If you have found this page, you are probably dealing with something that feels deeply personal — finishing sooner than you or your partner would like, and not knowing how to change it. I hear this from men every week in my clinic, and I never tire of saying it: you are not alone, and this is not your fault. I am Mr Giangiacomo Ollandini, a Consultant Urological Surgeon specialising in men's sexual health and andrology, and I have spent over 15 years helping men with premature ejaculation (PE), which affects around 30% of men at some stage. Effective treatment exists — and coming to see me about this takes courage that is absolutely worth it.
PE is common and treatable. You do not have to manage this alone.
Ready to talk? I offer confidential consultations in a setting where nothing you say will surprise or embarrass me.
What Exactly is Premature Ejaculation (PE)?
Put simply, PE is when ejaculation happens sooner than you or your partner would like, and it causes you real distress [1]. There is no single stopwatch definition — but clinically, I consider ejaculation happening regularly within about one minute of starting intercourse (measured as IELT — intravaginal ejaculation latency time) as a marker of PE, particularly when it causes bother [1, 6]. The three things I look for are: a short time to ejaculation, the inability to delay it, and the negative effect this has on you — frustration, distress, or avoiding intimacy altogether [1, 6].
Defining PE: The International Standard
The International Society for Sexual Medicine (ISSM) defines PE in two main forms [1, 6]:
- Lifelong (Primary) PE: Ejaculation occurs before or within about 1 minute of penetration, and has been this way since your first sexual experiences. This form is often linked to neurobiological or genetic factors [3, 11].
- Acquired (Secondary) PE: This develops after a period of normal ejaculatory control — something has changed. Latency time typically drops to around 3 minutes or less [4], and physical causes (such as thyroid problems [4] or prostatitis) or psychological factors are more often involved.
Both forms share two defining features:
- The inability to delay ejaculation on all or nearly all penetrations.
- Negative personal consequences — distress, frustration, or avoiding intimacy altogether [1, 6]. The distress you feel matters as much as the timing.
Other Related Presentations:
It is also worth distinguishing PE from two related but different experiences [13]:
- Natural Variable PE: Occasional, inconsistent episodes of rapid ejaculation. This is a normal variation and does not usually need medical treatment.
- Premature-like Ejaculatory Dysfunction (Subjective PE): When you feel you ejaculate too quickly and this causes real distress, even though your actual time is within the normal range. This is often rooted in anxiety or unrealistic expectations.
Why Classification Matters:
Understanding which type best describes your experience matters because it shapes the diagnostic process and guides the most effective treatment [1, 4]. For example, lifelong PE often responds well to medications that target neurotransmitters, while acquired PE may warrant investigation for underlying physical causes or benefit more from psychosexual therapy.
During our consultation, I will explore your specific history and symptoms carefully to classify your condition accurately — this forms the foundation of a plan that is genuinely tailored to you.
You Are Not Alone: How Common is PE?
PE is the most common male sexual problem — it affects men of all ages and backgrounds [5, 14]. Around 1 in 3 men experience it at some point [14]. Unlike erectile dysfunction, PE does not become more common as men get older [5]. Most men I see have been carrying this quietly for months or years, too embarrassed to raise it — and that silence is understandable. But help is available, and it works.
Epidemiological Insights on Premature Ejaculation
Large-scale studies give us a clearer picture of how common PE is and who it affects [5]:
- Global consistency: Major international surveys (including the PEPA study) consistently report prevalence rates of 20–30% using broad definitions [5, 15]. Using stricter clinical criteria, the figure is lower but still substantial — around 5–10%.
- Age distribution: Unlike erectile dysfunction, PE prevalence remains relatively stable across adult age groups [5]. The overall likelihood of experiencing PE does not dramatically increase as men get older, though the causes and impact may shift with age.
- Relationship status: PE occurs in both single and partnered men at similar rates. Men in stable relationships are often more likely to seek help, because the impact on their partner and relationship becomes harder to ignore [20].
