Treating Early Ejaculation, and Which Approaches Actually Work

Two licensed routes treat premature ejaculation in the UK, one taken by mouth and one applied to the skin, and there are recognised approaches that involve no medicine at all.

That is the short answer. The more useful one is what the evidence behind each actually shows, because the published trial figures are more modest than most pages imply, and the gap between the marketing and the data is where people end up disappointed.

This page gives you the numbers: how much the measured time changed, how many men reported good control, how quickly each option works, and what the evidence does not establish. It also covers what does not help, which matters as much. Every figure comes from UK licensed product information or NICE guidance.

Key things to know

• Two routes are licensed in the UK: a tablet taken by mouth, and a spray applied to the skin. Both are prescription-only
• In the pooled trial data for the tablet, measured time rose from a baseline of 0.9 minutes to 3.1 minutes on the lower strength studied. Placebo reached 1.9 minutes
• Around a quarter of men on the tablet reported good or very good control, against roughly one in nine on placebo. That is a real effect, and it is not a majority
• The spray is described as effective within five minutes of application. The tablet reaches its maximum blood concentration about one to two hours after it is taken

The Two Options, Side by Side

Both are prescription-only medicines. They work differently, suit different situations, and their licences are not identical.

The Licence Difference Most Pages Miss

The two licences do not cover the same group of men.

The tablet is licensed for premature ejaculation in adult men aged 18 to 64. The spray is licensed for primary premature ejaculation, meaning the lifelong form, present from the beginning rather than developing later.

That is a meaningful distinction. Someone whose difficulty developed after a settled period has the acquired form, which the spray's licensed indication does not describe. It is a question for a prescriber rather than something to work out alone, but the two are not interchangeable.

How Well Does the Tablet Work?

This is the part most pages skip, and the part worth reading twice.

The Size of the Evidence

NICE summarises a pooled analysis of five phase III randomised controlled trials involving 6,081 men aged 18 and over, with an average age of 41. Four ran over 12 or 24 weeks, and one over nine weeks.

A randomised controlled trial assigns participants to treatment or placebo by chance, which is what allows a real effect to be separated from an apparent one. Six thousand participants is a substantial body of evidence in this field.

The Headline Figures

The primary measure was time to ejaculation, recorded by stopwatch. At 12 weeks, against a starting average of 0.9 minutes:

• Placebo reached a mean of 1.9 minutes
• The lower of the two strengths studied reached 3.1 minutes
• The higher strength reached 3.6 minutes

Both treatment results were statistically significant against placebo, meaning the difference is very unlikely to be down to chance.

Why the Placebo Figure Matters More Than It Looks

Read that placebo line again. It more than doubled the starting time on its own.

That is not a trick of the data. It reflects something real about this condition: attention, expectation and simply doing something about it all shift the outcome. Any page quoting a before and after without a placebo comparison is showing a number that is partly this effect.

The treatment effect is the gap between 1.9 and 3.1, not between 0.9 and 3.1. Presented honestly, the medicine adds a little over a minute beyond what placebo achieved. That is a genuine effect, and it is smaller than most people expect.

How Many Men Reported Good Control

Time is one measure. Whether it felt better is another, and the trials recorded both.

On the lower strength, 26.2% of men rated their control as good or very good, against 11.2% on placebo. Satisfaction with the outcome was reported by 37.9%, against 24.4% on placebo. Both differences were statistically significant.

So the honest success rate is roughly this. Around one man in four reported good or very good control, against roughly one in nine on placebo. The treatment more than doubles that proportion, and around three quarters of men still did not report good control.

Anyone quoting a success rate far above that is not using the pooled trial data.

How Many Men Stopped Taking It

Discontinuation rates were similar in both groups: 31.1% of participants on treatment and 28.9% on placebo.

That is a useful and rarely quoted figure. Roughly three in ten stopped, at a similar rate whether they were receiving the medicine or not, which suggests the reasons were not primarily about side effects.

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How Well the Spray Works

The spray has a smaller evidence base and a different shape of result.

Two randomised controlled trials included 539 patients, 358 on the active spray and 181 on placebo. Over three months, 85.2% of men in the active group achieved a mean stopwatch-measured time of more than one minute, against 46.4% on placebo.

How to Read That Number

The 85.2% figure looks far better than anything in the tablet data, and the two are not comparable.

The measure is different. It counts how many men passed a one-minute threshold, rather than reporting an average time. A man who moved from 40 seconds to 70 seconds counts as a success on that measure. The tablet trials reported mean times instead.

