Premature Ejaculation: Causes, Symptoms and Treatments in the UK

Premature ejaculation (PE) is the most common male sexual dysfunction, affecting at least 1 in 3 men between 18 and 59. Despite its prevalence, it remains widely underreported — many men feel too embarrassed to seek help. But PE is a recognised medical condition with a range of effective, evidence-based treatments including prescription medication, topical agents, self-help techniques, and psychological therapy.

Understanding Premature Ejaculation: Definition and Types

Premature ejaculation is defined clinically as ejaculation that occurs consistently within approximately 1 minute of penetration (for lifelong PE) or a significant reduction in IELT (intravaginal ejaculation latency time) from a previously normal level (for acquired PE), accompanied by inability to control ejaculation and personal distress.

Causes of Premature Ejaculation

Biological Factors

• Serotonin dysregulation — low serotonin levels in the ejaculatory pathway reduce inhibitory control of the ejaculatory reflex
• Genetic factors — a family history of PE increases risk
• Prostate or urethral inflammation — prostatitis and urethritis can trigger or worsen PE
• Hormonal imbalances — abnormal testosterone or thyroid hormone levels
• Penile hypersensitivity — some men have heightened sensitivity of penile nerve endings

Psychological Factors

• Performance anxiety — the most common psychological trigger; anxiety about performance can accelerate ejaculation in a self-reinforcing cycle
• Depression and stress — reduce control over sexual responses
• Early sexual experiences — rushed early sexual encounters
• Low self-esteem and negative body image
• Relationship difficulties

Treatments for Premature Ejaculation

Priligy (Dapoxetine) — Prescription Oral Medication

Priligy (dapoxetine) is the only medication specifically licensed in the UK for the treatment of premature ejaculation. Unlike daily SSRI antidepressants, dapoxetine is a short-acting SSRI taken on demand — 1–3 hours before sexual activity. It increases serotonin’s inhibitory effect on the ejaculatory reflex, significantly extending time to ejaculation.

Available in 30mg and 60mg doses, Priligy is effective in the majority of men. Common side effects include nausea, dizziness, headache, and diarrhoea. It should not be taken with monoamine oxidase inhibitors (MAOIs), other SSRIs, or thioridazine.

EMLA Cream (Lidocaine/Prilocaine Topical Anaesthetic)

EMLA 5% cream (lidocaine 25mg + prilocaine 25mg per gram) is a topical local anaesthetic applied to the penis 20–30 minutes before sex. It reduces penile sensitivity, helping to delay ejaculation. Available by prescription through Access Doctor. A condom should be used to prevent anaesthetic transfer to the partner.

Self-Help Techniques

• Pelvic floor exercises (Kegels) — strengthening the ischiocavernosus and bulbocavernosus muscles improves voluntary control over ejaculation; these are the same muscles that contract during orgasm
• Pause-squeeze technique — during sexual activity, when ejaculation feels imminent, pause and firmly squeeze the glans (head of the penis) for several seconds; repeat as needed; with practice, this can train better ejaculatory control
• Thicker condoms / desensitising condoms — contain benzocaine or lidocaine in the tip; available OTC

Psychological Therapy

Cognitive behavioural therapy (CBT), sex therapy, and couples counselling are effective for PE with a significant psychological component — particularly performance anxiety. Psychological therapy is most effective when combined with medication or self-help techniques rather than used in isolation.