Concierge men’s health · London & online
Premature ejaculation treatment private in London.
A discreet, evidence-led route through the full menu of options: on-demand dapoxetine, daily off-label SSRIs, topical anaesthetic spray, behavioural techniques, and COSRT-accredited psychosexual therapy. Andrology-led assessment first, firm quote before you commit, in-person or secure video.
What premature ejaculation is
A common, treatable condition, defined precisely.
The International Society for Sexual Medicine and the European Association of Urology define premature ejaculation by three things together: short intravaginal ejaculatory latency time (IELT), a perceived lack of control, and personal or relationship distress. All three matter.
Lifelong PE
IELT of under 1 minute since the first sexual experience, present with almost every partner. Strong biological component. Responds best to daily SSRI or on-demand dapoxetine.
Acquired PE
A clinically significant drop in IELT to under 3 minutes, after a period of normal function. Often has a treatable trigger: prostatitis, thyroid dysfunction or early ED.
Variable and subjective PE
Normal IELT but a subjective sense of poor control or distress. Usually psychological in origin, and responds best to psychosexual therapy rather than medication.
Prevalence in UK community surveys is around 20 to 30 per cent of adult men across the lifespan. It is the most common male sexual complaint after erectile dysfunction, and one of the most under-treated.
Common causes
What the honest assessment looks for.
A thorough first consultation splits the causes into biological, psychological and mixed. Most men have contributions from more than one column, and treatment reflects that.
-
5-HT receptor sensitivity
A biological trait in many men with lifelong premature ejaculation. Serotonergic pathways controlling the ejaculatory reflex fire earlier, which is why SSRIs are the most consistent pharmacological answer.
-
Prostate inflammation
Chronic prostatitis and pelvic pain syndromes are linked to acquired PE. Treating the underlying inflammation, and any pelvic floor over-activity, can restore ejaculatory latency.
-
Hyperthyroidism
Overactive thyroid is a recognised, and often missed, cause of acquired PE. A simple TSH and free T4 blood test at first consultation is standard.
-
ED-related early ejaculation
Men with early erectile dysfunction often ejaculate quickly to avoid losing the erection. Treating the ED with a PDE5 inhibitor is often the fastest route to fixing both.
-
Anxiety and early conditioning
Performance anxiety, adolescent rushed masturbation habits, and a fear of being caught can condition a rapid ejaculatory reflex that persists into adult life.
-
Relationship and mixed factors
Communication difficulty, a partner’s distress, and secondary avoidance behaviours all sustain the problem. In practice, most presentations are a mix of biological and psychological drivers.
First-line treatment
On-demand medication and behavioural techniques.
For most men the sensible starting point is on-demand dapoxetine, or well-taught behavioural techniques, or a combination. Both are low-risk and quick to try.
Dapoxetine (Priligy)
The only SSRI licensed in the UK specifically for premature ejaculation. Taken one to three hours before planned sex, at 30 mg or 60 mg. Around six in ten men report clinically meaningful improvement in ejaculatory control, with a three to fourfold increase in IELT in pooled trial data. Short half-life means little accumulation and no daily dosing burden.
Behavioural techniques
The stop-start method (Semans) and the squeeze technique (Masters and Johnson) are the two classic behavioural interventions. Both teach recognition of the point of ejaculatory inevitability and how to back away from it. Taught properly, usually across three to six psychosexual sessions, they add durable control on top of any medication.
Second-line options
Daily SSRIs and topical anaesthetics.
Where dapoxetine is unsuitable, poorly tolerated, or insufficient, the two main second-line routes are a daily off-label SSRI or a topical anaesthetic applied before sex.
Off-label daily SSRI
Paroxetine 20 mg, sertraline 50 mg, or escitalopram 10 mg once daily. Paroxetine has the largest evidence base and typically the biggest IELT improvement, though also the highest side-effect burden. These are the most effective pharmacological option for lifelong PE, particularly where dapoxetine has not delivered enough control.
Topical anaesthetic
Lidocaine-prilocaine cream (EMLA, off-label) or Fortacin, a licensed lidocaine-prilocaine spray designed for controlled dosing. Applied five to fifteen minutes before sex, then wiped off. Reduces glans sensitivity enough to prolong IELT without abolishing sensation, and can be combined with dapoxetine.
Sex therapy
COSRT-accredited psychosexual therapy.
A structured course, typically six to twelve sessions, delivered by a therapist on the College of Sexual and Relationship Therapists register. It is the intervention most likely to produce lasting change, and works well alongside medication.
Session 1 to 2
Individual formulation
Sexual history, current pattern, contributory anxiety, and any partner factors. Agree goals in measurable terms.
Session 3 to 5
Sensate focus
Graded, non-goal-directed touch exercises to break the performance loop and rebuild arousal awareness.
Session 6 to 8
Stop-start and squeeze
Behavioural techniques rehearsed at home and refined week by week, with or without on-demand medication.
Session 9 to 12
Couples work and relapse plan
Communication skills, addressing any partner distress, and a written plan for the first signs of recurrence.
When to also treat ED
The overlap with erectile dysfunction.
A large minority of men presenting with acquired PE have subclinical erectile dysfunction driving the pattern: rushing to ejaculate before losing the erection.
Screen every PE consultation for ED
A brief IIEF-5 or SHIM at first visit takes two minutes. Where ED is present, treating it with a PDE5 inhibitor (sildenafil, tadalafil) often improves ejaculatory control on its own, before any PE-specific medication.
Combined PDE5 plus SSRI
Where PE and ED coexist, trial evidence supports combined tadalafil plus daily SSRI, or sildenafil plus on-demand dapoxetine. Safe when nitrates are excluded and cardiac risk is assessed. Both problems improve together in most men.
