When You Have Both
They occur together far more often than either is discussed alone — and which came first usually decides what should be treated first.
Part of the Complete Premature Ejaculation Guide.
Key fact: Premature ejaculation and erectile dysfunction occur together far more often than either is discussed alone — and the order matters. Treating them the wrong way round makes both worse. Where an erection problem came first, treating that alone frequently resolves the ejaculation problem entirely.
How often they occur together
These two conditions are usually written about as though they were separate problems affecting separate men. In practice a substantial proportion of men who seek help for one turn out to have both, and the combination is under-recognised largely because most men describe only the symptom that bothers them more.
That matters because the two interact. Each can cause the other, the treatments differ, and the sequence in which they are addressed changes whether treatment works.
Which came first
This is the single most useful question, and almost nobody is asked it. The answer usually determines the whole approach.
| Pattern | What it usually means |
|---|---|
| Erection problems came first, ejaculation became quicker afterwards | The rushing is a consequence. Treating the erection problem often resolves both |
| Quick ejaculation came first, erection problems developed later | Anxiety and avoidance have built up around sex. Both usually need addressing |
| Both have always been there | More likely to need assessment rather than self-management |
| Both started recently and together | Worth looking for a cause behind both — a new medicine, a health change, a relationship change, alcohol or drug use |
Men frequently cannot answer this immediately, and thinking back over the last couple of years before an appointment is time well spent.
When the erection problem is driving it
This is the sequence people find most surprising, and it is common.
A man who is worried about losing an erection does two things without deciding to. He hurries — because finishing while the erection lasts feels safer than risking losing it. And he increases stimulation, often with harder, faster movement, to maintain rigidity. Both shorten the time to ejaculation considerably.
The practical consequence: what looks like premature ejaculation is a rational response to an erection that cannot be relied on. Treat the erection problem and the hurry has no reason to exist. This is why men in this situation who are given a PE treatment alone often report that it did not help much — it was aimed at the wrong problem.
There is a second mechanism worth knowing. As an erection becomes less firm, the sensation required to reach ejaculation can be reached at a point where the erection is already partly lost, which makes the whole encounter feel like a failure of control when it is a failure of rigidity.
Our guide to erectile dysfunction covers the causes and what the assessment involves.
When it runs the other way
The reverse sequence is slower and more psychological. Repeated experiences of finishing sooner than wanted produce anticipatory anxiety, and anxiety is a potent cause of erection difficulty — the sympathetic nervous system that drives a stress response actively opposes the parasympathetic activity an erection depends on.
- Anticipatory monitoring — watching yourself, assessing how close you are, mentally stepping outside the encounter. This is deeply unhelpful for both problems at once.
- Avoidance — initiating less often, which increases pressure on the occasions that do happen.
- Rushed, tense encounters that leave neither partner relaxed.
Where anxiety is the connecting thread, addressing it does more than either medicine alone — covered in premature ejaculation and anxiety.
Working out your own pattern
Three questions separate most cases, and they are worth answering honestly before any appointment.
| Question | What the answer suggests |
|---|---|
| Do you get firm erections on waking, or alone? | Yes points to a psychological or situational driver rather than a physical erection problem. No, consistently, points at a physical cause and warrants assessment |
| Are you hurrying because you are worried about losing the erection? | If yes, the erection is the primary problem however it feels |
| Is it every time, or only in some situations? | Situational — a new partner, particular circumstances — points strongly at anxiety rather than physiology |
Erectile dysfunction can be the first sign of a cardiovascular problem, because the arteries involved are small and show narrowing earlier than larger ones. New erection difficulty in a man over about 40, particularly alongside high blood pressure, diabetes, raised cholesterol or smoking, deserves proper assessment rather than a prescription alone. That is true whether or not there is also an ejaculation problem.
Treating both
The general principle in UK practice is to address the erection problem first where both are present, because it is often the driver and because treating the ejaculation problem while erections remain unreliable rarely satisfies anyone.
