Premature Ejaculation

Premature ejaculation is the most common male sexual disorder, and is when ejaculation happens too quickly before or during sex, usually within 1 minute.

Occasional episodes of PE are common and not usually a cause for concern, but if they happen more often than you’d like, you may need to access treatment or rule out possible underlying causes.

What causes premature ejaculation?

There is no single cause of premature ejaculation. Instead, it’s usually a combination of factors. It’s commonly caused by psychological issues, but physical causes are also possible.

Common physical causes are:

• prostate problems
• recreational drug use
• an overactive or underactive thyroid
• erectile dysfunction-related
• over-excitability of the glans, foreskin, or frenulum

Common psychological causes include:

• stress
• relationship issues
• depression
• anxiety about sexual performance
• a traumatic sexual experience
• a strict upbringing, including beliefs related to sex
• conditioning

The main treatments for premature ejaculation are:

• topical creams to numb the penis, reducing its sensitivity, and delaying ejaculation
• antidepressants, which can be taken to delay ejaculation

At Superdrug Online Doctor, we can prescribe EMLA cream or Priligy tablets.

EMLA cream

EMLA cream is a topical premature ejaculation treatment which is prescribed “off-licence”. It contains 2 anaesthetics as its active ingredients: 25mg of lidocaine and 25mg of prilocaine. Together, when applied to the penis, they work by numbing the area to reduce its sensitivity and delay ejaculation.

Some research suggests that it can help you last 6 times longer in bed and should be applied 20 minutes before you intend to have sex for the best results.

Priligy

Priligy is a branded antidepressant, specifically a selective serotonin reuptake inhibitor (SSRI) that is licensed to treat premature ejaculation. It contains the active ingredient dapoxetine and works by binding to the serotonin receptors in the brain to block the reuptake of serotonin and delay ejaculation.

The usual dose is one tablet 1 to 3 hours before you have sex, and research shows it can help 69% of people delay ejaculation by 1 minute and 44% last 2 minutes longer in bed.

Premature ejaculation treatments work by either delaying ejaculation through changing the brain chemistry or reducing the sensitivity of the penis. Several treatment options are available, depending on your individual needs and circumstances.

Some of the common treatments and how they work are:

1. SSRIs – SSRIs like Priligy work by blocking the reuptake of serotonin, a neurotransmitter that’s associated with ejaculation. By blocking its reuptake in the brain, SSRIs like Priligy can delay ejaculation, making you last longer in bed.
2. Topical anaesthetics – Topical anaesthetic agents like lidocaine and prilocaine found in EMLA cream reduce the sensitivity of the penis, delaying ejaculation.
3. Phosphodiesterase type-5 (PDE-5) inhibitors – PDE-5 inhibitors like Viagra are usually prescribed for erectile dysfunction, but they are sometimes prescribed off-label for PE. They can be effective if your PE is caused by ED, by reducing performance anxiety and increasing confidence, which can delay ejaculation.

Very common Priligy side effects are:

• dizziness
• headache
• feeling sick

Most Priligy side effects are mild and can be managed by:

• getting some rest until you feel better
• lying down until the dizziness passes, and avoiding driving or operating machinery
• drinking plenty of fluids to stay hydrated
• eating smaller, more frequent meals

Common EMLA cream side effects are:

• localised skin reactions
• mild burning, itching, or warmth at the application site

Most EMLA side effects are short-lasting, mild, and will go away on their own. If they do not or are severe, wash the cream off straight away.

All medications can cause side effects, although not everyone will get them. You can find a full list of potential side effects in the patient information leaflet that comes with your medication.

If you get any side effects that are concerning or difficult to manage, contact your doctor for more advice.

Premature ejaculation is usually diagnosed by a healthcare professional following an in-depth discussion about your medical and sexual history, which may include:

• how well you can control ejaculation
• how quickly you usually ejaculate
• stress or relationship issues
• underlying health conditions, medications, or recreational drug use

Some of the key symptoms of premature ejaculation are:

• regularly ejaculating within 1 minute of penetration or stimulation
• feeling like you have no control over when you ejaculate
• feelings of frustration, distress, or it negatively impacting your sex life or relationship

Can you test for premature ejaculation?