What doesn’t work
Where to save your money.
The private PE market attracts a lot of marketing. A short list of interventions has genuine evidence; a longer list does not.
Surgical procedures to avoid
Selective dorsal penile neurotomy and glans hyaluronic acid augmentation are marketed by a handful of overseas clinics for PE. Neither is recommended by the European Association of Urology or the British Society for Sexual Medicine. Complications, including permanent sensory loss and cosmetic deformity, are irreversible.
Unproven supplements and devices
Herbal blends, delay condoms with novel additives, and vibratory devices marketed as PE cures have weak or absent trial evidence. A condom with lidocaine inside can be a reasonable adjunct; the wider category of unregulated products is not.
Cost in London
What private PE treatment costs.
Indicative ranges across the vetted London andrology and psychosexual panel. Firm quotes provided after your first consultation.
| Component | Indicative range | Notes |
|---|---|---|
| Initial andrology or urology consultation | £150 to £350 | 45 to 60 minutes, includes basic bloods |
| Dapoxetine (Priligy) 30 mg / 60 mg | £4 to £8 per dose | On-demand, pack pricing varies |
| Daily off-label SSRI | £8 to £25 per month | Paroxetine, sertraline or escitalopram |
| Fortacin licensed spray | £5 to £10 per application | Bottle-based, cost per use approximation |
| Psychosexual therapy (per session) | £120 to £220 | Individual or couples, 50 minutes |
Where
The London providers we work with.
A short panel of andrology-led centres and COSRT-accredited therapists, screened for genuine multidisciplinary care rather than dispensary-style prescribing.
-
The London Andrology Centre
Harley Street, andrology-led PE and ED pathway
-
HCA Wellington Men’s Health
St John’s Wood, consultant urology and psychosexual medicine
-
Cromwell Bupa Men’s Health
South Kensington, integrated urology and sexual health
-
London Sex Therapy Clinic
Central London, COSRT-registered psychosexual therapists
-
The Institute of Psychosexual Medicine
National register of doctor-therapists for PE and ED
-
COSRT-registered therapists
Nationwide directory of accredited psychosexual therapists
Evidence
The trial data, in numbers.
Meta-analyses across dapoxetine, off-label SSRIs and topical anaesthetics consistently show meaningful IELT and control gains over placebo.
-
60%
of men on on-demand dapoxetine report clinically meaningful improvement in ejaculatory control.
-
3–4x
increase in intravaginal ejaculatory latency time (IELT) with daily off-label SSRIs.
-
6–12
sessions of COSRT-accredited psychosexual therapy for durable behavioural change.
Related guides
Related routes for men’s sexual and relationship health.
-
Erectile dysfunction clinic
Andrology-led ED assessment, PDE5 inhibitors, shockwave and injection therapy.
Learn more -
Testosterone replacement therapy
Diagnosis and monitoring of low testosterone in adult men.
Learn more -
Couples therapy
Evidence-based relationship therapy where sexual difficulties feature.
Learn more -
Private psychiatric assessment
Consultant-led diagnostic assessment for anxiety and mood contributions.
Learn more
Frequently asked
Everything we get asked about PE treatment.
-
Can dapoxetine (Priligy) be taken daily?
No. Dapoxetine is licensed as an on-demand SSRI only, taken one to three hours before planned sex. Its short half-life is what makes it suitable for as-needed use. Men who want daily treatment are moved to an off-label SSRI such as paroxetine, sertraline or escitalopram, which have longer half-lives and were the original off-label PE treatments before dapoxetine was licensed.
-
What are the side effects of PE medication?
Dapoxetine most commonly causes nausea, headache, dizziness and rarely fainting on standing. Daily SSRIs can cause reduced libido, delayed orgasm, nausea in the first two weeks, and, on stopping, a discontinuation syndrome. Topical lidocaine-prilocaine can cause local numbness and, if not wiped off, partner transfer. Your prescriber will screen for cardiac risk before dapoxetine.
-
Will topical anaesthetic cream numb my partner?
It can, if applied heavily and not wiped off before intercourse or a condom is not used. Fortacin, the licensed lidocaine-prilocaine spray, is designed for minimal transfer at the recommended dose. Standard practice is to apply five to fifteen minutes before sex, wipe residue away, and use a condom for the first few uses while you calibrate.
-
Does premature ejaculation come back if I stop treatment?
On-demand dapoxetine and topical anaesthetics work only when used, so the effect stops when you stop. Daily SSRIs often maintain benefit for a period after tapering, but recurrence is common if underlying anxiety or conditioning has not been addressed. This is the argument for combining medication with psychosexual therapy or behavioural techniques, which produce more durable change.
-
Will private medical insurance cover PE treatment?
Cover is patchy. Bupa, AXA and Vitality will usually fund the initial urology or andrology consultation and investigations to exclude prostatitis or thyroid disease. Prescription-only medication and psychosexual therapy are more often self-pay, though some policies include a limited number of counselling sessions. We confirm cover with your insurer before you commit.
-
Can I have an online consultation for premature ejaculation?
Yes. A first PE consultation is well suited to secure video. The clinician takes a full sexual and medical history, arranges any blood tests locally, and issues a private prescription for dapoxetine or a daily SSRI where clinically appropriate. In-person review is usually offered for ED, pelvic examination, or if psychosexual therapy is being considered.
Ready to start?
Private premature ejaculation treatment in London, matched discreetly.
Send a short confidential note. We come back within one working day with an andrology consultation slot, a firm quote, and a matched psychosexual therapist if you want the combined pathway.