What is premature ejaculation?
Premature ejaculation (PE) is the most common type of ejaculation problem. It is also referred to as rapid ejaculation.
This is where the male ejaculates before he and/or his partner wants to.
There is wide variation in what PE means to different individuals in different situations. For example, it may range from ejaculating in foreplay, to being able to have penetrative intercourse for many minutes (but which is still not enough to satisfy the male/the partner).
Does premature ejaculation matter?
The average time taken to ejaculate during intercourse is around 5½ minutes. However, it’s up to each couple to decide if they’re happy with the time taken – there’s no definition of how long sex should last.
Occasional episodes of premature ejaculation are common and aren’t a cause for concern. However, if you’re finding that over half of your attempts at sex result in premature ejaculation, it might help to get treatment.
If either you or your partner feel that orgasm is happening much too soon, there may be a degree of PE. In many cases, premature ejaculation does matter, because it makes people unhappy and frustrated. In severe cases, PE can threaten or even ruin a relationship – simply because it spoils the sex lives of both partners.
What causes premature ejaculation
Most cases of premature ejaculation do not have a clear cause. Various psychological and physical factors can cause a man to suddenly experience premature ejaculation, including:
- Physical causes
- prostate problems
- hormonal problems including an over or underactive thyroid gland
- using recreational drugs
- Psychological causes
- depression
- stress
- relationship problems
- anxiety about sexual performance - particularly at the start of a new relationship, or when a man has had previous problems with sexual performance
It is possible, but less common, for a man to have always experienced premature ejaculation since becoming sexually active. Possible causes of this are:
- early sexual experiences that influence future sexual behaviour;
- traumatic sexual experience from childhood;
- a strict upbringing and beliefs about sex; and
- biological reasons e.g. some men may find their penis is extra sensitive.
What should I do if I have premature ejaculation?
If your ejaculation is earlier than desired (before or soon after penetration) with minimal stimulation and you have little control over it, you should consider seeking further advice from your GP
What are the facts about premature ejaculation?
- Premature ejaculation (PE) can be lifelong (often dating back to the first sexual experience) or acquired (occurring later in life with previously satisfactory ejaculation time);
- PE can be situational (occurring under specific circumstances or with a specific partner);
- We do not know accurately how common it is but between 1 in 3 & 1 in 5 men (20-30%) are thought to have PE;
- Less than a quarter of men with PE actually seek medical advice for their condition;
- PE can be associated with erectile dysfunction (impotence) and with rapid loss of erection after ejaculation; and
- PE can cause significant patient distress and bother.
What should I expect when I visit my GP?
Your GP should work through a recommended scheme of assessment for men with troublesome premature ejaculation. This will normally include one or all of the following:
A full history
Your GP will enquire about lifestyle factors (e.g. your job, work pressures, smoking habits, alcohol intake and drug consumption and will take a detailed sexual history. Your GP may also ask you to complete a premature ejaculation symptom questionnaire as an aid to further assessment and discussion of treatment options. Download a premature ejaculation questionnaire
This will allow your GP to:
- identify your needs & expectations;
- help you & your partner share in decision-making; and
- decide whether psychosexual counselling might be helpful.
A physical examination
A general physical examination will be directed to the suspected cause of your problem and may include an assessment of the development of your male sexual characteristics and to detect any abnormality of your genitals. Your blood pressure will normally be measured as part of this examination.
The pulses in your legs and nerve reflexes involving your legs, penis and anus (back passage) may also be tested. Rectal examination (pictured) may also be performed to assess the tone of your anal muscles and to feel your prostate gland, if there is a suspicion that you may have erectile dysfunction and low testosterone levels.
Additional tests
Specific tests are not usually needed but the following may be performed, depending on whether there is a suspicion of other problems:
a. General blood tests
The actual tests performed will be left to your GP's discretion. It is common to measure kidney function, liver function and cholesterol as well as checking your blood for anaemia or other problems. A blood sugar measurement may be performed to exclude diabetes
b. Routine urine tests
Your urine will normally be assessed by dipstick-testing to see whether it contains sugar which might indicate diabetes
c. Hormone measurements
Blood levels of testosterone, prolactin, FSH (follicle-stimulating hormone), LH (luteinising hormone) and thyroid hormones may be measured if you also have erectile dysfunction (impotence). Testosterone levels should be checked between 08.00 and 11.00hr, without breakfast or drinks (other than water) on the morning of the test.
d. Other specific tests
Your GP may ask you to time the interval between penetration and ejaculation (the intravaginal ejaculation latency time, IELT) using a stopwatch. A latency time of one minute or less, occurring more than 75% of the time, is regarded as abnormal.
