What is premature ejaculation

Premature ejaculation (PE) is when a man ejaculates (releases semen) sooner than he would like, during sex. This is distressing for both the patient and their partner and can significantly impact well being.

Occasional episodes of early ejaculation are common, but if it is happening more often, or is becoming distressing, this is when premature ejaculation is suspected.

The International Society for Sexual Medicine (ISSM) defines lifelong PE as:

• Ejaculation that always occurs within 1 minute of penetration

• Causes distress and/or the avoidance of sexual intimacy

• Inability to delay or withhold ejaculation

How Common is PE

PE is the most common sexual problem in men, with between 20-30% of men affected. Unlike other conditions which may be more likely in certain age groups, PE can affect men of all ages.

Lifelong vs Acquired PE: What's the Difference

PE can be broadly categorised into two types: lifelong, or acquired.

Lifelong PE occurs almost all the time beginning with the first sexual encounter, whereas acquired PE develops over time, following previous ‘normal’ sexual episodes. This is important as it can help determine the likely cause and most effective treatment.

What causes Premature Ejaculation

The exact cause of PE is unknown, though it is thought to be a combination of psychological and biological factors. Common causes include performance anxiety, stress, relationship issues as well as inflammation of the prostate, thyroid problems and erectile dysfunction.

Some men may experience hypersensitivity of the penis and may also be associated with previous traumatic sexual experiences.

How is premature ejaculation diagnosed

Diagnosing PE does not rely on laboratory tests or invasive procedures. A clinical diagnosis is established through a detailed sexual and medical history.

Clinicians would ask about your symptoms, how they affect your sex life, whether they cause distress and if PE is accompanied by other symptoms such as erectile dysfunction.

The main parameters assessed are:

• Intravaginal Ejaculation Latency Time (IELT) - this is the time taken between penetration and ejaculation

• Perceived lack of control

• Presence of emotional distress, frustration or performance anxiety.

The most widely used tool to screen for PE through a questionnaire is the Premature Ejaculation Diagnostic Tool or PEDT. This asks a series of questions to subjectively ‘score’ a patient against clinical standards to confirm a diagnosis.

Can premature ejaculation be cured or treated

Yes, PE can be treated. Many men find symptoms improve with the right treatment. With a range of treatment options, it's essential to work with your healthcare provider, to find a tailored cure, based on your circumstances.

What are the treatment options for premature ejaculation (comparison)

The main treatment options for PE in the UK are:

• Behavioural techniques

• Pelvic floor exercises

• Anaesthetic creams and sprays

• The medicine dapoxetine (Priligy)

• Climax-control condoms

• Psychosexual therapy

For those who have underlying erectile dysfunction, this should first be addressed.

Dapoxetine is the only oral medicine licensed in the UK specifically for PE, while Fortacin is licensed as a spray form.

Behavioural techniques: stop-start, squeeze and the role of practice

Behavioural techniques offer a drug-free treatment option, focusing on retraining the nervous system. By learning to recognise your body’s sensations as you approach climax, you can raise your ejaculation threshold over time. This can be achieved through a few different methods:

1. The stop-start technique - this is where you engage in sexual activity, only to stop when you feel you are close to ejaculating. Once arousal levels subside, resume stimulation

2. The Squeeze technique - is similar to the stop-start technique though when approaching ejaculation, targeted physical pressure is applied to suppress ejaculation.

The important thing is to practice. Behavioural techniques will not work overnight, usually taking a minimum of four to six weeks, if not longer.

Do pelvic floor exercises help premature ejaculation

Kegel exercises, also known as pelvic floor muscle training target muscles on the pelvic floor. Strengthening these muscles may help with ejaculation control in a way similar to ’the squeeze technique’ described above, without the physical squeezing of the penis.

Clinical studies confirm pelvic floor muscle training can benefit those experiencing PE. Another study found 82.5% of men gained greater control over their ejaculatory reflex after following a structured pelvic floor exercise routine.

Topical sprays and creams for premature ejaculation

Sprays and creams offer quick results without the need to take on demand or daily medication. Containing anaesthetics, these work by numbing the area, reducing sensitivity allowing you to last longer during sexual activity.

Most common forms contain lidocaine, prilocaine or benzocaine. When applied to the penis, these ingredients desensitise nerve endings. Because of this, it takes the nervous system longer to reach the point needed for ejaculation

In the UK, Fortacin spray is licensed for treating lifelong premature ejaculation and can be purchased over the counter from pharmacies.

Emla cream, whilst commonly used to numb the skin before minor procedures (such as injections), it is frequently used off-label to treat premature ejaculation. This is also a pharmacy-only medication and can be purchased without a prescription.

Dapoxetine - the Prescription tablet for PE

Dapoxetine, (or the brand Priligy) is the only oral licensed medication specifically for premature ejaculation. It is known as a Selective Serotonin Reuptake Inhibitor (SSRIs).

Serotonin is a chemical messenger released to pass signals between nerve cells. In the natural state, the signal is passed and serotonin is reabsorbed.

Dapoxetine keeps the serotonin released for longer, and higher levels of serotonin act as a ‘brake’ on the ejaculation reflex. In doing so, it takes longer to reach the state to ejaculate.

Data from clinical research proves dapoxetine is an effective treatment, increasing IELT - the time taken to ejaculate following penetration.

Premature ejaculation and erectile dysfunction: which to treat first

Both PE and erectile dysfunction (ED) can commonly occur at the same time. Some research suggests an overlap of 30-50%.

When dealing with both conditions, it is important to treat erectile dysfunction first. Men with ED are more likely to rush to ejaculate before losing their erection. Over time, this creates a neurological habit of rapid ejaculation.

Prioritising ED can help patients relax, solving premature ejaculation naturally without needing separate PE medication.

It's important to not treat both conditions at the same time. Treatments for ED, (Sildenafil, tadalafil, vardenafil) significantly interact with dapoxetine, causing a dangerous drop in blood pressure.

When should I see a pharmacist or GP about PE

You should speak to your pharmacist or GP if PE occurs regularly and is causing you personal distress, impacting your self-esteem or creating relationship issues.

Whilst the occasion early climax is normal, you should seek help from a medical professional if:

• Consistency - you have consistently experienced PE (ejaculated within 1-2 minutes) over the last 6 months

• Emotional Distress: Symptoms are causing you or your partner anxiety, frustration or is making you avoid intimacy altogether

• Sudden onset (Acquired PE): You have previously enjoyed a satisfactory period of ejaculatory control but your timing has suddenly decreased without an obvious cause.

• Concurrent Erection Issues: You are also struggling to get or maintain an erection firm enough for penetration (erectile dysfunction)