Ask the doctor: What works best for premature ejaculation?

Premature ejaculation is reaching sexual climax within one minute of starting intercourse. Another option is squeezing behind the head of the penis until the sensation passes.

How to prevent premature ejaculation

Numerous mechanisms have been invoked, including generalized or performance anxiety, unconscious negative feelings (hostility, fear) toward women, and unresolved marital problems. In addition to purely intrapsychic or relationship factors, a constitutionally faster ejaculatory reflex (based on shorter latency of bulbocavernosus reflex) has also been invoked. This latter finding appears to apply to primary premature ejaculators (premature ejaculation from the beginning of their sexual lives) but cannot be used for diagnosis because of the overlap of results with controls. The physician should be aware of the rare instances in which organic dysfunction is associated with premature ejaculation. The index of suspicion for an organic cause increases in cases where the problem is preceded by a period of normal performance (secondary failure of ejaculatory control).

Key Takeaways

Organic causes of premature ejaculation may include urologic conditions such as urethritis, prostatitis, and benign vardenafil 10 mg tablet prostatic hypertrophy. Careful review of the literature reveals poor substantiation of the belief that these urologic conditions cause premature ejaculation. Better accepted causes of premature ejaculation are instances in which the sympathetic nervous system has been directly lesioned (abdominal aortic aneurysm surgery and pelvic fractures). Premature ejaculation has also been reported after withdrawal from antipsychotics or narcotics, with the use of desipramine, and with alcoholism. The postulated association with cardiovascular disease, arteriosclerosis, or venous leakage is also poorly substantiated. To continue reading this article, you must log in.

• Dapoxetine is taken as needed, usually 1-3 hours before sex for rapid action.
• Topical anesthetics should be used sparingly to avoid numbness of partner.
• SSRIs may cause side effects like nausea, dizziness, or decreased libido.
• Tramadol carries potential for abuse and should only be used under medical supervision.
• Daily use of certain medications may be recommended for persistent PE.
• Psychological counseling helps address performance anxiety contributing to PE.
• Pelvic floor exercises improve control and delay ejaculation naturally.
• Partner involvement in therapy can improve treatment adherence.
• Discontinuing medication abruptly may cause withdrawal symptoms or rebound.
• For some men, combining therapy with lifestyle changes yields better results.
• Over-the-counter remedies should be approached cautiously and discussed with a doctor.
• Research continues into new pharmacological and non-pharmacological treatments.

Subscribe to HarvardHealthOnline+ FREE for 30 days for unlimited access to the site – where all content is reviewed by an HMS physician or faculty expert.

Product	Dosage	Quantity + Bonus	Price
Cialis Original	20mg	120 + 8 Pills	497.29€ 473.61€	Buy
Tadalista Super Active	20mg	90 + 10 Pills	314.14€ 299.18€	Buy
Cialis Generic	5mg	120 + 6 Pills	132.92€ 126.59€	Buy
Viagra Super Active	100mg	60 + 8 Pills	116.84€ 111.28€	Buy
Viagra Generic	200mg	90 + 6 Pills	170.79€ 162.66€	Buy
Cialis Generic	20mg	360 + 10 Pills	427.34€ 406.99€	Buy
Kamagra Gold	50 mg	180 + 6 Pills	371.27€ 353.59€	Buy
Kamagra Soft Tabs	100mg	180 + 8 Pills	425.45€ 405.19€	Buy
Priligy Generic Dapoxetine	60mg	30 + 6 Pills	106.65€ 101.57€	Buy
Viagra Generic	150mg	10 Pills	36.73€ 34.98€	Buy
Apcalis SX Oral Jelly	20mg	120 + 13 Sachets	280.38€ 267.03€	Buy
Kamagra Oral Jelly	100mg	110 + 9 Sachets	334.87€ 318.92€	Buy
Kamagra Effervescent Tablets	100 mg	14 Pills	51.61€ 49.15€	Buy
Cialis Generic	10mg	10 Pills	31.41€ 29.91€	Buy
Cialis Generic	40mg	360 + 10 Pills	477.87€ 455.11€	Buy
Cialis Generic	60mg	270 + 10 Pills	443.96€ 422.82€	Buy

With HHO+ you get these exclusive benefits: Unlimited access to all Harvard Health Online content Customized website experience aligned to your health goals In-depth health guides on topics like sleep, exercise, and more Members-only access to exclusive articles and resources UNLOCK EXPERT ACCESS for 30 days FREE!