The Hidden Impact of PE
The effects of PE reach well beyond the physical act. They touch emotional well-being and relationships in ways that are often underestimated [20]:
- Psychological consequences: Men with PE report significantly higher rates of anxiety, depression, low self-esteem, and feelings of inadequacy compared to men without PE [20].
- Relationship effects: PE can reduce sexual satisfaction for both partners, create communication difficulties, lead to avoidance of intimacy, and increase relationship tension [20].
- Quality of life: The cumulative effect can be a noticeable reduction in overall well-being — affecting mood, social confidence, and general happiness [5].
Recognising these broader impacts matters. Effective treatment aims not just to increase time to ejaculation, but to reduce distress, rebuild confidence, improve relationship satisfaction, and restore quality of life.
What Causes Premature Ejaculation?
The causes of PE are rarely simple. In most men I see, there is a mix of physical and psychological factors at play — and understanding what is driving your PE is the key to finding the right treatment. Physical factors include nerve sensitivity, hormone levels (particularly thyroid hormones), and imbalances in neurotransmitters — especially serotonin, which plays a central role in regulating ejaculation. Psychological factors often include performance anxiety, stress, depression, or relationship difficulties.
Biological and Physical Factors
Research has identified several biological contributors to PE:
- Neurotransmitter imbalances: Serotonin (5-HT) plays a central role in regulating ejaculation [12]. Men with lifelong PE often have altered sensitivity or function of specific serotonin receptors (particularly 5-HT1A and 5-HT2C) in the brain pathways that control ejaculation [3, 12]. This is the basis for using SSRI medications in PE treatment. Dopamine and oxytocin pathways are also involved [13].
- Penile hypersensitivity: Some men with PE — particularly lifelong PE — appear to have increased sensitivity of the penis, especially around the glans or frenulum [3]. Studies using sensory testing have sometimes shown lower thresholds for detecting vibration or touch in men with PE.
- Genetic predisposition: There is evidence of a genetic component, particularly for lifelong PE [11]. Twin and family studies suggest a higher likelihood of PE if close relatives are affected, possibly linked to genes regulating serotonin transport or receptor function.
- Hormonal factors:
- Thyroid dysfunction: Hyperthyroidism (an overactive thyroid) is strongly linked to acquired PE [4]. Correcting the thyroid problem often improves ejaculatory control.
- Testosterone: The relationship is complex. Severe deficiency can cause various sexual problems, but low testosterone is not a primary driver of PE. Some studies link both low and high testosterone levels to PE, suggesting that balance matters more than absolute level.
- Prolactin: Elevated prolactin levels (hyperprolactinemia) can sometimes be associated with ejaculatory dysfunction.
- Prostatitis or urethritis: Inflammation or infection of the prostate or urethra can sometimes trigger acquired PE [4]. Treating the underlying inflammation may resolve the PE.
- Erectile dysfunction (ED): There is a strong link between ED and PE [10]. Men with ED may unconsciously rush intercourse to ejaculate before losing their erection, establishing a pattern of rapid ejaculation. Conversely, anxiety about PE can sometimes lead to ED. Treating the primary issue often improves the other.
Psychological and Relationship Factors
Psychological factors play a major role — especially in acquired PE — and they interact with biological factors even in lifelong PE [7]:
- Performance anxiety: Worrying about satisfying a partner, or about ejaculating too quickly, creates a cycle where the anxiety itself speeds up ejaculation [10]. This is perhaps the most common psychological factor I encounter.
- Stress and depression: General life stress, anxiety disorders, or depression can significantly affect ejaculatory control [10].
- Relationship difficulties: Conflict, poor communication, or dissatisfaction within a relationship can manifest as sexual problems, including PE [20].
- Early sexual experiences: Hurried or anxiety-ridden early encounters may establish a pattern of rapid ejaculation that persists [10].
