Premature ejaculation: treatment, causes and what is normal

BAUS says psychosexual counselling, mindfulness therapy, cognitive behavioural therapy (CBT) and related techniques form the cornerstone of management, and the mainstay of long-term treatment is often a combination of drugs and behavioural therapy. It also says most patients can be managed in general practice without referral to a urologist.

BAUS says behavioural techniques tend to be used on their own in acquired premature ejaculation or when symptoms are mild, and with medication when symptoms are severe or lifelong. They are best learned under the supervision of a psychosexual counsellor.

The NHS suggests there are several things you can try yourself before or alongside treatment. They are worth discussing with a partner, because the NHS notes that psychosexual counselling can involve both of you.

• Masturbate an hour or two before sex. BAUS says improvements are seen in 50 to 60% of men but are not always maintained long term.

• Use a thick condom to help decrease sensation.

• Have sex with your partner on top, so they can pull away when you are close to ejaculating (NHS).

• Practise the stop-start or squeeze technique, first alone and then with a partner (NHS).

• Do regular pelvic floor exercises (BAUS).

BAUS describes premature ejaculation (PE) as the most common type of ejaculation problem, where the male ejaculates before he and/or his partner wants to. It says there is wide variation in what PE means to different people, from ejaculating during foreplay to lasting for many minutes in intercourse but still not long enough to satisfy.

BAUS says the average time taken to ejaculate during intercourse is around 5.5 minutes, and that there is no definition of how long sex should last. It says that if over half of your attempts at sex result in premature ejaculation, it might help to get treatment. For research purposes, BAUS says a latency time of one minute or less, occurring more than 75% of the time, is regarded as abnormal.

PE can be lifelong (dating back to first sexual experience) or acquired (starting later in life after satisfactory ejaculation), and can be situational. BAUS says it can be associated with erectile dysfunction.

BAUS says most cases do not have a clear cause. The NHS lists possible physical and psychological factors.

• Physical: prostate problems, thyroid problems (overactive or underactive), and using recreational drugs. BAUS adds prostatitis and notes a possible family tendency.

• Psychological: depression, stress, relationship problems, and anxiety about sexual performance, particularly early in a relationship.

• Lifelong PE: early sexual experiences that condition quick ejaculation, a previous traumatic sexual experience, a strict upbringing and beliefs about sex (NHS).

The NHS says dapoxetine (Priligy) is an SSRI designed to treat premature ejaculation. It acts much faster than other SSRIs used for this purpose and can be used on demand. Your response is reviewed after 4 weeks (or after 6 doses), and again every 6 months. Common side effects are headaches, dizziness and feeling sick, and it is not recommended for some men with heart, kidney or liver problems or who take other antidepressants.

BAUS says dapoxetine is normally available on the NHS, but local prescribing rules may restrict it, so check with your GP or urologist whether it is available in your area. BAUS says SSRIs should only be taken on prescription after a detailed discussion of risks and benefits. It lists imipramine and tramadol as not recommended for clinical use in premature ejaculation.

The NHS says if you have a persistent problem with ejaculation, visit your GP, who will discuss the problem and may examine you or refer you to a specialist. BAUS says you should consider seeking advice if ejaculation is earlier than desired with minimal stimulation and you have little control over it.

BAUS says the GP will usually take a full history, including lifestyle factors such as work pressures, smoking, alcohol and drug use, and a sexual history, and may ask you to complete a symptom questionnaire. A physical examination and blood or urine tests may be done to look for other problems such as diabetes or hormone problems, and specific tests are not usually needed.

On the NHS, premature ejaculation is usually assessed by a GP, who may offer medicines or refer to psychosexual counselling or urology if there is also erectile dysfunction. Dapoxetine and counselling access varies by area. Some men buy treatments such as sildenafil or numbing creams from pharmacies or consult privately; the NHS advises speaking to a pharmacist to make sure a medicine is safe for you.