How to Treat Premature Ejaculation

Premature ejaculation (PE) is one of the most common types of sexual dysfunction in men. Approximately 30% of men will deal with some form of it in their lives.

About 30% of men face the problem of premature ejaculation
About 30% of men will experience premature ejaculation

Men with premature ejaculation struggle to delay climax and thus ejaculate within 1-2 minutes of penetration. This is a problem that can lead to distress and frustration in both the man and his partner.

Try our online diagnostic tool. You can also read about the four types of premature ejaculation.

The primary treatments for premature ejaculation include the Stop-Start method, the Pause-Squeeze technique, medications, topical anesthetics and counseling. Often a combination of treatments yields the best results.

Luckily, PE is considered to be one of the most treatable sexual dysfunctions.

Behavioral Methods

  1. The Stop-Start Method

    The Stop-Start method can help you identify the signs leading up to climax, so that you can stop before ejaculation. You then practice repeatedly stopping the stimulation just before orgasm.

    With practice, your stamina will improve naturally, which in turn can help delay ejaculation during sex.

    To use the Stop-Start Method:

    1. You or your partner stimulate your penis until you are almost at the point of climax.
    2. Stop stimulation. Wait for 30-60 seconds and allow the arousal levels to subside.
    3. Once you’re relaxed, start stimulating the penis again.
    4. Repeat this process three times.
    5. After the third stop, stimulate the penis until you ejaculate.
    A graph that shows the ejaculation process while practicing the stop-start and squeeze technique exercises for premature ejaculation
    Process of ejaculation during the exercises

  2. The Pause-Squeeze Technique

    The Pause-Squeeze technique is meant to help you improve your ejaculatory control and to delay ejaculation. It is similar to the Stop-Start method but includes a small alteration. When you are nearing climax, you or your partner should use two fingers and the thumb to squeeze the area below the head of the penis (glans) to delay orgasm.

    To use the Pause-Squeeze technique:

    1. You or your partner stimulate your penis until you are almost at the point of climax.
    2. Stop stimulation. Firmly squeeze the penis glans using your thumb and the opposite two fingers.
    3. Hold the squeeze for about 10 seconds and allow the arousal to subside.
    4. Once you’re relaxed, start stimulating the penis again.
    5. Repeat this process three times.
    6. After the third stop, stimulate the penis until you ejaculate.

For How Long Should You Practice?

You should practice the Stop-Start or Pause-Squeeze exercises at least 3 times per week. Most men will take from 4 to 12 weeks to see the full effects.

With enough practice, you should be able to delay ejaculation even when you are not using the Stop-Start method or the Pause-Squeeze technique.

A graph that shows the process of ejaculation of men without premature ejaculation
Normal Process of Ejaculation

Efficacy

Up to 90% of men can be helped with these techniques. This 2006 study shows a nearly 900% increase in the duration of intercourse for premature ejaculation patients.

The Stop-Start method and the Pause-Squeeze techniques have been in use by sex therapists for over 5 decades. Numerous studies have demonstrated their efficacy.

How to Get Started

To get started, you can schedule a session with a certified sex therapist. He will create a personalized treatment plan. You will return to the sex therapist to follow-up so he can adjust your personal plan based on your progress.

An organized treatment plan will include a number of steps. Each step should provide a higher level of stimulation than the previous one.

If you plan to practice with a partner, it’s important to let her know and make sure she is onboard. The Stop-Start method is only intended to be used during practice and not during regular sexual relations.

Another option is the PE Program. This is a smart online program that is based on the Stop-Start method and the Pause-Squeeze technique. You can learn more about it here.

The PE Program
The PE Program – A personalized Exercise Program for Premature Ejaculation

Pelvic Floor Exercises

Recent studies suggest that strengthening the pelvic floor muscles may help delay ejaculation. Treatment teaches men to identify the muscles involved in pelvic floor contraction; and then strengthening these muscles.

How to Perform the Exercises

  1. Sit or lay down.
  2. Relax your abdominal and leg muscles – these muscles should never be active when you do pelvic floor exercises.
  3. Find your pelvic floor muscles. Think of these as the muscles you would squeeze if you wanted to stop urinating or prevent yourself from passing gas. You may feel a pulling sensation in your anus, or your penis may move slightly.
  4. Squeeze your muscles for about 5 seconds and then relax for another 5 seconds. As your muscles strengthen, you can squeeze for up to 10 seconds. A squeeze-relax cycle is one repetition; try to do 30 repetitions at least twice a day.
  5. Remember to breathe normally and to focus only on your pelvic floor muscles as you do these exercises.
  6. As you progress, you can do these exercises standing up, or even as you do your daily activities.

Efficacy

A 2014 study showed that with 12 weeks of treatment, 33 out of 40 men increased their ejaculation times from an average of 39 seconds to an average of 140 seconds.

The effectiveness of pelvic floor exercises as a treatment still needs further investigation. For this reason we have decided not to include pelvic floor exercises in the PE Program.

Oral Medications

oral medications for premature ejaculation
Prescription Antidepressants Can Help but may have Side-Effects

Some antidepressants medications from the SSRI group, such as Paroxetine (Paxil) and Fluoxetine (Prozac) may have the side effect of delaying ejaculation. Certain analgesics (pain killers) also have this side effect.

Although these drugs are not approved by the FDA to treat premature ejaculation, doctors prescribe them ‘off-label’ anyway. ‘Off-label’ use means taking advantage of the side-effects of a medication. So, while antidepressants were designed to treat depression, the side-effects can help with premature ejaculation.

Often, a combination of drug therapy and behavioral techniques (such as the Pause-Squeeze technique and the Stop-Start method) provide the best chances of success.