Further information

These include systemic drug treatments (such as selective serotonin reuptake inhibitors, tricyclic antidepressants, phosphodiesterase type 5 inhibitors, and analgesics), topical anesthetic creams and sprays, and behavioral therapies (BTs) [7,8]. Behavioral and psychological therapies for PE include two main classes of therapy, with overlapping elements [1]. The first consists of psychotherapy (such as psychosexual or relationship counselling) for men and/or couples, to address psychological and interpersonal issues that may be contributing to PE. The second consists of physical techniques to help men develop sexual skills to delay ejaculation and improve sexual self‐confidence. The “stop‐start” technique, developed by Semans, involves the man or his partner stimulating the penis until he feels the urge to ejaculate, then stopping until the sensation passes; this is repeated a few times before allowing ejaculation to occur [9].

Paroxetine (Paxil®) for PE

The aim is to learn to recognize the feelings of arousal in order to improve control over ejaculation. With the related “squeeze” technique, proposed by Masters and Johnson, the man's partner stimulates the penis until he feels the urge to ejaculate, then squeezes the glans of the penis until the sensation passes; this is repeated before allowing ejaculation to occur [9]. Within sensate focus or sensate focusing [7], the man and his partner begin by focusing on touch, which excludes breasts, genitals, and intercourse, to encourage body awareness while reducing performance anxiety; this is followed by gradual reintroduction of genital touching and then full intercourse [10]. Pelvic floor muscle rehabilitation exercises may also assist with ejaculatory control [11]. The aim of this study was to systematically review ed gels the evidence base for BTs in the management of PE. As a service to our readers, Harvard Health Publishing provides access to our library of archived content.

• Topical anesthetic creams temporarily desensitize the penis to delay ejaculation.
• SSRI medications like paroxetine are prescribed off-label for premature ejaculation.
• Dapoxetine is a short-acting SSRI specifically approved for PE treatment.
• Tramadol, an opioid, can help delay ejaculation but carries dependency risks.
• Topical sprays offer quick, localized numbing effects to control ejaculation timing.
• PDE5 inhibitors like sildenafil may improve performance in men with PE and ED.
• Behavioral therapies include the stop-start and squeeze techniques to extend duration.
• Kegel exercises strengthen pelvic muscles, potentially delaying ejaculation.
• Counseling and sex therapy can address psychological causes of PE.
• Combining medication with behavioral techniques enhances treatment effectiveness.
• Herbal supplements lack robust clinical evidence but are used by some for PE.
• Consultation with a healthcare provider is essential to tailor appropriate therapy.

Please note the date of last review or update on all articles.

Beta-adrenergic Blocker

This definition insists, therefore, that the subjective dimension of the complaint be taken into account in the definition of the disorder. The definition listed in the International Classification of Diseases is also very interesting: “premature ejaculation entails an inability to control ejaculation sufficiently in order that both partners to enjoy sexual interaction (sexual relations? The relational notion, which was developed by Masters and Johnson but abandoned in early definitions of the DSM, makes its return in this definition from the WHO: sexuality, even sexual function, is hereby considered a matter of the couple. The disorder is vardenafil vilitra 60 mg not rapid ejaculation in itself, but primarily the inability to control ejaculation at the moment desired by the man, which has consequences for himself and for his partner. From this perspective, rapid ejaculation is thus a pathology of control and it is the inability to exercise this control over sexual function that has dysphoric implications for the man. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Additional info

It has been stated that premature ejaculation may be caused by certain neurologic conditions such as multiple sclerosis, spinal cord tumors, polyneuritis, and alcoholic neuropathy. A closer review of some of the quoted sources fails to reveal with clarity the evidence on which these statements are based, particularly in the case of multiple sclerosis and spinal cord tumors. We still recommend that the clinician search for elements in the history or neurologic examination that raise the possibility of a true organic neurologic disorder underlying premature ejaculation. If clinically warranted, further neurologic investigation (i.e., magnetic resonance imaging, evoked responses, and cerebrospinal fluid analysis to rule out multiple sclerosis) may be necessary. Otherwise, there are no neurologic or non-neurologic paraclinical investigations specifically indicated for premature ejaculation, and referral to a sexologist or sex therapist is the next recommended step.

