What is premature ejaculation?

It is when a man ejaculates (comes) too quickly during sexual intercourse. It’s a common problem. Generally, from studies, it is found that the average time for ejaculation was about 5-and-a-half minutes after starting sex. This time could be longer for men who have sex with men.

The generally accepted definition of premature ejaculation is anyone regularly ejaculating within 1 minute of entering their partner. It is also up to you and your partner to decide if you’re happy with the time it takes you to ejaculate. If ejaculation times are causing you persistent distress then it’s a problem that can be helped with treatment.

There are 2 types:

• primary premature ejaculation – where you have always had the problem
• secondary premature ejaculation (or “acquired premature ejaculation”) – where you recently developed the problem

The causes of primary premature ejaculation are often psychological, such as having a traumatic sexual experience at an early age. 

Secondary premature ejaculation can be caused by both psychological and physical factors. Physical causes can include drinking too much alcohol and issues with the prostate gland. 

Treatment

If your premature ejaculation is caused by a physical condition, treating the underlying condition should help. Doctors can talk through and investigate the problem and then try any underlying problems. 

When the cause is psychological, it can be more challenging to treat. But most men who persevere with treatment find the problem resolves.

Self-help

There are lots of things you can try without the need for medication and these include:

• masturbating 1 to 2 hours before having sex
• using a thick condom to help decrease sensation
• taking a deep breath to briefly shut down the ejaculatory reflex (an automatic reflex of the body, during which you ejaculate)
• having sex with your partner on top (to allow them to pull away when you’re close to ejaculating)
• taking breaks during sex and distracting yourself by thinking about something completely different

If you’re in a long-term relationship, you may benefit from having couples therapy.

Medicine

There are a group of medicines called Selective serotonin reuptake inhibitors (SSRIs) that can be used if self-help techniques do not improve the problem. These are mediSSRIs are mainly used to treat depression, but one of their side effects is delaying ejaculation.

Dapoxetine is an SSRI specifically designed to treat premature ejaculation. It can be used “on-demand”. You’ll usually be advised to take it between 1 and 3 hours before sex, but not more than once a day.

If dapoxetine does not work, your GP may recommend trying another SSRI on an “off-label” basis. This is when a medicine is used for a different purpose than it was licensed for. Doctors can prescribe an off-label medicine if they decide it’s in the patient’s best interest.

Other SSRIs that may be prescribed for premature ejaculation include paroxetine, sertraline, or fluoxetine. You’ll usually need to take these types of SSRIs for 1 or 2 weeks before gaining the full effects.

Anaesthetic creams and sprays such as lidocaine or prilocaine cream can help by making your penis less sensitive. Using an anesthetic cream with a condom can be particularly effective. A GP should be able to recommend a suitable cream.

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