It was Blake’s wife who came to see me first – not because he had asked her to, but because she didn’t know what else to do.
The couple had been together for a few years. They were having sex, but Blake had premature ejaculation – where a man ejaculates sooner than he or his partner desire – and it was getting worse.
His wife told me it wasn’t necessarily an issue for her – but it was causing Blake enormous distress. He was so anxious that it was beginning to affect his erections too. He felt so ashamed he didn’t know where to turn.
Blake is far from alone. Premature ejaculation is one of the most common male sexual difficulties there is, affecting somewhere between 20 and 30 per cent of men at some point in their lives.
Accurate figures are hard to come by because of the shame and stigma attached to talking about anything sexual – which is precisely why premature ejaculation has historically received far less attention than erectile dysfunction, despite being just as common and often just as distressing, for both the person experiencing it and their partner.
Here is something that might surprise you: studies suggest the average time to ejaculation during penetrative sex is around five and a half minutes. That’s it. Despite what Hollywood, pornography and social media – or the banter of friends in a pub – might suggest, there is no Olympic standard for bedroom endurance.
The feeling of having ejaculated ‘too quickly’ is highly subjective and varies wildly between couples. For some, it means ejaculating before penetration has even begun. For others, it means lasting several minutes but still feeling disappointed. Occasional early ejaculation is extremely common, and nothing to worry about.
Clinically, premature ejaculation is usually defined by three things: ejaculation consistently occurring within about a minute of penetration; distress or relationship difficulties as a result; and avoidance of sexual intimacy because of it.
Premature ejaculation is one of the most common male sexual difficulties there is, affecting somewhere between 20 and 30 per cent of men at some point in their lives
There are two main types. Lifelong premature ejaculation has usually been present since the very first sexual experiences and tends to stay consistent over time.
It can be related to nerve sensitivity or early sexual experiences – conditioning plays a role here. If someone learned to masturbate quickly as a teenager to avoid being caught by parents with an uncanny ability to knock at exactly the wrong moment, the body can become trained to rush towards ejaculation.
Strict attitudes to sex or certain beliefs around intimacy can also be a factor.
Acquired premature ejaculation develops later in life, after a period of previously normal sexual function. It is often linked to other issues: erectile dysfunction, prostate problems or mental health difficulties.
The connection between erectile dysfunction and premature ejaculation is important. As with Blake, anxiety about losing an erection can create an unconscious sense of urgency – a ‘hurry before it disappears’ panic that leads to rushing and then ejaculating quickly. Treat the erection problem and the ejaculation often sorts itself out.
Perhaps the best-known behavioural approach is the Semans stop-start technique, and the principle is beautifully simple.
Continue with stimulation until you feel close to ejaculation – hovering near that point of no return. Then stop. Completely. Not distracting yourself, not slowing down, not reciting the alphabet backwards in your head. Stop.
After 20 to 30 seconds, when the intensity has settled, stimulation begins again. The cycle is repeated several times before ejaculation is finally allowed to happen.
There is a topical spray available on prescription called Fortacin, which contains a local anaesthetic, that can help combat premature ejaculation
This technique is usually practised alone at first, so you can learn your own arousal patterns without any pressure.
Then a partner is gradually introduced – typically starting with manual stimulation before moving to penetrative sex. Over time, the body becomes more comfortable tolerating higher levels of arousal without immediately crossing the finish line.
Building on the same idea is the squeeze technique, developed by pioneering US sex researchers Dr William Masters and Virginia Johnson.
When ejaculation feels close, a firm squeeze is applied just below the head of the penis for around ten to 20 seconds.
It shouldn’t be painful – but the pressure helps reduce arousal before stimulation restarts. This method involves a partner from the start, partly because it’s easier with help, and partly because premature ejaculation affects both people in a relationship.
It’s worth trying some more straightforward adjustments too. Condoms containing a local anaesthetic can help, and some men find thicker condoms useful – though I’d caution strongly against doubling up on condoms, which risks them splitting.
Even changing positions, or adjusting the angle or depth of thrusts, can make a real difference. Some men find that masturbating before penetrative sex helps delay ejaculation.
There is a topical spray available on prescription called Fortacin, which contains a local anaesthetic. It works by decreasing penile sensitivity – effectively taking the edge off the sensation that triggers early ejaculation.
GP, author and broadcaster Dr Philippa Kaye
There is also an oral medication called dapoxetine. It belongs to the SSRI family – the group of drugs typically used to treat depression and anxiety – but it is much shorter-acting than other SSRIs and is taken one to three hours before sexual activity.
Where premature ejaculation and erectile dysfunction occur together, dapoxetine can be prescribed alongside medication for the erection problem.
Psychosexual therapy also plays an important role – helping to address performance anxiety, challenge unrealistic expectations about sex, and support couples in communicating and working through the issue together.
And as with most things in sexual health, a combination of approaches is often most effective.
Blake’s story is a reminder that premature ejaculation rarely exists in a vacuum. It is tangled up with anxiety, self-esteem, relationship dynamics, and sometimes other physical conditions. But it is also, in most cases, very treatable. The hardest part is often simply finding the courage to start the conversation.
If any of this sounds familiar – whether you are the person experiencing it or the partner watching someone you love suffer in silence – please do speak to your GP. You do not have to keep struggling alone.