There are also no head-to-head trials. NICE notes there are no randomised controlled trials comparing the tablet against an active comparator. So nobody can tell you which works better, because that trial has not been done.

How Quickly Each Works

The spray has a rapid onset, described as effective within five minutes of application. The tablet reaches its maximum blood concentration about one to two hours after it is taken, and is designed as a short-acting medicine taken when needed rather than daily.

For both, the effect on a given occasion is the effect. Neither needs weeks to build up.

What does take longer is knowing whether it suits you, since a single occasion is not a fair test. The trials measured outcomes over 12 weeks and three months respectively, so a few weeks of use gives a clearer picture than one or two attempts.

Treatment Without Medicine

Approaches that do not involve medicine are recognised in guidance, and they are recommended for a specific group rather than as a universal alternative. They fall under behavioural therapy and psychological therapy.

Pelvic Floor and Kegel Exercises

Pelvic floor exercises, often called Kegel exercises, are widely recommended online for this purpose. No regulator source reviewed for this page identifies them as a treatment for premature ejaculation.

That is a verified absence rather than a claim that they do nothing. Training the pelvic floor has established uses elsewhere, and is recommended in UK guidance for other purposes. What is not supported is presenting it as an evidence-based treatment for this condition.

Topical Creams and Wipes

No creams and no wipes are licensed in the UK for premature ejaculation. The licensed topical route is the spray.

Creams and wipes marketed to delay ejaculation sit outside the licensed routes. Some are sold as cosmetics or general products, which means they have not been assessed by the MHRA for this use, and the evidence and safety information that comes with a licensed medicine does not exist for them.

A product being available to buy is not the same as a product being assessed. That distinction is the whole point of the licensing system.

Can It Be Cured Permanently?

No treatment is described in licensed product information or guidance as a permanent cure.

Both licensed medicines are used when needed rather than as a course that ends with the condition resolved. Behavioural approaches aim at gradually developing control, which is a different kind of outcome and one some men maintain afterwards, although no regulator source quantifies how many or for how long.

The honest position is that premature ejaculation is managed rather than cured, that management can be effective, and that anyone promising a permanent cure is going beyond the evidence. Results vary between individuals.

NICE also notes there are limited data on the safety and effectiveness of the tablet used for longer than 24 weeks, so the long-term picture is not well documented. That is a limitation of the evidence rather than a judgement about the treatment.

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Which Option Suits Which Situation

No treatment is best for everyone, and the phrase does not survive contact with the evidence, since no head-to-head trial exists to support a ranking. What can be said is which considerations point where.

Safety Information Worth Having First

The Tablet

Very common side effects, meaning those occurring in more than 1 in 10 men, are dizziness, headache and nausea.

Fainting drives most of the caution. In the trials it was recorded in 0.05% of men on placebo, 0.06% on the lower strength and 0.23% on the higher strength. The rate is low, and it rises with strength, which is why the choice is a prescriber's rather than a preference.

Contraindications include significant heart conditions such as heart failure or significant ischaemic heart disease, a history of fainting, a history of mania or severe depression, and moderate to severe liver impairment.

It must not be used alongside monoamine oxidase inhibitors, thioridazine, other selective serotonin reuptake inhibitors or tricyclic antidepressants. It must not be used by men taking PDE5 inhibitors, the class used for erectile dysfunction, because that combination increases the risk of fainting.

Guidance also records that patients should be advised not to use it with recreational drugs or alcohol.

General Points

• Dosing is deliberately absent from this page. The product information supplied with the medicine is the authority on how it is used
• Never take a double amount to make up for a missed occasion
• Report any fainting, or any feeling of impending faint, to a prescriber before using the treatment again

How It Is Diagnosed Before Treatment

Premature ejaculation is diagnosed on history and clinical criteria rather than on a physical examination or blood tests. Both licensed treatments need an assessment before supply, and further tests are arranged only where an underlying condition is suspected.

The assessment covers when the difficulty started and whether there was a settled period beforehand, whether erectile function has changed, urinary or prostate symptoms, every current medicine including antidepressants, heart history including any fainting, mental health history including mania or severe depression, liver health, other conditions, and alcohol and recreational drug use.

Medical Disclaimer

This page provides general information about licensed treatments for premature ejaculation and the evidence behind them. It is not a diagnosis, and does not provide dosing instructions. Treatment suitability depends on an individual clinical assessment, and results vary between individuals.

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