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Treatment of early ejaculation


Premature ejaculation - Diagnosis and treatment

Diagnosis

Your health care provider asks about your sex life and your health history. Your provider might also do a physical exam. If you have both early ejaculation and trouble getting or keeping an erection, your provider might order blood tests. The tests may check your hormone levels.

In some cases, your care provider might suggest that you go to a urologist or a mental health provider who specializes in sexual problems.

Treatment

Common treatment options for premature ejaculation include behavioral techniques, medications and counseling. It might take time to find the treatment or combination of treatments that work for you. Behavioral treatment plus drug therapy might be the most effective.

Behavioral techniques

In some cases, therapy for premature ejaculation involves simple steps. They may include masturbating an hour or two before intercourse. This may allow you to delay ejaculation when you have sex with your partner.

Your care provider might recommend avoiding intercourse for a period of time. Focusing on other types of sexual play may remove the pressure you might feel during sexual intercourse.

Pelvic floor exercises

Male pelvic floor muscles

The pelvic floor muscles support the bladder and bowel and affect sexual function. Kegel exercises can help strengthen these muscles.

Weak pelvic floor muscles might make it harder to delay ejaculation. Pelvic floor exercises (Kegel exercises) can help strengthen these muscles.

To perform these exercises:

  • Find the right muscles. To find your pelvic floor muscles, stop urinating in midstream. Or tighten the muscles that keep you from passing gas. Both actions use your pelvic floor muscles. Once you've identified your pelvic floor muscles, you can exercise them in any position. However, you might find it easier to do them lying down at first.
  • Perfect your technique. Tighten your pelvic floor muscles, hold for three seconds and then relax for three seconds. Try it a few times in a row. When your muscles get stronger, try doing Kegel exercises while sitting, standing or walking.
  • Stay focused. For best results, focus on tightening only your pelvic floor muscles. Be careful not to flex the muscles in your abdomen, thighs or buttocks. Avoid holding your breath. Instead, breathe freely during the exercises.
  • Repeat three times a day. Aim to do at least three sets of 10 repetitions a day.

The pause-squeeze technique

Your health care provider might instruct you and your partner to use the pause-squeeze technique. This method works as follows:

  1. Begin sexual activity, including stimulating the penis, until you feel almost ready to ejaculate.
  2. Then you or your partner can squeeze the end of your penis where the head joins the shaft. Keep squeezing for several seconds until the urge to ejaculate passes.
  3. Repeat the squeeze process as needed.

By repeating as many times as needed, you can reach the point of entering your partner without ejaculating. After some practice, delaying ejaculation might become a habit that no longer requires the pause-squeeze technique.

If the pause-squeeze technique causes pain or discomfort, you can try the stop-start technique. It involves stopping sexual stimulation just before ejaculation. Then waiting until the level of arousal has diminished and starting again.

Condoms

Condoms might make the penis less sensitive, which can help delay ejaculation. Specially designed "climax control" condoms are available without a prescription. These condoms contain numbing agents such as benzocaine or lidocaine to delay ejaculation. They might also be made of thicker latex. Examples include Trojan Extended Pleasure and Durex Prolong.

Medications

Topical numbing agents

Creams, gels and sprays that contain a numbing agent — such as benzocaine, lidocaine or prilocaine — are sometimes used to treat premature ejaculation. They're applied to the penis 10 to 15 minutes before sex to reduce sensation and help delay ejaculation. They're available without a prescription. However, a cream containing both lidocaine and prilocaine (EMLA) is available by prescription.

Although topical numbing agents are effective and well tolerated, they have potential side effects. They may cause decreased feeling and sexual pleasure in both partners.

Oral medications

Many medications might delay orgasm. These drugs aren't approved by the Food and Drug Administration to treat premature ejaculation, but some are used for this purpose. They include antidepressants, pain relievers and drugs for erectile dysfunction.

These medications might be prescribed for either on-demand or daily use. Also, they may be prescribed alone or with other treatments.

  • Antidepressants. A side effect of certain antidepressants is delayed orgasm. For this reason, selective serotonin reuptake inhibitors (SSRIs) are used to treat premature ejaculation. SSRIs include paroxetine (Paxil, Pexeva, Brisdelle), escitalopram (Lexapro), citalopram (Celexa), sertraline (Zoloft) or fluoxetine (Prozac).

    The SSRI dapoxetine is often used as the first treatment for premature ejaculation in some countries. It's not currently available in the United States.

    Of the drugs approved for use in the United States, paroxetine seems to be the most effective. These medications usually take 5 to 10 days to begin working. But it might take 2 to 3 weeks of treatment to see the full effect.

