Male Patients - Application for Premature Ejaculation Treatment.

Premature Ejaculation

Have you been experiencing premature ejaculation? Complete a short online assessment for your preferred treatment and our doctors will confirm if it’s suitable. 

Priligy is a tablet used to treat premature ejaculation.  You need to take it one hour before having sex and its effects last for around three hours.

Dr. Jody is online now


  • Dr. Jody Shanahan-Prendergast
  • M.D., MRCGP, FRACGP

STEP 1 OF 3

For how long have you been sexually active? *

For how long has your Premature Ejaculation (PE) been a problem? *

How often do you experience PE? *

When does ejaculation occur? *

Are you in a relationship at this time (Does PE affect your relationship)?? *

During masturbation, does PE occur? *

Do you know what might be the cause of your PE? *

Have you ever tried any therapy or medicine for PE? *

Do you have any problems getting or maintaining an erection before ejaculation? *

Have you ever received or are you currently receiving treatment for erectile dysfunction? *

Which medication would you like to apply for? *


STEP 2 OF 3

Were you ever advised by any Healthcare provider (Doctor, Nurse or Pharmacist) that you should avoid sexual activity? *

Do you have any pain in your genitals, when you ejaculate or when you pass urine? *

Apart from the issues already mentioned, were you ever treated for any previous Accidents, Operations, Investigations or Illnesses? *

Do you have a history of low blood pressure, fainting or, after lying down, do you get dizzy when you stand up? *

Do you suffer from any heart conditions such as angina or irregular heart rhythm? *

Do you have a bleeding or clotting disorder? *

Do you have a history of migraines or severe headaches? *

Have you been treated for epilepsy or have you suffered from seizures? *


STEP 3 OF 3

What is your birth sex? *

Can you tell us your height (enter as centimeters)?

Can you tell us your current weight (enter as kg)?