Premature is the most common form of male sexual dysfunction but the fact that it is so common does not trivialise or dismiss the stress it can cause to men of all ages. The stigma associated with sexual dysfunction of all types prevents many men from seeking medical help and this article hopes to establish that there is nothing to be ashamed of and there is help out there.

Premature ejaculation is a condition where a man ejaculates too quickly during sexual intercourse. The length of time which is ‘too quickly’ is subjective but in order to put this in perspective, the average time that it takes a man to ejaculate is around five and a half minutes.

The condition can cause serious distress and self esteem problems as well as psychological and emotional issues. It may not be the easiest subject to broach with your GP but overcoming any embarrassment is vital as it will pave the way for the first step towards overcoming the condition.


Types of premature ejaculation

Men who suffer PE tend to fall into one of two categories:

  • Primary ejaculation – this is the type of PE where the condition has always been present

  • Secondary ejaculation (acquired premature ejaculation) – this is the type of PE that has developed recently

In the case of primary ejaculation, the cause is often psychological and may stem from a sexual experience earlier in life.

Secondary premature ejaculation may also have some psychological causes but it is also likely that there are some physical issues that need to be addressed.



The actual causes of premature ejaculation are not clearly understood but it often has physical, psychological and emotional problems at its foundation.

If PE is occurring too often then it may become necessary to seek a diagnosis, especially if it causing problems within a relationship or if you are self conscious about it and this is preventing you from entering into an intimate relationship. Your GP will need to know which category of PE you are suffering from and will also ask questions about your current sex life as well as details of sexual history.

The doctor will also need details as to which conditions make the problem worse and which make it better as well as asking about occasions when sexual experiences fell into the ‘normal’ category.

If your GP ascertains that there is an emotional or psychological problem behind the PE, then treatment by a sexual health professional may be appropriate. If the GP believes the problem is rooted in a physical issue, the most likely referral will be to a urologist.


What are the causes of premature ejaculation?

There are some physical conditions that are closely related to premature ejaculation as well as some psychological and emotional factors.

Physical causes

  • Studies have indicated that hyperthyroidism (overactive thyroid) is closely related to the incidence of premature ejaculation a man suffers.  It has been shown that once the hyperthyroidism has been successfully treated then the risk of experiencing premature ejaculation is reduced.

  • Chronic infection of the prostate gland (prostatitis) has also been shown to be related to premature ejaculation and once the infection is treated, the time lapse for a man to ejaculate is significantly increased.

  • There is a theory that investigates the link between a penis being circumcised and premature ejaculation. One theory suggests that once a penis has been circumcised it becomes desensitised and so there is less chance of premature ejaculation occurring. The opposing view is that by removing the foreskin and exposing the head of the penis, the glans is likely to be more sensitive and so more vulnerable to premature ejaculation. 

  • The use of recreational drugs has also been linked to premature ejaculation.


Psychological causes

  • The sympathetic nervous system is triggered by anxiety. This results in semen being emitted early which in turn triggers ejaculation.  

  • As anxiety can trigger ejaculation, other factors such as depression, stress and historical sexual trauma may be linked to both primary and secondary PE. Relationships can also be a contributor cause of premature ejaculation.

  • Early sexual influences can affect future sexual behaviour. For example, a teenager may fear being discovered whilst masturbating and as a result may condition himself to ejaculate quickly; the result may be a habit which he finds difficult to break in later life.

  • Sexual trauma in childhood such as sexual abuse will leave a lasting and possibly warped impression of what sex should be.

  • Some people experience a rigid upbringing with regard to sexual matters; this may be related to religious beliefs and can instil stigma around sex into a young mind.


Treating premature ejaculation

Self help measures

These may be able to help in reducing the chance of climaxing too quickly. Measure you can try include:

  • Masturbate 1 – 2 hours before having sex
  • Use a thick condom to reduce the level of stimulation to the end of the penis
  • Taking a deep breath quickly can help by shutting down the ejaculatory reflex, an automatic reflex that happens when ejaculation takes place
  • Have sexual intercourse with your partner on top. This will allow your partner to pull away when ejaculation is close
  • Taking breaks during sex will not only lengthen the process but will also ‘kill the moment’, especially if you to try to think about something other than sex. Thinking about the mother in law works pretty well for some men!


Couples therapy

For people who are in a long term relationship, couples therapy may be a good option. The therapist may try different techniques which may include:

  • If there are any issues or problems in the relationship the therapist may suggest that the couple explore these areas and give them help to resolve them.
  • One suggested treatment is to encourage couples to explore each other’s bodies in different ways, non-sexual ways, that can retrain the brain and body as well as being a relaxing and stress free experience.
  • Teaching ways to reverse behaviors; there are techniques that will enable a couple to relearn better habits that are less likely to result in premature ejaculation. There are two popular techniques for this:

The ‘squeeze’ technique involves the penis being stimulating, but the stimulation stops just before the point of ejaculation.  At this point, you, or your partner, squeeze the head of the penis for 10 – 20 seconds.  Then you wait for about 30 seconds then start stimulating the penis again.  If this technique is repeated several times.  This way the period leading up to ejaculation is extended substantially.

The other technique is known as the stop-go technique which is similar, but the penis is not squeezed, there are just periods of masturbating with intermittent breaks before ejaculation is allowed to occur.

Whilst these techniques may sound simple they actually need more practice than you may think.


Drug therapy

There are some antidepressants that are used to treat depression but have also been shown to delay ejaculation. They are SSRIs or selective serotonin reuptake inhibitors. Types of this drug that can be used for this purpose include:

  • Paroxetine
  • Sertraline
  • Fluoxetine

There are some men who may see an instant reaction although it usually takes 2 – 3 weeks for the full effects to be felt. It is important to be mindful that as with most drugs, there are side effects that are usually mild and only tend to last 2 -3 weeks. They include:

  • Fatigue
  • Nausea and vomiting
  • Diarrhoea
  • Excessive sweating


Dapoxetine (Priligy)

There is a specific SSRI drug that has now been licenced to treat premature ejaculation known as dapoxetine, marketed as Priligy.

Compared with other SSRIs it acts quickly to treat PE, so much so, that it can actually be used as and when it is needed, rather than having to take drugs on a regular basis. It needs to be taken 1 – 3 hours before sex and once per day is the maximum dosage. Side effects can include nausea, headaches and dizziness and it is not advised for use by men who suffer from heart, kidney or liver problems. It is also contraindicated for use with some antidepressants.


Phosphodiesterase-5 inhibitors

Drugs that can be given to treat erectile dysfunction such as Viagra or Cialis can be used to treat premature ejaculation.


Topical anaesthetic

Medication such as lidocaine or prilocaine can be administered as cream or ointment. The disadvantage to this is it can be transferred to the walls of the vagina and may reduce the sensation. Using condoms along with the cream will further reduce sensation in the penis whilst also protecting the partner from the effects of the medication.



Any subject which is embarrassing can be difficult to talk about but communication is always the best first step. Talk to your partner and certainly discuss the matter with your GP. The doctor has heard it all before and will be able to help with medication, self help techniques and if necessary, sexual therapy.

Do not let the problem destroy your confidence and your relationship when there is help out there!