- If the erection problem resolves, reassess the ejaculation timing before adding anything for it. A meaningful proportion of men find it has normalised.
- If both persist, they can be treated together, and combining a PDE5 inhibitor with a PE treatment — either an on-demand tablet such as dapoxetine or a topical anaesthetic such as Emla cream — is an established approach.
- Anxiety running through both is treated on its own terms — behavioural work and, where appropriate, psychosexual therapy, which is more effective than either medicine at addressing the cause.
- Do not self-combine treatments bought from different places. Interactions matter here, and a prescriber needs to see the whole picture.
What is available, and how assessment works, is set out on our erectile dysfunction and premature ejaculation treatment pages, and the topical option is covered in detail in our guide to Emla cream for premature ejaculation.
What to say when you seek help
Consultations for this are short, and men routinely describe only half the problem. Four sentences cover almost everything a clinician needs:
- Which came first, and roughly when.
- Whether you get erections on waking or alone.
- Whether it happens every time or only in certain situations.
- What you are already taking — including anything bought online, and any antidepressant, blood pressure medicine or recreational drug.
Volunteering the second one is the most useful thing you can do, because it separates a physical erection problem from an anxiety-driven one faster than any test.
Frequently Asked Questions
Can erectile dysfunction cause premature ejaculation?
Yes, and it is a common and under-recognised sequence. A man worried about losing his erection tends to hurry, and to use more intense stimulation to maintain rigidity — both of which shorten the time to ejaculation. What presents as premature ejaculation is then a rational response to an unreliable erection. Where this is the pattern, treating the erection problem often resolves the ejaculation problem without anything being aimed at it directly.
Which should be treated first if I have both?
Usually the erection problem. It is frequently the driver of the other, and treating quick ejaculation while erections remain unreliable rarely produces a satisfactory result. If the erection problem resolves, it is worth reassessing the ejaculation timing before adding anything further — a meaningful proportion of men find it has normalised on its own. Where both persist, they can be treated together under a prescriber who sees the whole picture.
How do I know whether my problem is physical or psychological?
The most useful single question is whether you get firm erections on waking or when alone. If you do, the machinery works and the difficulty is more likely to be situational or anxiety-related. If you consistently do not, that points towards a physical cause and warrants proper assessment. Problems that occur only in certain situations — with a new partner, for example — also point strongly towards anxiety rather than physiology.
Why do both problems seem worse with a new partner?
Because anticipatory anxiety is at its highest then, and anxiety works against both at once. The stress response actively opposes the physiological state an erection depends on, while heightened arousal and self-monitoring shorten time to ejaculation. Difficulty that appears with a new partner and not in established circumstances is one of the clearest indicators that anxiety rather than physiology is the main driver.
Should I mention both problems to a clinician, or just the worse one?
Both, and say which came first. Men routinely describe only the symptom that bothers them more, and the sequence is often what determines the right approach. It is also worth saying whether you get erections on waking or alone, whether the problem happens every time or only in certain situations, and listing everything you are taking — including anything bought online.
References
- National Institute for Health and Care Excellence. Clinical Knowledge Summary: Ejaculatory dysfunction. cks.nice.org.uk
- NHS. Ejaculation problems. nhs.uk
- European Association of Urology. Guidelines on Sexual and Reproductive Health. uroweb.org
- International Society for Sexual Medicine. Definition and guidelines for premature ejaculation. issm.info
- Joint Formulary Committee. British National Formulary: dapoxetine and selective serotonin reuptake inhibitors. bnf.nice.org.uk
- British Association of Urological Surgeons. Patient information. baus.org.uk
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Dapoxetine is the only oral medicine licensed in the UK specifically for premature ejaculation (the lidocaine/prilocaine spray Fortacin is licensed as a topical treatment); other antidepressants used for it are prescribed off-licence and require assessment by a clinician who knows your history. Never start, stop or change a prescribed antidepressant on your own. Always consult a qualified healthcare professional for diagnosis and treatment.