Premature Ejaculation

at Cadogan Clinic, London’s Leading Cosmetic Surgery Specialists. 

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Medically Reviewed April 2023, by Mr. Bryan Mayou (GMC: 1414396) - founder of the Cadogan Clinic and one of the world's leading plastic surgeons

What is Premature Ejaculation?

Premature ejaculation is a common sexual problem in men where sexual climax occurs ‘too early’. This means the man is unable to delay his ejaculation until a point that is mutually desirable for both partners. There are two different types of premature ejaculation

Primary: The term primary premature ejaculation is used if you have always had difficulty controlling your orgasms. The causes of primary premature ejaculation are often pyschological and may stem from a traumatic early sexual experience. Primary premature ejaculation is sometimes referred to as lifelong premature ejaculation.

Secondary: This type of premature ejaculation, sometimes referred to as acquired premature ejaculation, develops later on, where there was no problem previously. Psychological factors, such as ‘performance anxiety’, perhaps with a new partner, or physical factors, such as drinking too much alcohol, may be to blame for secondary premature ejaculation.

According to the NHS, guidelines define premature ejaculation as regularly ejaculating within one minute of entering your partner.

However, when diagnosing premature ejaculation, it’s important to remember that the length of time you can last before ejaculating is not the issue. The issue is whether you are satisfied with the length of time taken for sexual intercourse.

Luckily there are a number of different treatments which can successfully treat the problem of premature ejaculation.

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What are the causes and symptoms of Premature Ejaculation?

The main symptom of premature ejaculation is the inability to delay your climax during sex or masturbation. This can lead to difficult feelings, such as anxiety, depression, stress and guilt, which can sometimes make premature ejaculation worse. The condition can have a negative impact on your relationship.

There are a number of different things which may be causing your premature ejaculation. You may be experiencing one or more of these.

  • Early sexual experiences: Men who had early sexual experiences that required sexual activity to be over quickly find that behaviour still persists. However it is possible for them to learn to control their orgasm with no lasting ill effect.
  • Performance anxiety: Worrying about premature ejaculation can in fact cause you to climax too soon. Men who experience this often find themselves trapped in a vicious circle of performance anxiety and premature ejaculation. This is frequently seen in sexual relationships involving a new partner.
  • Sexual abuse or trauma: Sexual abuse or past sexual trauma can have a major impact on a man’s ability to have a positive sexual experience. Issues may include premature ejaculation.
  • Feelings of guilt: If you are harbouring feelings of guilt or shame, this may cause you to rush through sex and feel unable to delay your ejaculation. Guilty feelings surrounding sex may stem from growing up in a strictly religious household, for example.
  • Age: Younger men tend to ejaculate more quickly than older men, leading experts to believe that sexual experience is associated with ejaculatory control.
  • Erectile dysfunction: If you are anxious about getting and maintaining an erection in the first place, this may cause premature ejaculation.
  • Missing internal cues: Men who suffer with premature ejaculation often struggle to identify the point where ejaculation cannot be stopped, so corrective action can’t be taken in time. The ability to identify this point often comes with experience, therefore age can once again play a part.

Other possible causes of premature ejaculation include swelling of the prostate, irregular hormone levels, thyroid problems and irregular levels of chemicals in the brain.

However sometimes the root cause of premature ejactulation is not known.

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When should I seek professional help?

If you are regularly experiencing episodes of premature ejaculation and these are having a negative impact on your mental health, then this would be a good time to seek professional help.

If premature ejaculation is causing problems between you and your partner, including affecting the ability of both of you to enjoy sex, then you should see a doctor.

There is no shame in asking for help. Premature ejaculation is a common problem, but luckily there are a number of treatment options available.

What treatment options are available for Premature Ejaculation?

There are a number of different options for premature ejaculation treatment. The effectiveness of these vary from person to person, so what may work for you may not work for someone else. Sometimes a combination of treatments for premature ejaculation may be required.

There are several behavioural techniques that can prove highly effective at treating premature ejaculation. These require practice and patience, so you will need to stick with them in order to enjoy the full benefit.

A common technique is the Masters and Johnson method. This involves practising a non-penetrative sex act with your partner, allowing yourself to be stimulated until just before ejaculation would normally occur. At that point you should stop, allow yourself to lose your erection, relax, and then repeat the process. Each time you should bring yourself close to orgasm until you can’t control it any longer. This method helps you to learn where your point of climax is. After a few days, you can try this technique while having penatrative sex.

