Premature Ejaculation

Diagnosis

To diagnose premature ejaculation, a healthcare provider asks questions about sexual activity and overall health history. A physical examination may also be performed. When premature ejaculation occurs along with difficulty getting or maintaining an erection, blood tests may be ordered to check hormone levels.

In some situations, a referral may be made to a urologist or a mental health professional who specializes in sexual health concerns.

Treatment

Treatment for premature ejaculation often includes behavioral techniques, medications, counseling, or a combination of these approaches. Finding the most effective treatment may take time. In many cases, combining behavioral therapy with medication provides the best results.

Behavioral techniques

Simple behavioral steps may help delay ejaculation. These can include masturbating one or two hours before sexual activity, which may allow better control during intercourse. Temporarily avoiding intercourse and focusing on other forms of sexual intimacy may also reduce pressure and performance anxiety.

Pelvic floor exercises

Weak pelvic floor muscles can make ejaculation control more difficult. Pelvic floor exercises help strengthen these muscles and improve control.

Steps involved in pelvic floor exercises include:

• Identifying the correct muscles by stopping urination midstream or tightening muscles used to prevent passing gas

• Tightening the pelvic floor muscles for three seconds, then relaxing for three seconds

• Gradually performing the exercises while sitting, standing, or walking

• Avoiding tightening the abdomen, thighs, or buttocks and breathing normally

• Completing three sets of 10 repetitions daily

The pause-squeeze technique

This technique involves sexual stimulation until ejaculation feels imminent. At that point, pressure is applied to the head of the penis for several seconds until the urge subsides. This process is repeated as needed. With practice, ejaculation control may improve without needing the technique.

If discomfort occurs, the stop-start technique may be used instead. Sexual stimulation is stopped just before ejaculation, resumed once arousal decreases, and repeated as necessary.

Condoms

Condoms can reduce penile sensitivity and help delay ejaculation. Some condoms are specifically designed for climax control and may contain mild numbing agents or be made of thicker material.

Medications

Medications may be used alone or alongside behavioral approaches to manage premature ejaculation.

Topical numbing agents

Creams, gels, or sprays containing benzocaine, lidocaine, or prilocaine are applied to the penis before intercourse to reduce sensation. These are generally effective but may reduce sexual pleasure for one or both partners.

Oral medications

Several oral medications may help delay ejaculation, though they are not specifically approved for this use.

• Antidepressants
  Certain antidepressants, particularly selective serotonin reuptake inhibitors such as paroxetine, sertraline, fluoxetine, escitalopram, and citalopram, can delay ejaculation. These medications usually take several days to begin working and may require a few weeks for full effect. Possible side effects include nausea, fatigue, sweating, and reduced sex drive.

• Pain relievers
  Tramadol may delay ejaculation when other medications are ineffective. It should not be taken with antidepressants and may cause side effects such as dizziness, nausea, or sleepiness. Long-term use carries a risk of dependence.

• Phosphodiesterase-5 inhibitors
  Medications used to treat erectile dysfunction, such as sildenafil or tadalafil, may also help with premature ejaculation, especially when combined with antidepressants. Side effects can include headache, flushing, and indigestion.

Potential future treatments

Research continues into other medications that may be helpful. These include drugs used for sleep disorders, prostate conditions, and injections such as botulinum toxin. Further studies are needed to confirm safety and effectiveness.

Counseling

Counseling involves working with a mental health professional to address emotional concerns, stress, or relationship difficulties linked to premature ejaculation. Counseling can help reduce performance anxiety and improve communication between partners. It is often most effective when combined with medication.

Premature ejaculation can affect emotional closeness, leading to feelings of frustration, embarrassment, or withdrawal. Partners may also feel distressed by changes in intimacy. Open communication, relationship counseling, or sex therapy may help both partners cope and strengthen their connection.