Premature ejaculation, or PE, is the most common sexual concern in men. Studies suggest around one in three men experience it at some point. It is more common than ED but talked about even less, perhaps because there is no famous blue pill associated with it.
PE is genuinely treatable. Most men who seek help see substantial improvement.
What Counts As PE
The clinical definition has three parts:
- Ejaculation that consistently happens sooner than wanted, often within about a minute of penetration
- The inability to delay ejaculation on most occasions
- The distress or interpersonal difficulty that results
If only the first applies but it does not bother you or your partner, it does not need treating. The third criterion matters.
How PE Differs From ED
| Erectile Dysfunction | Premature Ejaculation | |
|---|---|---|
| Core issue | Getting or keeping an erection | Reaching orgasm too quickly |
| Mechanism | Vascular and nervous system | Mostly serotonin and conditioning |
| First line treatment | PDE5 inhibitors | Behavioural techniques, topical agents, SSRIs |
| Often comes with | Anxiety, low libido | Anxiety, sometimes ED |
Some men have both PE and ED at the same time. When that happens, ED is usually treated first, because anxiety from ED can drive PE. Once erections are reliable, PE often improves on its own.
Types Of PE
- Lifelong PE. Has been there since the first sexual experiences. Usually has a stronger biological component.
- Acquired PE. Developed after a period of normal function. Often linked to anxiety, relationship factors, or other sexual issues.
- Variable PE. Sometimes happens, sometimes does not. Often situational.
- Subjective PE. Falls within normal timing ranges but feels too quick to the man or partner.
Treatment Options
Behavioural techniques
The classic ones are the start stop method (stimulate to near climax, stop, repeat) and the squeeze technique (apply pressure at the base of the glans when close to climax). Sounds basic but the evidence supports them, particularly combined with other treatments.
Topical anaesthetics
Lidocaine sprays or creams applied to the head of the penis a few minutes before sex reduce sensation enough to delay ejaculation. Effective for many men. Some find the reduced sensation unwelcome. Easily available with a prescription.
Dapoxetine
A short acting SSRI specifically developed for on demand treatment of PE. Taken one to three hours before sex. Approved for PE specifically. Available in South Africa with a prescription.
Off label SSRIs
Other SSRIs like paroxetine, sertraline, and fluoxetine are sometimes prescribed off label for PE because of their well known side effect of delaying ejaculation. Taken daily rather than on demand. More common in men with persistent PE.
Combination treatment
Many men benefit from combining approaches. For example, behavioural techniques alongside dapoxetine, or a topical anaesthetic with brief counselling for anxiety.
Get An Assessment
An online consultation covers PE in the same way as ED. The clinical form sorts which treatment fits best.
Start ConsultationPsychological Approaches
Performance anxiety drives a lot of PE, particularly the acquired type. Brief sex therapy or CBT can be very effective, especially when combined with medication that breaks the cycle by ensuring the man can last long enough to reduce the anxiety.
What Does Not Work
- Pretending it is not a problem and hoping it resolves
- Heavy drinking. May seem to delay orgasm but worsens overall function.
- Unregulated 'delay sprays' bought online from overseas. Often contain undisclosed lidocaine in unknown concentrations, sometimes causing significant numbness in partners as well.
- Repeated masturbation before sex. Sometimes helps for one occasion but is not a real strategy.
Related Reading
Frequently Asked
No. ED is difficulty achieving or maintaining an erection. PE is reaching orgasm sooner than wanted. They are different conditions, although some men have both at the same time.
Clinically, ejaculating within about one minute of penetration is the typical threshold. But the definition also includes the inability to delay ejaculation, and the distress this causes. If it bothers you, it is worth treating.
Yes. Behavioural techniques, topical anaesthetic creams or sprays, and prescription medications like dapoxetine or off label SSRIs are all options. Most men respond well to one approach or a combination.
Yes. PE assessment and prescription is available through Online Doctor SA in the same way as ED treatment, through a short clinical form.