Should I see a doctor for premature ejaculation, and which one?

I’m not a doctor, and nothing on this site replaces one. So this page is the one I’d most like you to read if any of the signs below sound familiar.

When to see a doctor first

Before trying anything on your own, book an appointment if:

• it started after a period when everything was fine (doctors call that “acquired” premature ejaculation, and it’s more often linked to something else);
• you also have trouble getting or keeping an erection;
• you have pain when you ejaculate, pain in the pelvis, or urinary symptoms;
• you have signs like palpitations, weight loss or nervousness (the thyroid can be involved);
• it started after you began, changed or stopped a medication or a drug;
• it’s dragging your mood down, or causing real anxiety or distress.

None of this is rare, and a lot of it can be dealt with. In men with an overactive thyroid, for example, the share with premature ejaculation dropped from about half to 15% once the thyroid was treated.

Which doctor?

Your family doctor (or general practitioner) is the simplest place to start. They can check the basics, look at your medication, and refer you if needed.

A urologist is the specialist for the urinary and genital system. The American Urological Association’s guideline is the one most of what I cite comes from, and urologists are the ones who prescribe the medical options when they make sense.

A sex therapist (a psychologist or counsellor trained in sexual problems) is the right person when anxiety, pressure or the relationship weigh heavily. Behavioural approaches and talking things through are their field.

What the appointment looks like

The guideline says the starting point is a conversation: your medical history, your sex life, your relationship, when it started and how often it happens. A short physical exam may follow. For most men, that’s it. It’s an awkward conversation for about five minutes, and then it’s just a doctor doing their job.

My take

Talking about it is hard, I know. If one of the signs above applies to you, talk to a doctor anyway. And if none of them does, training is a reasonable place to start (see can you train yourself to last longer).

Sources

• Disorders of Ejaculation: AUA/SMSNA Guideline, American Urological Association, 2020
• SSRIs and SNRIs for Premature Ejaculation in Adult Men, American Family Physician (Cochrane for Clinicians), 2022
• The pathophysiology of acquired premature ejaculation, McMahon et al., Translational Andrology and Urology, 2016
• Premature ejaculation, Cleveland Clinic