What could have caused the problem?
The cause of premature ejaculation is unknown; it appears unrelated to performance anxiety, hypersensitivity of the penis or nerve receptor sensitivity
Premature ejaculation may have a genetic tendency, running in some families. It is also associated with prostate inflammation (prostatitis), thyroid disorders, emotional or pyschological disorders and previous traumatic sexual experiences.
What treatments are available?
Psychosexual counselling, mindfulness therapy, cognitive behavioural therapy (CBT) and other associated techniques form the cornerstone of managing this condition, and may help men with less troublesome premature ejaculation. Numbing agents such as sprays or creams can also be used. Often, the mainstay of long-term treatment is a combination of drugs & behavioural therapy
Most patients can be managed in general practice without the need for urological referral. If you have troublesome erectile dysfunction (impotence) as well, your GP may ask you to consult a urologist.
Psychosexual counselling
Behavioural strategies, listed below, are all effective:
- the "stop-start" technique involves stopping or withdrawing stimulation just bnefore orgasm;
- the "squeeze" technique involves applying pressure to or squeezing your penis at one of the points shown in the image (below) just before orgasm, to delay ejaculation;
- the Kegel technique (learning to control the ejaculatory muscles) involves doing pelvic floor exercises regularly to strengthen your ejaculatory muscles through training.
Drugs
Selective serotonin release inhibitors (SSRIs)
These are powerful antidepressants, which can also be used for treatment of premature ejaculations. They have been shown to increase the length of time to ejaculation.
Dapoxetine (Priligy®) is the only SSRI licensed for use "on demand" (i.e. taken an hour before sexual activity) in premature ejaculation. It is normally available on the NHS, but local prescribing rules may restrict its use: you should, therefore, check with your GP or urologist whether it is available in your area.
Common side-effects of SSRIs include fatigue, drowsiness, nausea, dry mouth, diarrhoea & excessive perspiration. These are often mild and usually settle after 2-3 weeks.
SSRIs are powerful drugs. You should only take them by getting a prescription from your GP & you should have a detailed discussion about the risks & benefits before starting treatment.
Other drugs which delay ejaculation
Drugs such as imipramine or tramodol have been used, but their role is unclear and, at the moment, they are not recommended for clinical use in premature ejaculation.
If there is a suspicion that premature ejaculation is a result of, or is associated with, erectile dysfunction, it may be felt necessary to treat you with appropriate medications, either alone or in combination with therapy for premature ejaculation.
PDE-5 inhibitors
PDE-5 inhibitors such as sildenafil, tadalafil, vardenafil or avanafil have been used, but their exact role is uncertain. Your urologist may suggest using them in combination with dapoxetine. If poor erections are a problem, they can improve sexual confidence and reduce performance anxiety by producing better erections.
Information about PDE-5 inhibitors
Topical treatment
Local anaesthetic creams or sprays (lidocaine/prilocaine), applied 20 - 60 minutes before intercourse, work to numb the area to which they are applied, with the aim of delaying ejaculation. Once applied & dried, you should wash the area or use a condom during sexual intercourse to avoid transferring the local anaesthetic to your partner. These treatments can occasionally cause irritation of the penile skin (or your partner's vagina) and may reduce the partner's sensation/pleasure.
Condoms containing the local anaesthetic benzocaine, are also available commercially and have proved useful in some patients.
Masturbation before intercourse
Other techniques that may benefit younger patients include masturbation before anticipated intercourse. This may result in desensitising the penis and a longer delay to ejaculation.
Although improvements are seen in 50-60% of men, they are not always maintained in the long term. All of these techniques are best learned under the supervision of a psychosexual counsellor. They tend be used on their own in acquired premature ejaculation or when symptoms are mild. When symptoms are severe or lifelong, they are best used in conjunction with medication.
Page dated: March 2024 - Due for review: August 2026