- Unrealistic expectations: Comparing oneself to portrayals in media or pornography can create anxiety and a subjective sense of PE even when latency times are normal.
- Body image: Negative feelings about one’s body can contribute to sexual anxiety.
In most cases, PE results from an interplay between biological vulnerability and psychological factors. A man might have a slight biological predisposition to faster ejaculation, but it only becomes a real problem when performance anxiety is added to the mix. This is why a holistic approach — addressing both aspects together — is usually the most effective strategy.
Diagnosing Premature Ejaculation: Understanding Your Situation
Getting an accurate diagnosis is the first step towards effective treatment. When you come to see me, we will have a private, confidential conversation about your sexual history, how PE affects you, and any relevant medical background. I may use validated questionnaires to help measure the problem objectively. A physical examination is sometimes appropriate to rule out underlying causes.
A thorough consultation is the foundation of everything I do.
Comprehensive Diagnostic Methodology
In my practice, diagnosing PE goes well beyond simply asking about timing. I take a multi-dimensional approach to understand the full picture:
- Detailed history: This is the most important part of the consultation. I will ask about:
- Onset: When did the PE start? (Lifelong vs. acquired) [1, 6]
- Duration and frequency: How long does intercourse typically last before ejaculation (IELT)? Does it happen every time? [1, 6]
- Control: Do you feel you have any ability to delay ejaculation? [1, 6]
- Distress and impact: How much does it bother you? How does it affect your confidence, mood, and relationship? [1, 6, 20]
- Circumstances: Does it happen with all partners and situations, or only specific ones?
- Medical history: Any relevant conditions (thyroid, prostatitis, neurological issues, ED)? Medications? [4, 10]
- Psychological factors: Stress levels, anxiety, depression, relationship status and dynamics? [10, 20]
- Validated questionnaires: Standardised tools help to objectify symptoms and track progress:
- Premature Ejaculation Diagnostic Tool (PEDT): A simple 5-item questionnaire assessing control, frequency, distress, and interpersonal difficulty.
- Index of Premature Ejaculation (IPE): Measures ejaculatory control, satisfaction, and distress.
- Other tools such as the Premature Ejaculation Profile (PEP) may also be used.
- Objective timing (IELT): While subjective distress is the key measure, objectively recording the time from penetration to ejaculation over several encounters can be helpful — particularly for classifying PE type and monitoring treatment response [6]. I will discuss practical ways to do this if it seems appropriate.
- Physical examination: While often normal in men with PE, an examination (including the genitals and, where indicated, a prostate check) is sometimes performed to rule out physical abnormalities, signs of infection, or neurological issues.
- Targeted investigations (less common):
- Blood tests: May be ordered to check hormone levels (thyroid function, testosterone, prolactin) if acquired PE or other symptoms suggest an endocrine cause [4].
- Specialised testing: In rare or complex cases, neurophysiological tests (such as penile biothesiometry to assess sensitivity) may be considered, but these are not routine [3].
The goal of this assessment is not simply to confirm a diagnosis, but to understand the specific type, severity, contributing factors, and impact on your life. That understanding is what allows me to build a treatment plan that is genuinely personalised.
Effective Premature Ejaculation Treatment Options
PE can be treated very effectively — and I offer a full range of evidence-based options. I almost always combine approaches, because that tends to give the best results. Treatments include behavioural techniques, psychosexual therapy, topical anaesthetics (creams or sprays such as EMLA), and oral medications (including Priligy/dapoxetine, or off-label SSRIs). The right combination depends on your situation and preferences.
There is no single answer that works for everyone — but there is almost always an answer.
Managing PE effectively usually involves more than one approach. Relying on a single method may help, but combining strategies tends to produce better and more lasting results. Here is a closer look at the main evidence-based options:
The Foundation of Control
These techniques help you recognise the sensations that precede ejaculation and learn to delay it. They require practice and patience, but they offer a drug-free route to better control [8].