    If SSRIs don't improve the timing of your ejaculation, your health care provider might prescribe the tricyclic antidepressant clomipramine (Anafranil). Side effects of antidepressants might include nausea, perspiration, drowsiness and decreased sex drive.

  • Pain relievers. Tramadol (Ultram, Conzip, Qdolo) is a medication used to treat pain. It also has side effects that delay ejaculation. Tramadol might be prescribed when SSRIs haven't been effective. Tramadol can't be used in combination with an SSRI.

    Side effects might include nausea, headache, sleepiness and dizziness. Tramadol can become habit-forming when taken long-term.

  • Phosphodiesterase-5 inhibitors. Some medications used to treat erectile dysfunction also might help premature ejaculation. These drugs include sildenafil (Viagra), tadalafil (Cialis, Adcirca), avanafil (Stendra) and vardenafil. Side effects might include headache, facial flushing and indigestion. These medications might be more effective when used in combination with an SSRI.
Potential future treatment

Research suggests that several drugs might be helpful in treating premature ejaculation. But more study is needed. These drugs include:

  • Modafinil (Provigil). This is a treatment for the sleeping disorder narcolepsy.
  • Silodosin (Rapaflo). This drug treats prostate gland enlargement.
  • OnabotulinumtoxinA (Botox). Researchers are studying whether injecting Botox into the muscles that help cause ejaculation can treat premature ejaculation.

Counseling

This approach involves talking with a mental health provider about your relationships and experiences. Sessions can help you reduce performance anxiety and find better ways of coping with stress. Counseling is most likely to help when it's used in combination with drug therapy.

With premature ejaculation, you might feel that you lose some of the closeness shared with a sexual partner. You might feel angry, ashamed and upset, and turn away from your partner.

Your partner also might be upset with the change in sexual intimacy. Premature ejaculation can cause partners to feel less connected or hurt. Talking about the problem is an important step. Relationship counseling or sex therapy also might be helpful.

More Information

  • Cognitive behavioral therapy

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Alternative medicine

Several alternative medicine treatments have been studied, including yoga, meditation and acupuncture. However, more research is needed to determine their effectiveness.

Preparing for your appointment

It's typical to feel embarrassed when talking about sexual problems. But you can trust that your health care provider has had similar conversations with many others. Premature ejaculation is a very common condition. And it's one that can be treated.

Being ready to talk about premature ejaculation will help you get the treatment you need to put your sex life back on track. The information below should help you prepare to make the most of your appointment.

Information to gather in advance

  • Pre-appointment restrictions. When you make your appointment, ask if there are any restrictions you need to follow in the time leading up to your visit.
  • Symptoms. How often do you ejaculate before you or your partner would wish? How long after you begin having intercourse do you typically ejaculate?
  • Sexual history. Think back on your relationships and sexual encounters since you became sexually active. Have you had problems with premature ejaculation before? With whom, and under what circumstances?
  • Medical history. Write down any other medical conditions with which you've been diagnosed, including mental health conditions. Also note the names and strengths of all medications you are currently taking or have recently taken, including prescription drugs and those you buy without a prescription.
  • Questions to ask your health care provider. Write down questions in advance to make the most of your time with your provider.

Basic questions to ask your doctor

The list below suggests questions to ask your health care provider about premature ejaculation. Don't hesitate to ask more questions during your appointment.

  • What may be causing my premature ejaculation?
  • What tests do you recommend?
  • What treatment approach do you recommend?
  • How soon after I begin treatment can I expect improvement?
  • How much improvement can I reasonably expect?
  • Am I at risk of this problem recurring?
  • Is there a generic alternative to the medicine you're prescribing?
  • Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

What to expect from your doctor

Your health care provider might ask very personal questions and might also want to talk to your partner. To help your provider determine the cause of your problem and the best course of treatment, be ready to answer questions, such as:

  • How often do you have premature ejaculation?
  • When did you first experience premature ejaculation?
  • Do you have premature ejaculation only with a specific partner or partners?
  • Do you experience premature ejaculation when you masturbate?
  • Do you have premature ejaculation every time you have sex?
  • How often do you have sex?
  • How much are you bothered by premature ejaculation?
  • How much is your partner bothered by premature ejaculation?
  • How satisfied are you with your current relationship?
  • Are you also having trouble getting and keeping an erection (erectile dysfunction)?
  • Do you take prescription medications? If so, what medications have you recently started or stopped taking?
  • Do you use recreational drugs?

