Premature Ejaculation: Causes, Treatments & What Actually Works

Premature ejaculation (PE) is the most common sexual dysfunction in men, yet most men who experience it never seek treatment. According to Healthdirect Australia, PE is common, treatable, and nothing to be embarrassed about.

What counts as premature ejaculation?

Clinically, PE is defined as persistent ejaculation within one minute of penetration, combined with an inability to delay climax and personal distress. However, many men experience concerns about timing even lasting longer — that's equally valid to raise with your GP.

PE can be lifelong (present from first sexual experiences) or acquired (developing later, often linked to stress, relationship changes, or other health conditions like erectile dysfunction).

What causes PE?

The RACGP's clinical review notes that PE typically results from a combination of factors:

• Psychological: Performance anxiety, stress, depression, relationship difficulties, early conditioning
• Neurobiological: Serotonin receptor sensitivity, penile hypersensitivity
• Medical: Prostate inflammation, thyroid disorders, hormonal imbalances
• Overlap with ED: About 1 in 3 men with PE also have erectile dysfunction. Anxiety about losing an erection can trigger faster ejaculation — as noted by Healthdirect.

Evidence-based treatments

Medication

• Dapoxetine (Priligy) — The only SSRI specifically developed and TGA-approved for PE. Taken on-demand 1–3 hours before activity. Studies show it approximately triples intravaginal ejaculatory latency time.
• Off-label SSRIs — Low-dose daily paroxetine or sertraline are used off-label for persistent PE, increasing serotonin levels to improve ejaculatory control.
• Topical anaesthetics — Sprays or creams containing lidocaine/prilocaine reduce penile sensitivity. Available OTC (Stud 100, EMLA) or by prescription in higher concentrations.

Behavioural techniques

• Stop-start method — Pausing stimulation at the point of high arousal, allowing the sensation to subside, then resuming. Practiced consistently, this retrains the ejaculatory reflex.
• Pelvic floor exercises (Kegels) — Strengthening the bulbocavernosus muscle improves ejaculatory control. Research shows significant improvement in 82% of men with consistent practice over 8–12 weeks.
• Psychological support — Cognitive behavioural therapy (CBT) and sex therapy can address performance anxiety, unhelpful beliefs about sex, and communication difficulties with partners.

The RACGP recommends that management is usually a combination of pharmacological, psychological, and behavioural approaches tailored to the individual.

Why most men don't seek help

PE is under-treated primarily because of stigma. Telehealth has changed this — a confidential video consultation from home removes the discomfort of discussing sexual health face-to-face. At Men's Health GP, your consultation is with a qualified GP who deals with these issues every day.