Premature Ejaculation

Advice: A common, difficult problem to treat.

Refer To: Men may benefit from psychosexual counselling.


This is a common problem, and does not have a urological cause. PE is difficult to define, but the WHO provide the following definition:

Inability to delay ejaculation sufficient to enjoy lovemaking, and/or ejaculation before or soon after the beginning of intercourse.

Prevalence in the population runs at 20-30%, and it can have major emotional and relationship effects. It may be acquired or lifelong.


Causation is unclear, but there may be the following associations:

  • Psychological problems (probably the majority)
  • Hormonal (hyperthyroidism, increased leptin). These associations have not been proven.


Care is required with potential treatments.

  • Psychosexual counselling, if indicated.
  • The following treatments may help, but are ‘off-label’ for premature ejaculation. Side effects are common. They are mentioned here purely for educational interest and treatment with these agents is not necessarily recommended.
    • Topical local anaesthetic preparations
    • SSRIs
    • PDE-5 inhibitors


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