What you can do in the meantime

Deciding to talk with your health care provider is an important step. In the meantime, consider exploring other ways in which you and your partner can connect. Although premature ejaculation can cause strain and anxiety in a relationship, it is a treatable condition.

By Mayo Clinic Staff

Related

Associated Procedures

Can premature ejaculation be controlled?

Premature ejaculation is where a man ejaculates (comes) too quickly during sexual intercourse. It's a common ejaculation problem.

What is premature ejaculation ?

A study involving 500 couples found the average time for ejaculation was about 5-and-a-half minutes after starting sex. This time could be longer for men who have sex with men.

International guidelines define premature ejaculation as regularly ejaculating within 1 minute of entering your partner.

However, it's up to you and your partner to decide if you're happy with the time it takes you to ejaculate.

If ejaculation times are causing you persistent distress then it's a problem that can be helped with treatment.

Types of premature ejaculation

There are 2 types of premature ejaculation:

  • primary premature ejaculation – where you have always had the problem
  • secondary premature ejaculation (or "acquired premature ejaculation") – where you recently developed the problem

The causes of primary premature ejaculation are often psychological, such as having a traumatic sexual experience at an early age. Secondary premature ejaculation can be caused by both psychological and physical factors. Physical causes can include drinking too much alcohol and inflammation of the prostate gland (prostatitis).

Treatment

If your premature ejaculation is caused by a physical condition, treating the underlying condition should help. A GP can suggest possible treatment options.

Treating premature ejaculation caused by psychological factors can be more challenging. But most men who persevere with treatment find the problem resolves.

Self-help

There are a number of self-help techniques you can try before getting medical help.

These include:

  • masturbating 1 to 2 hours before having sex
  • using a thick condom to help decrease sensation
  • taking a deep breath to briefly shut down the ejaculatory reflex (an automatic reflex of the body, during which you ejaculate)
  • having sex with your partner on top (to allow them to pull away when you're close to ejaculating)
  • taking breaks during sex and distracting yourself by thinking about something completely different

If you're in a long-term relationship, you may benefit from having couples therapy.

You'll be encouraged to explore issues that may be affecting your relationship and be given advice on how to resolve them. You may also be shown techniques that can help you "unlearn" the habit of premature ejaculation.

Medicine

Selective serotonin reuptake inhibitors (SSRIs) can be used if self-help techniques do not improve the problem. SSRIs are mainly used to treat depression, but one of their side effects is delaying ejaculation.

Dapoxetine is an SSRI specifically designed to treat premature ejaculation. It can be used "on demand". You'll usually be advised to take it between 1 and 3 hours before sex, but not more than once a day.

If dapoxetine does not work, your GP may recommend trying another SSRI on an "off-label" basis. This is when a medicine is used for a different purpose than it was licensed for. Doctors can prescribe an off-label medicine if they decide it's in the patient's best interest.

Other SSRIs that may be prescribed for premature ejaculation include paroxetine, sertraline or fluoxetine. You'll usually need to take these types of SSRIs for 1 or 2 weeks before gaining the full effects.

Anaesthetic creams and sprays such as lidocaine or prilocaine cream can help by making your penis less sensitive. Using an anaesthetic cream with a condom can be particularly effective. A GP should be able to recommend a suitable cream.

Page last reviewed: 21 July 2020
Next review due: 21 July 2023

Premature ejaculation (ejaculation) in men

Effective treatment for early ejaculation!

Premature ejaculation is a delicate issue that many choose to keep quiet and hide because of a false sense of shame and embarrassment. This is not worth doing, due to the fact that this disorder is progressive in nature. It will not disappear on its own over time or when taking dubious drugs - an integrated approach and treatment by doctors is required: an andrologist-urologist, a neurologist, a sexopathologist.

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What is premature ejaculation

Premature ejaculation (or early ejaculation) is a sexual disorder in which a man cannot maintain the desired duration of sexual intercourse. Ejaculation occurs during sex much faster than necessary. In severe and advanced forms, ejaculation in men can occur even before the penis enters the vagina, which makes sexual contact impossible or difficult, causes a feeling of sexual dissatisfaction in both partners and can become a trigger for the development of a number of complexes and complete renunciation of sexual life.

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  • Assistance even in difficult clinical cases, when premature ejaculation has a long chronic course, when there are related urological diseases, diseases of the nervous system, etc.

Causes of early ejaculation

Premature ejaculation can occur due to one or more reasons. It is very important to understand the origin of the sexual disorder, so you need to confidentially answer the questions of the andrologist, without hiding important points.

