Premature ejaculation (PE) is the most common male sexual dysfunction, affecting an estimated 20–30% of men at some point in their lives. Despite its prevalence, it remains a largely undertreated condition — most affected men either attempt to self-manage or accept it as an immutable part of their sexual experience.
It is neither. Premature ejaculation is a medical condition with identifiable causes and effective treatments. Understanding what type of PE you have is the first step toward finding a solution that works long-term.
Lifelong vs Acquired PE
Lifelong (primary) PE has been present since a man's first sexual experience. It is more likely to have neurobiological underpinnings — a lower serotonin receptor sensitivity threshold affecting ejaculatory reflex control — and tends to respond well to pharmacological treatment.
Acquired (secondary) PE develops after a period of normal ejaculatory function. This type more commonly has an identifiable trigger: new onset erectile dysfunction (the most common cause), prostatitis, thyroid dysfunction, or significant life stress. Treating the underlying cause is the most effective long-term approach.
The Role of Erectile Dysfunction in PE
One of the most important — and frequently missed — associations in sexual medicine is between ED and acquired PE. A man experiencing difficulty maintaining an erection unconsciously accelerates toward ejaculation before losing the erection entirely. The result is premature ejaculation that is in fact a consequence of underlying ED.
In these men, treating the PE without addressing the ED produces no sustained improvement. We always assess for co-existing ED in men presenting with PE.
Medical Causes of PE
Beyond the ED-PE overlap, other medical conditions that can cause or contribute to acquired PE include:
- Chronic prostatitis or pelvic floor dysfunction
- Hyperthyroidism (often overlooked)
- Hypersensitivity of the glans penis
- Serotonergic medications affecting sexual function
- Neurological conditions affecting ejaculatory control
Treatment Options
Pharmacological treatment — dapoxetine (the only licensed on-demand treatment for PE in the UK) is a short-acting SSRI taken one to three hours before intercourse. Daily low-dose SSRIs (such as paroxetine or sertraline) are used off-label and are effective for lifelong PE. Topical anaesthetics (lidocaine/prilocaine sprays or creams) reduce penile sensitivity and delay ejaculation without systemic effects.
Behavioural techniques — the stop-start method and squeeze technique have a long evidence base. They are most effective when practised consistently with a cooperative partner and often delivered within a structured sex therapy framework.
Pelvic floor physiotherapy — emerging evidence supports pelvic floor rehabilitation as an effective treatment for both lifelong and acquired PE, and for men with co-existing chronic pelvic pain.
Glans augmentation — for men with hypersensitivity of the glans contributing to lifelong PE, hyaluronic acid injection into the glans penis to reduce sensitivity is a procedure offered at specialist centres. Evidence is limited but growing.
Treating co-existing conditions — where PE is secondary to ED, prostatitis, or thyroid dysfunction, treating the primary condition takes priority.
Our Approach
At London Andrology, we take a full sexual health history and investigate for co-existing conditions before recommending any treatment. The approach is individual: what works for lifelong PE driven by neurobiological factors differs significantly from what works for PE caused by anxiety, ED, or prostatitis.
