Premature ejaculation is one of the most common things men come to see me about, and one of the most misunderstood. Most men who raise it have been carrying some quiet shame about it for years, often since their teens or twenties.
It is common, it is rarely as simple as lasting longer, and in almost every case there is something useful to do about it.
There is no official normal, and I would gently question the idea that there should be one. Since it is usually the first thing men want to know: studies that actually timed penetrative sex found an average of around five to six minutes, with an enormous spread either side. Some men under a minute, some over twenty. Most of that research looked at straight couples, because that is what got studied, but the wider point holds for every kind of sex.
The clock is not the thing that matters. What matters is whether you feel you have some say over when you come, and whether the pattern is causing you or your partner real distress.
Three minutes you are both happy with is not a medical problem. Twelve minutes that leaves you anxious and avoiding sex is worth doing something about.
01Why do I come so quickly
There isn't one answer, and that is useful rather than a cop-out. Coming quickly is a symptom rather than a diagnosis, and the same symptom has quite different causes in different men. Working out which pattern you fit is what makes treatment effective rather than hit and miss. The European Association of Urology describes four types, and most men recognise themselves fairly quickly.
Lifelong, or primary. Very quick, usually within about a minute, on almost every occasion, right back to your earliest experiences. Mostly down to how you are wired, in particular how sensitive you are to serotonin, which controls the timing of ejaculation. It often runs in families. It is not caused by anxiety or a bad early experience, though anxiety builds on top of it over the years
Acquired, or secondary. You had reasonable control and at some point that changed. The type most likely to have a specific trigger behind it, physical or emotional, which is encouraging, because it means there is often something to correct rather than manage
Variable. Quick sometimes and not others. Considered a normal fluctuation rather than a dysfunction, though it can still be frustrating
Subjective. You feel you come too quickly but the actual time is average or longer. The distress is entirely real, but it comes from expectation rather than timing, so it needs a different conversation
Knowing you are in the lifelong group changes where we start. I would usually consider medication earlier, alongside the psychological work, rather than hunting for a single hidden cause that probably isn't there.
Both, literally rather than diplomatically. Lifelong premature ejaculation has a real physical basis and is not in your head in the sense of being caused by worry, though worry joins in later. The acquired type often starts with something physical, an erection problem or a medication change, or something emotional, a new relationship or a hard year. Then the two feed each other: the trigger creates anxiety, the anxiety worsens control, poorer control creates more anxiety. By the time a man is in my consulting room it is very rarely one or the other in a pure form.
There is a third piece that gets missed and is often the most important. Alongside the body and the mind sits your erotic world: what actually turns you on, the conditions your desire runs on, how you learned about sex, what you absorbed about what a man is supposed to do in bed, and how much of your sexual self you can bring into the room. Men whose real erotic life sits some distance from the sex they are having, through shame or secrecy or never having had the language, often find their bodies register that gap long before they consciously do.
Two things follow. Psychological does not mean unreal, or your fault, or something you should be able to think your way out of. And a physical cause does not mean therapy has nothing to offer. Working across all three at once is what gets the best results, which is why I trained in medicine and in psychosexual therapy rather than doing one and referring on.
These matter most for the acquired type, where something has changed. The commonest by a distance is an erection problem: if your erection feels unreliable it makes complete sense, even without your noticing, to rush towards coming before you lose it. Treat that and the timing often sorts itself out.
The others I check for:
Prostate inflammation or ongoing pelvic pain
An overactive thyroid
Heavy drinking or recreational drug use
Coming off an antidepressant. SSRIs usually delay ejaculation, so stopping one can reveal a pattern that was being masked
A tight or overworked pelvic floor
Poor sleep and run-down general health, which affect arousal more than most men expect
I take a history, examine you and sometimes arrange bloods to sort these in or out. Treating what is driving it always works better than treating the symptom alone.
It only happens with new partners. Why?
That points at arousal and anxiety rather than any fixed limit on how long you can last. Several things happen at once with someone new. Novelty genuinely raises arousal and leaves your body more revved up. There is no established rhythm between you yet and no easy way to say slow down. And there is usually a lot of self-monitoring: watching yourself perform rather than being in the experience, which speeds things up rather than helping.
With a long-term partner your body has learned the situation is safe, and you have almost certainly developed pacing habits without deciding to. None of that exists yet. This pattern usually responds well to the anxiety side of treatment, and sometimes to looking at what a new partner specifically stirs up for you.
Usually a combination, matched to your type and your triggers. There isn't one correct treatment for premature ejaculation. There's a correct treatment for yours, once we know what's underneath it.