- Stop-start technique: Stimulation continues until just before the point of ejaculation, then stops completely until the urge subsides — repeated several times before finally ejaculating [8]. This builds awareness of pre-ejaculatory sensations.
- Squeeze technique: Similar to stop-start, but when the urge to ejaculate is felt, you or your partner firmly squeezes the head of the penis for several seconds until the urge passes [8].
- Pelvic floor exercises (Kegels): Strengthening the muscles involved in ejaculation can improve voluntary control [8]. This involves regularly contracting and relaxing the pubococcygeus and bulbospongiosus muscles.
- Mindful masturbation and edging: Practising masturbation slowly, focusing on sensation, and learning to stay near the point of no return without crossing it can help recalibrate the ejaculatory reflex.
Success rates of around 50–60% are reported with consistent practice over several weeks to months [8]. Results are often better when combined with other therapies.
Addressing Underlying Factors
When psychological factors — performance anxiety, stress, relationship difficulties, or past experiences — are contributing significantly to PE, psychosexual therapy can be invaluable [7, 10].
- Cognitive behavioural therapy (CBT): Helps identify and modify negative thought patterns and behaviours related to sex and performance anxiety [7].
- Mindfulness-based approaches: Teach techniques to stay present and manage anxiety during intimacy.
- Couples therapy: Addresses relationship dynamics, improves communication about sexual needs and concerns, and involves your partner in the treatment process [20].
- Sensate focus: Exercises designed to reduce performance pressure and shift attention towards sensual pleasure rather than intercourse or orgasm.
Psychosexual therapy is highly effective, particularly for acquired PE or when anxiety is a major factor [7]. It often produces more sustainable results than medication alone, especially when combined with other approaches.
Reducing Penile Sensitivity
These products contain local anaesthetics that temporarily reduce penile sensitivity, delaying ejaculation [9].
- Formulations:
- Lidocaine/prilocaine creams (e.g., EMLA): Applied 15–20 minutes before intercourse. Often requires washing off residue or using a condom to prevent partner numbness.
- Lidocaine sprays (e.g., Promescent, Fortacin): Applied 5–15 minutes beforehand, generally with less transfer risk. A metered dose allows for titration.
- Benzocaine wipes (e.g., Roman): Convenient single-use wipes applied before intercourse.
- Application: Correct application (usually to the frenulum and underside of the glans) and timing are important for effectiveness and for minimising numbness or partner transfer.
Topical treatments can increase IELT by two to six times [9]. They work well for many men, particularly as an on-demand option, and combine effectively with behavioural techniques.
Considerations: There is potential for reduced sensation for both partners if the product transfers, and application is required before sex.
Targeting Neurotransmitters
These medications work primarily by affecting serotonin levels in the brain, which helps regulate the ejaculatory reflex [3, 9, 12].
- Dapoxetine (Priligy): The only medication specifically licensed in the UK for on-demand treatment of PE [16, 17]. Taken 1–3 hours before anticipated sexual activity, it is a short-acting SSRI designed for rapid onset and clearance. It increases IELT by approximately three to four times [9, 16]. Side effects can include nausea, dizziness, and headache.
- Off-label daily SSRIs: Certain antidepressants (such as paroxetine, sertraline, and fluoxetine) taken daily can significantly delay ejaculation — often by five to ten times [9]. They require daily intake and take two to three weeks to reach full effect. Potential side effects include reduced libido, fatigue, and nausea. Their off-label use requires careful discussion and monitoring.
- PDE5 inhibitors (e.g., Viagra, Cialis): Primarily used for ED, but can sometimes help PE — particularly when ED is contributing or performance anxiety is high [10]. There is limited evidence for using them solely for PE without ED, but they are sometimes used in combination with PE-specific treatments [9].
- Tramadol: An atypical pain medication sometimes used off-label for PE due to its effects on serotonin and norepinephrine. It can be effective but carries a risk of dependence and side effects, and is generally reserved for specific cases [9].
