Premature Ejaculation Treatment London: Causes, Options and What to Expect

Premature ejaculation is the most common male sexual dysfunction by prevalence — affecting approximately 1 in 3 men at some point in their lives — yet it remains one of the least discussed conditions in men's healthcare. Most men who experience it say nothing to their GP, manage it alone, and assume either that nothing can be done or that seeking help would be embarrassing.

Neither assumption is correct. Premature ejaculation has recognised causes, a well-established evidence base for treatment, and responds well to appropriate clinical management. The barrier is not a lack of effective treatment — it is a lack of clinical attention given to a condition that profoundly affects quality of life, confidence, and relationships.

At Shockwave ReVibe Clinic, I see men with premature ejaculation regularly — often after years of managing the condition without seeking help. This guide explains what PE is, why it happens, what the evidence-based treatment options are, and what to expect from a specialist consultation in London. See also our Premature Ejaculation service page.

What Is Premature Ejaculation?

The International Society for Sexual Medicine (ISSM) defines premature ejaculation as ejaculation that consistently occurs within approximately one minute of penetration (lifelong PE) or a significant reduction in latency time to approximately three minutes or less (acquired PE), causing personal distress. (Althof SE et al., Journal of Sexual Medicine, 2014)

The key elements of this definition are worth unpacking:

• Consistency — occasional early ejaculation, particularly during periods of stress or with a new partner, is not PE. The condition is defined by its persistent, recurrent nature.
• Personal distress — the defining clinical criterion is not a specific time threshold but the distress the condition causes. A man who ejaculates in two minutes and is not distressed by this does not have PE as a clinical condition requiring treatment. A man who ejaculates in four minutes and is significantly distressed does.
• Two types — lifelong (primary) PE is present from first sexual experience; acquired (secondary) PE develops after a period of normal ejaculatory function. The distinction matters clinically — the causes and optimal management differ.

How Common Is Premature Ejaculation?

PE is the most prevalent male sexual dysfunction — more common than erectile dysfunction. Prevalence estimates consistently range from 20-30% of adult men across age groups. (Serefoglu EC et al., Journal of Sexual Medicine, 2011)

Unlike ED, which becomes more prevalent with age, PE affects men across all age groups without a clear age-related increase. This is one of the reasons it is so frequently underestimated — the assumption that sexual dysfunction is an older man's problem leads many younger men to dismiss their symptoms rather than seek help.

What Causes Premature Ejaculation?

PE has both biological and psychological contributing factors — and in most men, both are present to some degree.

Biological Causes

• Serotonin signalling — the most well-established biological basis for lifelong PE is reduced central serotonergic activity. Serotonin (5-HT) plays an inhibitory role in ejaculatory control — higher serotonin activity in specific neural pathways delays ejaculation. Men with lifelong PE appear to have reduced serotonin receptor sensitivity in these pathways, producing a lower ejaculatory threshold. This is the mechanism targeted by SSRIs and dapoxetine in pharmacological treatment. (Waldinger MD, European Urology, 2007)
• Penile hypersensitivity — some men with PE have demonstrably increased sensitivity of the glans penis, a lower threshold for the afferent sensory signals that trigger the ejaculatory reflex. This is a peripheral rather than central mechanism and may contribute to acquired PE in some cases.
• Hormonal factors — elevated prolactin, thyroid dysfunction, and low testosterone have all been associated with acquired PE in some studies. Hormonal assessment is therefore part of a comprehensive PE evaluation — particularly where PE has developed after a period of normal function. See our Low Libido & Sexual Wellness service.
• Erectile dysfunction — acquired PE frequently co-exists with ED, with men subconsciously rushing to ejaculate before losing their erection. In these cases, the PE is secondary to the ED, and treating the ED effectively often resolves the PE without specific PE treatment.
• Prostatitis/CPPS — chronic pelvic pain syndrome and prostatitis are associated with acquired PE in a significant proportion of affected men. The inflammation and pelvic floor dysfunction of CPPS can lower the ejaculatory threshold. Treating the CPPS frequently improves associated PE.