It is customary to divide four groups of causes of dysfunction in men:

  • Physiological
  • Psycho-emotional
  • Organic
  • Toxic

The physiological causes of early ejaculation lie in the increased sensitivity of the skin of the head of the penis, low testosterone levels and other features of the body and the functioning of the genitourinary system. Sometimes there is a hereditary factor - if the problem is transmitted through the male line, then in this case special attention to men's health is required from an early age, before the problem of premature ejaculation appears.

Psycho-emotional causes of premature ejaculation may lie in internal factors or in relationships with a partner. Internal factors of early ejaculation are stresses, experiences, an accelerated pace of life, chronic fatigue, prolonged being in a state of emotional or mental overstrain. Failures at work, loss of loved ones, financial collapse - all this and more can cause a decrease in libido and potency, affect the duration of sex. As for relationships with a partner, misunderstanding between partners, jealousy, distrust, frequent conflicts, and the inability to achieve orgasm can lead to premature ejaculation and other sexual disorders. If there was at least one failure, this can cause a fixation on this situation and the development of fear of sexual intercourse. Anxiety and negative memories often accompany a man during sex, leading to serious frustration, even if there was a change of partner. The psychological factor is not eliminated by itself, and it makes no sense to uncontrollably try to use other means to satisfy yourself or your partner, to achieve orgasm.

Organic causes of premature ejaculation most often lie in various hormonal disorders, diseases of the genitourinary system, injuries of the lumbosacral spine or genital organs. That is, there is some kind of pathological or traumatic process due to which early ejaculation occurs. Quite often, phimosis, balanoposthitis, prostatitis, vesiculitis, and sexual infections become the cause of premature ejaculation. These diseases can significantly reduce the duration of an erection during intercourse.

The toxic causes of early ejaculation lie in the excessive use of alcohol and drugs, heavy smoking, while taking certain medications. That is, there is a general poisoning of the body, because of which the sexual function is inhibited. Against the background of the use of toxic agents, an erection may not occur at all.

Classification and stages of early ejaculation

According to the classification, primary and secondary premature ejaculation are distinguished. In the first case, we are talking about a problem that has been observed since the onset of sexual activity, that is, the patient encounters it at a young age already at the first sexual contact. Sex with a partner is difficult or impossible at all. Secondary premature ejaculation manifests itself already at an older age - this can occur at any period of sexual life.

As for the stages, they share the initial and advanced stages of early ejaculation. The initial one may appear sporadically at first, then premature ejaculation becomes regular and progresses to a more severe form. Launched premature ejaculation, as a rule, occurs almost immediately after the excitation of the penis and does not make it possible to have sexual contact with a partner and achieve orgasm.

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Premature ejaculation in men. Causes, symptoms, treatment

Diagnosis of early ejaculation

It is extremely important to conduct a differential diagnosis and understand the cause of premature ejaculation. Otherwise, all treatment will be temporary or will not be successful.

First of all, the urologist-andrologist collects an anamnesis and clarifies with the patient all the features of the course of the disease. You should tell the doctor when the first cases of early ejaculation appeared, what preceded this, what is the regularity of sexual activity, whether there are psychogenic factors, diseases of the genitourinary system, whether there were or are sexual infections. To diagnose and evaluate prolonged sexual intercourse, there are many questionnaires and tests that a specialist uses as part of the initial appointment.

Based on the anamnesis and conversation with patients, the andrologist prescribes an individual examination.

The most common studies are:

  • Lidocaine test - performed to diagnose the sensitivity of the glans penis. It is not painful, not dangerous, without intervention. Emla cream or Lidocaine spray is applied to the head of the penis 20 minutes before sexual intercourse, 10 minutes before the composition is washed off with water and soap. If the duration of the act increases, ejaculation is restored, then skin hypersensitivity is established.
  • Ultrasound - is prescribed to assess the condition of the prostate gland and seminal vesicles and provides important information about the state of internal structures
  • Clinical blood tests are prescribed to assess the hormonal status, determine the level of sex and thyroid hormones
  • Electroencephalography - performed to assess the functional state of the brain and nervous status
  • PCR-diagnostics - appointed to detect latent infections
  • Urethroscopy is an endoscopy performed to examine the urethra (urethra)
  • Microbiological tests - ordered to exclude chronic prostatitis and other urological diseases

Treatment of premature ejaculation

When choosing tactics for the treatment of premature ejaculation, the doctor takes into account the patient's age, classification and stage of premature ejaculation, the presence of chronic diseases, anatomical features of the structure of the genitourinary system.