- Medication for delayed ejaculation: While this page focuses on PE (ejaculating too quickly), some men have the opposite problem. Adrenergic agonists (such as midodrine, or off-label use of ephedrine in select cases) can sometimes help facilitate ejaculation when there is a neurological or medication-induced cause.
Oral medications are generally very effective, particularly SSRIs [9]. The choice between on-demand (dapoxetine) and daily SSRIs depends on frequency of sexual activity, personal preference, and side effect tolerance.
The Synergy of Multiple Strategies
For most men, combining treatments gives the best results [7, 9]. Examples include:
- Oral medication (e.g., dapoxetine or daily SSRI) combined with behavioural techniques
- Topical anaesthetic combined with behavioural techniques
- Medication combined with psychosexual therapy
- Any of the above combined with lifestyle modifications
Combining approaches addresses multiple aspects of PE simultaneously — medication helps biologically while therapy addresses psychological factors. This tends to produce greater improvement and more durable control.
My recommendation: I almost always advocate for a combination approach, tailored to your specific situation after a thorough assessment. This gives the highest likelihood of achieving significant, lasting improvement in ejaculatory control and overall sexual satisfaction.
Premature Ejaculation and Your Relationship
PE does not only affect you — it can have a real impact on intimacy and relationship satisfaction [20]. In my experience, open conversation with your partner is one of the most powerful things you can do. Talking through your feelings and treatment options together can strengthen your bond and lead to a more fulfilling sex life for both of you. Involving your partner in the process — with your consent — is often very helpful.
Addressing PE together can transform it from a source of shame into a shared challenge — and often brings couples closer.
The Relational Dimensions of Premature Ejaculation
PE does not exist in isolation — it lives within the context of intimate relationships [20]. Understanding how it affects both partners is key to managing it well.
Impact on the Partner:
Research into partner experiences reveals important insights [20]:
- Sexual satisfaction: Partners may experience reduced sexual satisfaction — not necessarily because of the short duration itself, but often because of the perceived lack of control, the abrupt ending, or the associated anxiety and tension.
- Emotional responses: Partners can feel a range of emotions — frustration, disappointment, confusion, concern for their partner, or even a mistaken sense of responsibility.
- Communication avoidance: Like the man experiencing PE, partners often find it difficult to raise the issue openly for fear of causing hurt or embarrassment.
Impact on the Relationship:
- Reduced intimacy: Couples may begin avoiding sexual encounters altogether to prevent distress or disappointment [1, 6].
- Communication breakdown: Lack of open discussion about sex can spill over into other areas of the relationship.
- Misunderstandings: Assumptions about lack of attraction or desire can arise if the issue is not discussed.
- Increased tension: Underlying sexual frustration can sometimes manifest as general relationship tension.
Strategies for Couples:
Addressing PE as a couple can be genuinely powerful. Here are some thoughts on how to approach that conversation — though I would always say that couples counselling or psychosexual therapy together is often the most valuable option.
- Open & Empathetic Communication:
- Choose a calm, private time outside the bedroom to talk.
- Use "I feel" statements (e.g., "I feel frustrated when..." rather than "You always...")
- Focus on PE as a shared challenge ("How can *we* manage this?") rather than blaming.
- Acknowledge and validate each other's feelings and experiences.
- Partner Involvement in Treatment:
- Learning about PE together can demystify the condition.
- Partners can assist with behavioural techniques (like the squeeze technique) [8].
- Attending psychosexual therapy sessions together can be highly beneficial [7].
- Expanding the Definition of Sex:
- Focus on overall intimacy and pleasure, not just intercourse duration.
- Explore other forms of sexual expression and extended foreplay.
- Ensure both partners' needs are being met throughout the sexual encounter.
- Using Treatments Together: Understanding how treatments like topical creams or on-demand pills work can help manage expectations and integrate them into your sexual routine.
Addressing PE together can transform it from a source of conflict into an opportunity for deeper connection. Many couples find their relationship strengthens through navigating this challenge side by side.