Psychological Causes

• Performance anxiety — the anticipation of early ejaculation, particularly after it has happened once or twice, creates a self-perpetuating anxiety cycle. Anxiety increases sympathetic nervous system arousal, which accelerates ejaculation, which increases anxiety at the next encounter. See our Sexual Performance Anxiety service.
• Relationship factors — relationship tension, poor sexual communication, and unrealistic expectations about sexual performance all contribute to the psychological drivers of PE.
• Early sexual experiences — some men with lifelong PE associate their condition with early sexual experiences characterised by rushed or anxiety-laden encounters, a conditioned response that persists into adult sexual life.

Treatment Options for Premature Ejaculation in London

Pharmacological Treatment

Dapoxetine (Priligy). The only medication licensed specifically for PE in the UK. Dapoxetine is a short-acting SSRI designed to be taken 1-3 hours before sexual activity. It increases serotonergic activity in the ejaculatory control pathways, delaying ejaculation. Clinical trials demonstrate a 2-3 fold increase in intravaginal ejaculatory latency time (IELT) with dapoxetine compared to placebo. (Buvat J et al., European Urology, 2009) Available on private prescription following medical assessment. Dr Bahl can prescribe dapoxetine where clinically appropriate following a consultation.

Daily low-dose SSRIs. Paroxetine, sertraline, and clomipramine have well-established evidence for PE when taken daily. Paroxetine has the strongest evidence base, producing the greatest delay in ejaculation latency among the SSRIs studied. (Waldinger MD et al., Journal of Urology, 1998) These are prescribed off-label for PE and require medical assessment and monitoring.

Topical anaesthetics. Lidocaine/prilocaine sprays or creams (e.g. EMLA, Fortacin spray) reduce penile sensitivity, delaying ejaculation. Fortacin (lidocaine/prilocaine spray) is licensed for PE in the UK and has good evidence for efficacy and tolerability. (Dinsmore WW et al., BJU International, 2012) Available on private prescription.

Behavioural Techniques

Squeeze technique and start-stop method. Structured behavioural techniques designed to increase ejaculatory control through practised recognition of the point of ejaculatory inevitability and deliberate interruption. Effective in motivated men — but require consistent practice and partner involvement.

Treatment of Underlying Conditions

This is why a comprehensive specialist assessment matters — identifying whether the PE is primary (lifelong, likely serotonergic) or secondary (acquired, possibly related to ED or CPPS) determines the most appropriate treatment pathway.

Combination Approach

The evidence consistently shows that combination treatment — pharmacological management alongside behavioural techniques and where relevant treatment of underlying conditions — produces better and more durable outcomes than any single approach alone. (Jern P, Journal of Sexual Medicine, 2014)

Treatment Options at a Glance

What a PE Consultation at Shockwave ReVibe Clinic Involves

• Comprehensive history — Dr Bahl takes a thorough history covering onset (lifelong vs acquired), severity (IELT estimate), impact on quality of life and relationships, presence of associated ED or CPPS, current medications, relevant medical history, and psychosexual context
• Validated scoring — the Premature Ejaculation Diagnostic Tool (PEDT) and the Index of Premature Ejaculation (IPE) are used to assess severity and impact, providing an objective baseline for tracking treatment response
• Blood tests where indicated — where hormonal causes are suspected, particularly in acquired PE, relevant blood tests (testosterone, prolactin, thyroid function) are recommended
• Treatment discussion — all treatment options are presented honestly, including pharmacological, behavioural, and treatment of underlying conditions. Dr Bahl prescribes dapoxetine or appropriate SSRI where clinically indicated. Where PE is secondary to ED or CPPS, the primary condition is addressed as the priority

Initial consultation: £59. No referral needed. See also our Men's Urology consultation for the full assessment pathway.

Dr Kishore Bahl is a Specialist Grade Doctor in Urology (GMC Registration: 6070860) and founder of Shockwave ReVibe Clinic, 22 Notting Hill Gate, London W11 3JE. To book a consultation, call 020 3004 0564 or visit shockwave-revibe.co.uk.

Last reviewed: September 2026