The following methods of treatment of premature ejaculation are used:

  • Medicinal
  • Surgical
  • Injectables
  • Behavioral

Medical therapy

Drug therapy can be aimed at treating existing diseases of the genitourinary system, genital infections. Also, with increased excitability of the central nervous system, psychotropic drugs can be prescribed. There are a large number of inhibitors that can affect sexual function, ensure the elimination of early ejaculation and sexual problems. Most drugs have strict indications and contraindications, they can not be taken on their own and without medical supervision.

Surgical methods

Surgical methods used to treat premature ejaculation: circumcision, penile frenuloplasty, partial penile neurotomy. Surgical intervention for early ejaculation is resorted to according to strict indications and only with a forecast that the treatment will achieve the desired effect.

Circumcision allows you to eliminate excess skin of the glans penis, which entails the prevention of many inflammatory diseases and increases the sensitivity of the glans itself. After excision, the skin around the head of the penis coarsens, which in some cases eliminates premature ejaculation and prolongs sexual intercourse.

Frenuloplasty may be shown if it is too short. The fact is that this place is a highly sensitive area, and when correcting the position of the frenulum, it is possible to eliminate premature ejaculation caused by the anatomical features of its structure.

Partial penile neurotomy is performed for the purpose of layer-by-layer dissection of the skin and intersection of nerves. After the operation, the man returns to a stable sexual life and a new "reflex" is formed - the duration of sexual intercourse increases. This method of treating premature ejaculation is considered radical, it is resorted to according to indications and the inability to improve the quality of sex in other ways.

Injection techniques

Injections of hyaluronic acid into the penis have long established themselves not only as a penis enlargement procedure, but also as an effective way to combat premature ejaculation. The procedure uses hyaluronic acid, a safe medical substance. In our body, hyaluronic acid is found in connective tissue, that is, lymph, blood, bones, cartilage, and also in the dermis. This means that the drug does not cause an allergic reaction and is tolerated by patients without complications.

The drug is evenly distributed over the entire length of the organ. Injections are carried out using a thin needle, having previously anesthetized the injection site. The patient easily tolerates the procedure, without pain. The procedure takes place on an outpatient basis during the appointment of a urologist, hospitalization is not required. It takes only 15-20 minutes, and the effect is enough for at least 1.5 years.

Behavioral methods

Behavioral Techniques: There are techniques (“start-stop”, “squeeze”, etc. ) that allow you to control ejaculation. The exercises are simple, and after a while they help to form natural reflexes during friction.

Prognosis for the treatment of premature ejaculation

Predictions for the treatment of premature ejaculation are favorable with timely access to a doctor and compliance with all specialist prescriptions. With advanced forms, a comprehensive approach is usually required, including psychological correction, but even in these clinical cases, it is possible to help a man get rid of sexual problems.

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Urologist recommends: treatment of premature ejaculation with fillers

Early ejaculation is one of the most common types of sexual disorders. According to various estimates, it is diagnosed in 4-39% of men in the world.

Because of her, millions of men cannot satisfy their partner and enjoy sexual intercourse. However, this disease will not pose a great danger to the couple's intimate life if the man turns to the help of specialists in time.

Diagnostic criteria for premature ejaculation:

- Ejaculation occurs at the slightest sexual stimulation before the moment of insertion of the penis, during or immediately after insertion, resulting in problems in communicating with a partner.

- Premature ejaculation is not associated with the action of any pharmacological preparations.

What to do if a man has premature ejaculation?

With this diagnosis, doctors recommend the following:

- drug therapy using drugs that eliminate inflammation and infection. If premature ejaculation is caused by nervous disorders, then the use of antidepressants and reflexology sessions are prescribed;

- sexologist assistance. Consultation of a specialist is most effective in the case when premature ejaculation is caused by psychological reasons;

- surgery. It is used in a situation where a man has an increased sensitivity of the penis, which makes it impossible to control the process of orgasm. Surgical operations include circumcision and denervation - cutting off part of the nerves.

- injections with hyaluronic acid.

In our medical center, urologist-andrologist Mendelyan Shavarsh Samvelovich uses a highly effective method of treating premature ejaculation with high molecular weight hyaluronic acid fillers.

The injection of a hyaluronic acid gel separates the superficial layer of the scalp from the nerve endings, and thus causes a decrease in the sensitivity of the penis.

When the filler is injected, the appearance of the glans penis also changes: it becomes larger and more expressive.

Depending on the technique and methodology, it is possible to inject from 2 to 3 ml of high molecular weight hyaluronic acid.

Learn more