There is not a single diagnostic test available for premature ejaculation, but if your doctor suspects an underlying condition may be causing your PE, they may carry out further tests, including:

• blood tests to check your kidney and liver function, cholesterol levels, and to rule out conditions such as anaemia or diabetes
• urine tests to see if your pee contains sugar, which could indicate that you have diabetes
• hormone tests to measure testosterone, prolactin, follicle-stimulating hormone (FSH), luteinising hormone (LH), and thyroid hormone levels

As well as medication, there are other ways you can treat or manage premature ejaculation, including counselling, physical techniques, and lifestyle changes. By making small changes to your lifestyle or accessing counselling services for relationship issues, low confidence, or anxiety, you may be able to better control your sex life.

Counselling

Also known as psychosexual therapy, counselling can help you deal with sex-related issues. If you have a partner, counselling can also help both of you discuss these issues safely and openly. For example, they can encourage you to explore any potential relationship issues and help you resolve them, or they can show you techniques to help you slow down the time it takes to ejaculate.

Behavioural techniques

Behavioural techniques like the “stop-start” or “squeeze” techniques can be effective ways to delay ejaculation. Here are some of the most common and effective techniques:

• stop-start – this is where you stop and withdraw stimulation to the penis just before orgasm
• squeeze – this technique involves applying pressure to the penis by squeezing the head of the penis just before orgasm, to delay ejaculation. and can be repeated several times
• Kegel – this involves doing pelvic floor exercises to strengthen your ejaculatory muscles

Lifestyle changes

Making some simple lifestyle changes can help manage premature ejaculation. Some common examples include:

• reducing your caffeine and alcohol intake
• losing weight, if excess weight is reducing your confidence or causing health conditions that are affecting your symptoms
• eating a healthy, balanced diet
• exercising regularly
• managing stress and anxiety
• prioritising sleep
• quitting smoking
• talking to your partner about any anxieties, relationship issues, or concerns

Premature ejaculation treatment is not suitable for everyone. Some medical conditions and medications can interact with PE treatments, making them ineffective or potentially unsafe.

Do not take Priligy if you:

• are allergic to dapoxetine or any other ingredients in Priligy
• have heart problems
• have a history of fainting
• have ever had mania or severe depression
• have moderate or severe liver issues

You should also avoid Priligy if you are taking any of the following medications:

• monoamine oxidase inhibitors (MAOIs)
• thioridazine
• depression medications
• lithium
• linezolid
• tryptophan
• St John’s wort
• tramadol
• migraine medications

EMLA cream is not suitable if you are allergic to lidocaine, prilocaine, or other similar anaesthetics.

If you are not sure if a premature ejaculation treatment is suitable for you, you should speak to your doctor or pharmacist for advice.

Can you cure premature ejaculation?

Premature ejaculation cannot always be cured, but it can be treated. Lifelong PE is not usually curable, whereas acquired PE, which often occurs later in life, may be cured by addressing the underlying cause, such as stress, lifestyle, or relationship issues.

How long should I last in bed?

Most men last between 5 and 7 minutes in bed. That is the time to reach orgasm and ejaculate. However, this can vary from individual to individual. If you are regularly ejaculating in less than 1 minute, this could indicate premature ejaculation.

Does Viagra help with premature ejaculation?

Viagra is not licensed for premature ejaculation, but some research suggests that PDE-5 inhibitors can improve confidence, sexual satisfaction, and ejaculatory control.

Does masturbation cause premature ejaculation?

No, masturbation does not cause premature ejaculation. Controlled masturbation techniques can help you manage premature ejaculation. PE is usually caused by underlying factors, like stress, anxiety, or depression.

Do Kegel exercises work for premature ejaculation?

Yes, Kegel exercises can help manage premature ejaculation. Research shows that 82.5% of people who completed a 12-week pelvic floor exercise program increased their time to ejaculation from less than 60 seconds to 146 seconds.

Can an STI cause premature ejaculation?

Yes, some STIs can cause premature ejaculation, especially those that cause chronic prostatitis, like chlamydia. If you think you may be affected, you can order an at-home chlamydia test.

Does exercise help with premature ejaculation?

Yes, lifestyle changes like increasing exercise can help you effectively manage premature ejaculation. One study found that yoga, running, and high-intensity interval training (HIIT) could effectively manage premature ejaculation similarly to medication.