Can Lifestyle Changes Help Premature Ejaculation?
Lifestyle changes are not a cure for PE — I want to be honest about that. But certain habits can make a real difference. Managing stress, taking regular exercise, limiting alcohol, getting enough sleep, and eating well all support your sexual health. These changes may also help other treatments work better, by reducing anxiety and improving your overall baseline.
Lifestyle Medicine for Premature Ejaculation: Evidence-Based Approaches
Emerging research supports the role of lifestyle in managing PE. While core treatments focus on behavioural, psychological, or pharmacological approaches, optimising lifestyle factors can provide valuable support and potentially improve outcomes.
- Physical activity:
- Evidence: Regular moderate exercise (such as brisk walking, jogging, or swimming) is linked to better ejaculatory control in some studies. Pelvic floor exercises are a specific, targeted form of physical therapy with direct benefits [8].
- Mechanisms: Exercise can reduce anxiety, improve mood (through endorphins), enhance cardiovascular health (which indirectly supports sexual function), and potentially improve body awareness and control.
- Stress management:
- Evidence: Chronic stress and anxiety are strongly linked to PE, particularly acquired PE [10]. Techniques like mindfulness meditation, deep breathing exercises, yoga, or tai chi have shown benefits in reducing anxiety and improving sexual function in some individuals.
- Mechanisms: Reduces sympathetic nervous system overactivity ('fight or flight' response) which can trigger rapid ejaculation. Improves focus and present-moment awareness, counteracting performance anxiety.
- Alcohol and substances:
- Evidence: While small amounts of alcohol might seem to delay ejaculation initially, chronic or excessive use often worsens PE and can cause other sexual dysfunctions such as ED. Recreational drugs can also negatively affect sexual performance and control.
- Mechanisms: Alcohol disrupts neurotransmitter balance and nerve function.
- Sleep:
- Evidence: Poor sleep quality and duration are associated with increased stress, anxiety, and potential hormonal imbalances, all of which can negatively impact sexual function, including ejaculatory control.
- Mechanisms: Sleep deprivation affects mood regulation, cognitive function, and hormone production (like testosterone).
- Diet:
- Evidence: No specific diet cures PE, but a balanced, healthy diet (like the Mediterranean diet) supports overall cardiovascular and neurological health, which is foundational for good sexual function. Some preliminary research explores links between deficiencies in nutrients like zinc or magnesium and PE, but more evidence is needed. Keywords: `natural supplements to last longer in bed`.
- Mechanisms: Supports vascular health, neurotransmitter synthesis, and hormonal balance.
While lifestyle changes alone are unlikely to resolve significant lifelong or severe acquired PE, they are important complementary strategies. Addressing stress, improving fitness, limiting alcohol, and ensuring good sleep can create a better physiological and psychological baseline — potentially enhancing the effectiveness of specific treatments like medication or therapy. I always discuss relevant lifestyle factors as part of a holistic plan.
When Should You Seek Professional Help for PE?
Come and see me if PE is causing you significant distress, harming your relationship, or affecting your quality of life. Come too if PE is new — meaning it developed after a period of normal ejaculatory control — as that warrants investigation. If self-help strategies have not worked, or if you have other symptoms such as erectile dysfunction or pain, do not wait. Effective treatment is available.
Overcoming Barriers and Knowing When to Act
Many men delay seeking help — because of embarrassment, uncertainty about whether their experience is bad enough to warrant attention, or simply not knowing that effective treatments exist. Here is a guide to help you decide:
Consider seeking professional help if:
- Significant distress: PE consistently causes you frustration, anxiety, low self-esteem, or feelings of inadequacy [1, 6].
- Relationship impact: It is leading to tension, conflict, communication problems, or sexual avoidance in your relationship [20]. Your partner expressing dissatisfaction or concern is also a key indicator.
- Inability to control: You feel unable to delay ejaculation during nearly all sexual encounters [1, 6].