Stop-start and squeeze techniques: pausing or easing off as you approach the point of no return, so you build tolerance to high arousal without tipping over
Pelvic floor training, which has reasonable evidence behind it for some men
Sensate focus: structured touching exercises, usually with a partner, that take the goal and the pressure out of sex so you can feel arousal rather than race it
Tackling performance anxiety directly, through therapy, mindfulness, or changing what sex is for in your head, away from a performance you are grading yourself on
Treating any erection difficulty, which is often doing more of the work than men realise
Where a specific memory or belief is keeping you braced during sex, EMDR is worth considering: a humiliating early experience, a cutting remark from a past partner, or shame absorbed from family, school or religion. Experiences like these do not sit quietly in the past. They keep the body primed and on edge, and that shows up physically as rushing towards ejaculation. Reprocessing the memory takes the sting out of it rather than erasing it, which can loosen the pattern enough for the practical techniques and the medical treatment to work, instead of pushing against an undercurrent of shame that is still running.
Do the sprays and creams work?
Yes. Numbing sprays reduce sensitivity and have decent trial evidence for increasing the time before you come. The licensed UK product is Fortacin. You apply a measured dose a few minutes beforehand and either wipe off the excess or use a condom, so your partner isn't left numb too.
The drawbacks, honestly: you have to plan ahead and get the timing right, some men and some partners dislike the dulled sensation, and it does nothing about why the pattern developed. It manages the symptom rather than the cause. I use it as part of a plan rather than the whole plan, though for lifelong premature ejaculation it can make a real difference alongside other work.
Can it be cured or only managed?
It depends which type you have. The acquired type, where there is an identifiable trigger, can often be fully resolved: treat the erection problem, the prostate inflammation or the anxiety underneath it and control usually returns to where it was.
The lifelong type has a stronger physical basis, so it is more accurate to say you learn to control it very well than to say it disappears. I would rather be straight about that than promise a cure I can't reliably deliver. But managed here can mean a genuinely different sex life rather than a consolation prize, and most men treated with a combined approach see substantial and lasting improvement.
What can I do that doesn't involve medication?
Quite a lot, and I would usually want these running alongside any medical treatment rather than instead of it.
Stop-start and squeeze techniques: pausing or easing off as you approach the point of no return, so you build tolerance to high arousal without tipping over
Pelvic floor training, which has reasonable evidence behind it for some men
Sensate focus: structured touching exercises, usually with a partner, that take the goal and the pressure out of sex so you can feel arousal rather than race it
Tackling performance anxiety directly, through therapy, mindfulness, or changing what sex is for in your head, away from a performance you are grading yourself on
Treating any erection difficulty, which is often doing more of the work than men realise
The clinic is at Central Health London, 23 Devonshire Place, Marylebone, a quiet and discreet address a short walk from Regent’s Park. Most men arrive anxious and leave relieved. You will be welcomed by reception, offered tea or coffee, and given time to settle before we start.
A first consultation is usually an hour. We go through your symptoms, your medical and family history, and your sexual experience, relationships and lifestyle: the medical, psychological and relational picture together rather than one at a time.
I will ask you a lot of questions. You do not have to answer any of them: saying "I would rather not answer that" is a complete answer and nothing follows from it. A physical examination is sometimes useful, particularly for erection problems, and it is always optional. You stay in control of the appointment throughout.
If you have had recent blood tests, send them ahead. If not I will arrange them, and I will tell you which ones need taking before 11am.
The waiting room at 23 Devonshire Place.
Who tends to benefit most from seeing me
Men in midlife who have not engaged much with healthcare
If you are in your fifties or sixties, have no GP you know well, do not much like going to the doctor, but recognise it is time to take your health seriously, this is a reasonable place to start. I often find things that matter and have been missed.
Gay, bisexual and queer men
If you want help but are wary of seeing someone who is not comfortable talking about gay or queer sex, you can come to someone who does not need it explained, and who will not judge or shame you.
Men who want a thoughtful, whole-person assessment
Men who have tried quick fixes, or had a purely medical or purely therapeutic approach that did not help. I see a lot of men for second opinions. And men of any age and in any kind of relationship who want to understand what is going on rather than be handed a prescription.
About Dr Ben Davis
I am a GP, a sexual medicine specialist and a COSRT-registered psychosexual therapist, working at 23 Devonshire Place, Marylebone, central London, alongside NHS general practice in Hackney.
Most men reading a page like this arrived from a search rather than my homepage, so this is probably the first you have heard of me. The short version: I hold the medical, the psychological and the relational picture together in one appointment, rather than sending you to three people who each see a third of it.