Medications for premature ejaculation

2003, Office Practice of Neurology (Second Edition) Premature ejaculation was first listed in the classification of sexual disorders of the DSM III in 1980. It was defined as: “ejaculation occurring before the person desires it, due to a recurrent and persistent absence of reasonable control over ejaculation and orgasm during sexual activity”. The criteria of “control” was dropped after the revision of the DSM III-R in 1980 (1987?) and the following definition was listed: “persistent and recurrent ejaculation after minimal sexual stimulation, or before or shortly after penetration, and sooner than the person wishes”. In this first definition, we can consider premature ejaculation to be defined as an undesirable behavior. In 1994, with the publication of the DSM IV and its revised version, DSM IV-R, in 2000, the criteria of “personal or interpersonal distress”, that is to say the negative subjective impact of this behavior on the individual, was added to the definition of 1987: “(…) to ensure that changes or variations in sexual behavior that are not associated with dysfunction or distress are not diagnosed as a disorder” (Segraves, 2010). No drug is specifically approved by the US Food and Drug Administration (FDA) for the treatment of premature (early) ejaculation.

• Dapoxetine's side effects can include nausea, headache, and dizziness.
• Topical anesthetics include lidocaine and prilocaine-based creams or sprays.
• SSRIs like fluoxetine, sertraline, may also be used off-label for PE.
• Opioid medications require careful medical oversight due to dependency potential.
• Behavioral approaches are first-line treatment for many men with PE.
• Regular exercise can improve overall sexual function and control.
• Some innovations include vibration devices to delay ejaculation temporarily.
• Medical tests may be recommended to exclude underlying causes.
• Education about sexual response stages can improve control strategies.
• Sex therapy often involves both partners to address relational issues.
• Medications may take several weeks to show maximum benefit.
• Lifestyle modifications, like reducing alcohol, can also help manage PE.

However, various agents have been safely and effectively used for this purpose.

Side effects of premature ejaculation pills

PE can be either lifelong (primary, present since first sexual experiences) or acquired (secondary, beginning later). The 2014 update of the International Society for Sexual Medicine (ISSM) Guidelines for the Diagnosis and Treatment of Premature Ejaculation define PE as a combination of (i) ejaculation usually occurring within about 1 minute of vaginal penetration (for lifelong PE) or a clinically significant reduction in latency time, often to around 3 minutes or less (for acquired PE); (ii) inability to delay ejaculation; and (iii) negative personal consequences such as distress, bother, frustration, and/or the avoidance of sexual intimacy [1]. PE is similarly defined by Diagnostic and Statistical Manual of Mental Disorders 5 (DSM 5) (2013) as ejaculation usually occurring within about 1 minute of vaginal penetration and before the individual wishes it and causing clinically significant distress [1]. Estimating the prevalence of PE is not straightforward due to the difficulty in defining what constitutes clinically relevant PE. Surveys have estimated the prevalence of Diagnostic and Statistical Manual of Mental Disorders IV‐defined PE as 20–30% [2-4]; however, these estimates are likely to include men who have some concern about their ejaculatory function but do not meet the current diagnostic criteria for PE [1].

What are common premature ejaculation medications?

It has been suggested that the prevalence of lifelong PE according to the ISSM and DSM‐5 definitions (with an ejaculatory latency of about 1 minute) is unlikely to exceed 4% [1]. Men with PE are more likely to report lower levels of sexual functioning and satisfaction, and higher levels of personal distress and interpersonal difficulty, than men without PE [5]. They may also rate their overall quality of life as lower than that of men without PE [5]. In addition, their partner's satisfaction with the sexual relationship has been reported to decrease with increasing severity of the condition [6]. Management of PE may involve a range of interventions. Selective serotonin reuptake inhibitors (SSRIs) and antidepressants with SSRI-like effects have been the most successful.

Drug Name	Approval Year	Primary Use	Recommended Dosage	Prescription Needed	Monitor Required	Typical Side Effects
Dapoxetine	2009	Premature ejaculation	30 mg before sex	Yes	Yes	Nausea, dizziness
Paroxetine	Approved for other uses, off-label for PE	20 mg/day	Yes	Yes	Yes	Fatigue, sexual dysfunction
Sertraline	Approved for depression, off-label for PE	50 mg/day	Yes	Yes	Yes	Insomnia, digestive issues

Desensitizing creams containing local anesthetics can also be useful in some cases; though not FDA-approved, they are believed to be of at least some efficacy and carry minimal risk.

• Dapoxetine used before sex provides quick relief from PE.
• Topical anesthetic applications should be tailored to individual needs.
• SSRIs may cause delayed orgasm or decreased sexual desire.
• Tramadol is an alternative but carries substantial risks.
• Training with behavioral techniques can lead to lasting improvements.
• Fatigue and stress reduction support sexual performance.
• Pelvic floor strengthening is a natural method to control ejaculation.
• Psychological support addresses underlying emotional issues.
• Mechanical aids are an option for some men.
• Combining medications with psychotherapy enhances efficacy.
• Avoid self-medicating without professional advice.
• Consistent follow-up optimizes long-term management.