- Avoidance behaviour: You find yourself avoiding sexual intimacy because of fear of ejaculating too quickly.
- Acquired PE: You previously had normal ejaculatory control but have now developed persistent PE [4]. This warrants investigation for underlying causes.
- Self-help failure: You have tried behavioural techniques or other strategies without satisfactory improvement.
- Co-existing issues: You also experience erectile dysfunction, pain during sex, or other urinary or sexual symptoms.
- Quality of life reduction: PE is diminishing your enjoyment of sex or life overall.
Don’t Wait Until It’s Unbearable:
There is no need to reach a crisis point before seeking help. Earlier intervention often leads to quicker improvement and prevents the accumulation of psychological distress or relationship strain. Even if you are unsure, a consultation can provide clarity, reassurance, and information about your options.
Addressing Barriers:
- Embarrassment: PE is extremely common [14, 15]. I discuss these issues every day in a confidential, non-judgmental setting. My only goal is to help you.
- Uncertainty: A specialist assessment can determine whether you meet clinical criteria for PE and explore the nuances — for example, distinguishing PE from natural variable PE or subjective PE.
- Finding the right doctor: Look for a urologist or sexual health specialist with specific expertise in andrology or psychosexual medicine. Your GP can refer you, or you can seek private specialist care directly.
Red Flags Requiring Prompt Attention:
While most PE does not signal a dangerous underlying condition, seek prompt medical advice if PE occurs alongside any of the following:
- Pain during ejaculation
- Blood in semen (hematospermia)
- Sudden onset in middle-age/older age with no obvious trigger
- Other neurological symptoms (numbness, weakness, coordination issues)
- Severe depression or suicidal thoughts related to sexual function
Taking the step to seek professional help is an act of self-care — and of care for your relationship. Effective treatments are available, and you do not have to manage this alone.
Frequently Asked Questions about Premature Ejaculation
Answer: Usually not. In most cases, PE is not linked to serious underlying disease. However, acquired PE — developing after a period of normal function — can sometimes be associated with conditions such as thyroid problems, prostate inflammation (prostatitis), or, rarely, neurological issues [4]. That is why a proper medical assessment matters, especially if the PE is new.
Answer: It is unlikely, especially for lifelong PE [1]. While occasional fluctuations happen — what we call natural variable PE — persistent PE rarely resolves completely without treatment. Waiting often means prolonged distress. Effective treatments are available regardless of how long you have had PE.
Answer: There is no scientific evidence that frequency of masturbation or pornography use causes PE [Clinical Consensus]. However, very rapid masturbation habits might contribute to conditioning a fast response in some individuals. The focus should be on mindful sexual experiences rather than frequency.
Answer: Success rates are generally high but vary by treatment [7, 8, 9, 16]:
- Behavioural techniques: around 50–60% success alone [8].
- Topical anaesthetics: around 70–80% report good improvement [9].
- Oral SSRIs (such as dapoxetine/Priligy): around 60–80% report significant improvement [9, 16].
- Psychosexual therapy: around 50–70% alone, higher when combined [7].
- Combination approaches (often the best option): 80–90%+ success rates [7].
Success also depends on individual goals — a consultation helps define realistic expectations.
Answer: Absolutely. PE affects the timing of ejaculation, not your fertility or the quality of your sperm. Conception remains possible. If you are using topical creams, discuss application timing with me if you are actively trying to conceive.
Answer: It varies. On-demand medications such as dapoxetine (Priligy) are taken only before sex [16, 17]. Daily SSRIs might be used for several months, often combined with therapy, with the aim of potentially reducing or stopping medication later if behavioural control improves [9]. Some men choose long-term medication if it works well without side effects. I tailor the duration to your needs.
