneath — erectile dysfunction, prostatitis, thyroid function, all testable here — rather than simply handing over a spray, and we offer psychosexual consultation and pelvic floor physiotherapy alongside.
Discreet, effective, seven days a week
Book online without discussing it at reception. No referral needed.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.