How to Manage Premature Ejaculation

Premature ejaculation is a condition where a man reaches orgasm earlier than desired during sexual activity. The diagnosis criteria include consistently ejaculating within one minute after starting intercourse or being unable to delay ejaculation. For most men, the average ejaculation time is around five minutes. This condition can lead to frustration and embarrassment, with some even avoiding intimacy with their partner. However, it can be addressed through counseling, techniques to delay ejaculation, and medications. Once this issue is resolved, both partners can enjoy a more relaxed sexual experience.

Use the stop-start method. If both partners are willing, this technique can help delay premature ejaculation.

• Stimulate the penis without engaging in full intercourse. Pay attention to the moment just before ejaculation.
• Ask your partner to gently squeeze the base of the penis where it meets the shaft. Hold the squeeze for a few seconds until arousal subsides.
• After about 30 seconds, resume foreplay and repeat the step if necessary. This allows for better control and can lead to intercourse without premature ejaculation.
• An alternative version of the stop-start method is the start-stop technique. This method works similarly but skips the squeezing step altogether.

Use self-help techniques. This method involves doing things on your own to help extend the time before ejaculation:

• Masterbate before intercourse. If you plan to be intimate in the evening, consider masturbating 1-2 hours beforehand.
• Wear thicker condoms to reduce sensitivity. These types of condoms help prolong the time it takes for you to reach orgasm. Avoid those designed to increase stimulation.
• Take deep breaths just before orgasm. This can help prevent the reflex of ejaculation. Alternatively, think about something else to distract yourself and ease the intense arousal.

Change positions during intercourse. If you typically take the top position, try switching to one where your partner can take control when nearing orgasm.

• You can then resume intercourse once the excitement has diminished.

Seek counseling. You can go alone or with your partner. This provides emotional support when dealing with:

• Anxiety or stress in life. Sometimes, men’s anxiety about their ability to maintain an erection is the root cause of premature ejaculation.
• Childhood sexual trauma. Some psychologists believe early sexual experiences, such as feeling guilty or fearing being caught, can lead to premature ejaculation.
• If you and your partner are facing relationship issues, this too can contribute to the problem. You might be experiencing this if it has only recently developed and didn’t occur in previous relationships. If so, both of you should consider counseling for help.

Topical numbing agents. These are available as sprays or creams. You can apply them to the penis before intercourse to reduce sensitivity and help delay orgasm. In some cases, both partners may temporarily lose sensitivity and feel less aroused. Some common options include:

• Lidocaine
• Prilocaine

Visit a doctor if self-help techniques don’t work. Sometimes premature ejaculation is a symptom of an underlying issue that needs treatment. Here are a few possibilities:

• Diabetes
• High blood pressure
• Alcohol or drug abuse
• Multiple sclerosis
• Prostate problems
• Depression
• Hormonal imbalances
• Neurological issues. Neurotransmitters are chemicals that carry signals in the brain.
• Abnormal reflex in the ejaculation system
• Thyroid problems
• Prostate or urethral infections
• Surgical or traumatic injury. This is not a common cause.
• Genetic disorders.

Consult your doctor about Dapoxetine (Priligy). This medication is similar to selective serotonin reuptake inhibitors (SSRIs), but specifically designed to treat premature ejaculation. It's a newer drug. When prescribed, you need to take it one to three hours before intercourse.

• Do not take more than once a day. Side effects may include headaches, dizziness, and discomfort.
• This medication is not for people with heart, liver, or kidney problems, as it may interact with other medications, including other antidepressants.

Talk to your doctor about other medications that may extend ejaculation time. These drugs are not FDA-approved for premature ejaculation or delaying orgasm, but your doctor might prescribe them if necessary, either on a daily basis or as needed.

• Other antidepressants. Some options include SSRIs like sertraline (Zoloft), paroxetine (Paxil), fluoxetine (Prozac, Sarafem), or tricyclic clomipramine (Anafranil). Side effects can include nausea, dry mouth, dizziness, and reduced sexual interest.
• Tramadol (Ultram). This painkiller has a side effect of delaying ejaculation, though it may also cause nausea, headaches, and dizziness.
• Drugs used for erectile dysfunction treatment. These include sildenafil (Viagra, Revatio), tadalafil (Cialis, Adcirca), and vardenafil (Levitra, Staxyn). Side effects can include headaches, facial flushing, vision changes, and nasal congestion.