Answer: Viagra (sildenafil) and similar drugs (PDE5 inhibitors) are primarily for erectile dysfunction [10]. They do not directly treat the mechanism of PE. However, they can sometimes help indirectly — if a man also has ED, or if significant performance anxiety related to erections is a factor. By improving erection confidence, anxiety may decrease, which can in turn improve ejaculatory control. There is limited evidence for using them solely for PE without ED, but they are sometimes used in combination with PE-specific treatments [9].
Myth Busters: Common Misconceptions about PE
Fact: While psychological factors such as anxiety are important, PE has clear biological underpinnings — including neurotransmitter regulation (serotonin) and potentially penile sensitivity [3, 12]. Effective treatment often requires addressing both physical and psychological aspects.
Fact: PE is a common medical condition, not a reflection of masculinity or character. Seeking help demonstrates self-awareness and commitment to your well-being and your relationship. Effective solutions are available through professional care.
My Approach to Treating Premature Ejaculation
I have been a Consultant Urological Surgeon specialising in andrology and sexual medicine for over 15 years. In that time, I have come to understand just how much PE can affect a man’s confidence, his relationships, and his sense of self — and I do not take that lightly. Every man I see gets my full attention and a plan built around his specific situation, not a template.
My approach is built around:
- Your situation, goals, and preferences come first. We build your treatment plan together.
- I use treatments backed by strong scientific evidence and current clinical guidelines — including those from the ISSM, EAU, AUA, and BAUS.
- I look at the physical, psychological, and relationship aspects of PE together — because they rarely exist in isolation.
- Combining methods — medication, therapy, behavioural techniques — almost always gives better and more lasting results than any single approach alone.
- Nothing you tell me will surprise or embarrass me. I provide a genuinely safe, non-judgmental space.
- I welcome everyone seeking help — including members of the LGBT+ community.
- Treatment is a journey, not a one-off event. I follow up with you and adjust your plan as things progress.
At the end of the day, my priority is your health and well-being.
Personal Reflections: What I’ve Learned from Treating PE
Over my career, treating thousands of men with PE has shaped how I practise. Here is what I have learned:
- Early intervention matters: The longer PE goes unaddressed, the more entrenched the psychological distress and negative relationship patterns can become. Seeking help sooner makes a real difference.
- The numbers are not everything: While IELT is measurable, the subjective experience of control and the level of distress are often more important to a man’s quality of life. I measure success by improvements in these areas too, not just stopwatch time.
- One size fits none: What works brilliantly for one man may be less effective or unsuitable for another. True personalisation requires understanding the individual’s biology, psychology, lifestyle, relationship context, and treatment goals.
- Integrating psychosexual insight is crucial: Many cases have underlying psychological drivers or consequences. Collaborating with skilled psychosexual therapists — or incorporating psychosexual principles into my own consultations — is often key to achieving results that go beyond symptom management.
- Hope is realistic: Despite the frustration PE causes, the vast majority of men can achieve significant improvement with the right approach. Offering that evidence-based hope is an essential part of what I do.
- Breaking the silence is powerful: Simply providing a safe space to talk openly about PE is often the first — and arguably most important — step for men who have suffered in silence for years.
What to Expect During Your Consultation:
I want the consultation to feel as comfortable and productive as possible:
- Listening: We start with you sharing your story, concerns, and what you hope to achieve.
- Assessment: A thorough but focused discussion covering your sexual, medical, and psychosocial history. Examination if indicated.
- Education: A clear explanation of PE, the factors that may be contributing in your case, and the rationale behind different treatment options.
- Collaboration: We explore suitable treatments together, weighing pros and cons and ensuring the plan aligns with your priorities.
- Action plan: We agree on an initial treatment strategy — which might involve medication, referral for therapy, behavioural exercises, or a combination — and clear follow-up arrangements.
My goal is to give you the knowledge and tools to regain control, reduce distress, and enjoy a more confident and satisfying sexual life.
If you are ready to take control of PE, I would welcome the opportunity to help. I am a Consultant Urological Surgeon and Andrologist with over 15 years of specialist experience, and I offer expert care in a supportive, confidential environment.