The squeeze technique is a variation of the Masters and Johnson method. The main difference is your partner will squeeze the tip or base of the penis just before climax, forcing some of the blood out of the penis, therefore reducing the erection. This can be used in conjunction with the Masters and Johnson method.

Antidepressants are often used as treatment for premature ejaculation. The most commonly prescribed drugs are sertraline, fluoxetine and paroxetine. You may notice an improvement straight away but it can take up to two weeks for the full effects to be felt.

Dapoxetine is a drug that is specifically used as treatment for premature ejaculation. It is taken on demand, usually between one and three hours before sex, but only once a day. Dapoxetine is not recommended for some men with heart, liver and kidney problems, plus it may interact with other medicines.

Desensitising creams, to be applied to the penis, can help, but these can decrease sexual pleasure.

You may benefit from couples counselling. This may be particularly helpful when used alongside behavioural techniques. Counselling is a great way of addressing the psychological issues which may be behind the premature ejaculation, for example, feelings of guilt surrounding sex.

Who is suitable for treatment?

Cadogan Clinic considers individuals fit for treatment for premature ejaculation if all of the following are true of them:

  • Physically and psychologically fit and healthy
  • Are experiencing frequent episodes of premature ejaculation
  • Have realistic expectations of what can be achieved by treatment

You may also be experiencing one, some or all of the following:

  • Relationship problems caused by premature ejaculation
  • Anxiety, depression, stress or emotional distress caused by premature ejaculation
  • Low self-esteem and a lack of confidence

The Patient Journey. A breakdown of what you can expect on your journey with us

We are deeply invested in ensuring that every step of your surgical journey with us is as informative and reassuring to you as it can be. This article outlines what you can expect at each stage of the journey

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Frequently Asked Questions

Ejaculation is the act of expelling semen (called the ejaculate) from the body. It occurs after the penis has been stimulated by sexual activity or masterbation and is the result of the male orgasm. Ejaculation itself typically occurs after five to seven minutes of stimulation and lasts for several seconds.

Semen contains sperm which is of course a vital component in reproduction. However sperm is not always present in semen and this may be due to the fact the man has had a vasectomy or down to a medical condition, such as azoospermia.  

The good news is that yes, it is possible to permanently cure premature ejaculation. However if you have primary premature ejaculation, the condition may be permanent, although it can still be successfully treated. But by seeing the appropriate healthcare professionals, such as urologist and counsellor or psychologist if required, it is highly likely that you will be able to gain control over your orgasms and improve your sexual enjoyment.

Erectile dysfunction, often known by its initials ED, is a condition which makes it difficult for a man to get and maintain an erection. Sometimes this fear of losing the erection may make him rush sex, which can lead to him climaxing too soon. This can be the start of premature ejaculation.

If you believe that you may be suffering from erectile dysfunction you should seek medical advice. Sometimes ED can be a sign of another underlying health condition, such as diabetes.


You can try behavioural techniques, such as the Masters and Johnson method or the squeeze technique to help you learn how to delay your orgasms.

Other things you may wish to try at home include masturbating a couple of hours before having sex, using a thick condom in order to decrease sensation and trying to think of something boring at the appropriate time in a bid to stave off climax.

It may also be a good idea to consider trying sexual positions with your partner on top. This allows them to pull away from you when you are close to ejaculating, which works in a similar way to the Masters and Johnson method.

There are three common ejaculation problems:

  • Premature: This occurs when the man ejaculates too quickly during sexual intercourse.
  • Delayed: Men suffering with delayed ejaculation may find they experience a repeated and prolonged delay before ejaculating during sex. This can be anywhere between 30 and 60 minutes. Alternatively, they may find themselves unable to ejaculate at all.
  • Retrograde: This is a much rarer condition which sees semen travel backwards into the bladder at the point of ejaculation rather than through the urethra and out of the penis. This condition has no adverse impact on a man’s health, but it may cause fertility problems.

Sildenafil (sold as Viagra) can be bought from a pharmacy without a prescription and is used to treat erectile dysfunction (problems getting and maintaining an erection).

Although the drug is not marketed as a treatment for premature ejeculation, by tackling the problem of erectile dysfunction, it may help this associated condition.

However if your premature ejaculation is caused by a different issue, you should speak to your doctor about an alternative treatment.

Alcohol and recreational drugs, such as cocaine, may be responsible for secondary premature ejaculation. They can also be responsible for erectile dysfunction.

If you are having problems with premature ejaculation, you should avoid exceeding the recommended daily limit of two to three units of alcohol and steer clear of any illegal substances. If this does not help, you should seek further medical advice.

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