Common Medications for Treating Premature Ejaculation:

  1. Antidepressant Medications

    Selective serotonin reuptake inhibitors (SSRIs) are the most common medications used to treat premature ejaculation.

    Commonly Prescribed SSRIs

    Some studies suggest Paxil may be the best option, as it can delay ejaculation for an average of nine minutes.

    It is taken once a day and you can slowly increase the dose every 3 or 4 weeks. It may take several weeks to see full results. Men need to keep taking the medication indefinitely to continue to see results.

    Common side effects of SSRIs include sleepiness or insomnia, a decreased sex drive, nausea, perspiration and perspiration.

  2. Anafranil (clomipramine)

    This is a tricyclic antidepressant that is used to delay ejaculation. It is usually taken if SSRIs don’t work or if they cause negative side effects. Anafranil is taken 5-6 hours before sex.

    Some side effects include dizziness, sleepiness, dry mouth and changes in sex drive.

  3. Ultram (tramadol)

    is a pain medication that can also help with premature ejaculation. It is used when other medications don’t work as it can be addictive. It should be taken an hour before sex.

    Common side effects include constipation, nausea, dizziness, and headaches.

  4. Phosphodiesterase 5 Inhibitors (Viagra, Cialis, Levitra)

    These medications are sometimes used to treat men who have both erectile dysfunction and premature ejaculation. If you don’t suffer from both conditions, these medications may not help to delay ejaculation.

    If you’d like to learn more about these treatments, read this article.

  5. Dapoxetine (Priligy)

    A new prescription SSRI drug for premature ejaculation called Dapoxetine (Priligy) has hit European markets. It still awaits clinical drug trials in the USA.

    Recent studies [1][2][3] show that approximately 90% of men discontinued using the drug after 12 months. The main reasons mentioned were that the effect of the drug did not meet their expectations or did not work at all. Other reasons included the drug’s costs, side effects and a resultant loss of interest in sex.

    Dapoxetine has to be taken 1-3 hours before sex.

    The most common side effects include yawning, nausea, dizziness and headaches.

    pie chart that shows the discontinuation rates of Priligy
    90% of Men Discontinued Using the Drug After 12 Months

Where to Seek Treatment

Since all of these drugs require a prescription, you will have to schedule an appointment with a licensed doctor or a sex therapist.

You can find a list of sex therapists near you on the AASECT website. Be aware that not all sex therapists will be able to prescribe medications.

Topical Anesthetics

Topical anesthetics sprays and creams that contain a numbing agent are often used to treat premature ejaculation. These creams usually contain Prilocaine, Lidocaine or Benzocaine. These anesthetics delay ejaculation by reducing sensation to the penis. You should apply the cream or spray to the flaccid penis about 5-20 minutes before sex.

a picture of Promescent, a numbing spray for premature ejaculation
Numbing Materials Usually Come in the Form of a Spray or Cream Which you Apply to the Penis

Some studies have shown that topical anesthetics can help men delay orgasm by up to 6.3 times.

Leading Brands

Some of the leading brands include EMLA cream (which requires a prescription), stud100 and Promescent.

You can purchase most of these topical sprays or creams in pharmacies without a prescription. They are also available in many online stores.

*We may receive a portion of revenues if you purchase a topical anesthetic using a link on this page.

Side Effects

Some side effects may include a temporary loss of sensitivity to the penis and decreased sexual enjoyment, which may lead to erectile dysfunction.

There is a risk that the cream or spray could be absorbed by your partner, causing them to also become numb. It is crucial to make sure the desensitizing cream or spray is completely absorbed or wiped off before penetration or oral sex.

Condoms

delay condoms for premature ejaculation

Condoms may help men delay ejaculation by reducing sensitivity to the penis. Thicker condoms may work better than regular condoms in this regard.

There are also condoms which have numbing agents inside them, such as lidocaine and prilocaine, which reduce sensitivity even further. The numbing agent takes about 5-20 minutes to be absorbed.

Some of the leading delay condoms include Trojan Extended Control condoms and Durex Prolong condoms.

*We may receive a portion of revenues if you purchase condoms using a link on this page.

Psychological Treatment for Performance Anxiety

Treating performance anxiety may resolve or improve premature ejaculation. Studies suggest that performance anxiety may be a cause in a large number of men. Alternatively, performance anxiety may worsen pre-existing cases. Performance anxiety is more likely to be the cause in men with acquired premature ejaculation.

How to Treat Performance Anxiety

Licensed Therapist

Man consulting a therapist about performance anxiety

You may benefit from seeking out a licensed therapist to help manage and overcome these issues. You can do this alongside another treatment, or as a sole treatment option.

Your therapist might suggest that you avoid sex for a period of time. This might help alleviate stress, frustration and anxiety. Instead, you engage in sexual activities that do not include penetration. This allows you to enjoy sex without worrying about ejaculating prematurely.

In the Plus and Premium packages of the PE Program, we offer our clients the option to consult with a sex therapist about sexual issues, including performance anxiety.

Guided Imagery Relaxation Method

A man listening to a guided imagery recording for performance anxiety

Another great tool for treating performance anxiety and premature ejaculation is guided imagery: a relaxation method that involves imagining positive scenarios.

You can learn more about performance anxiety and premature ejaculation in this article.

Counseling

Couple in counseling for premature ejaculation problems

Relationship issues can cause or worsen premature ejaculation. Therefore, resolving relationship issues may help.

Often, men feel embarrassed and find it difficult to speak openly with their partners. Seeking out a therapist, especially if your partner is willing to go with you, can really help you to deal with premature ejaculation.

Men often choose to combine counseling with the Pause-Squeeze technique/Stop-Start method, as well as using oral medications at times . In fact, combining different treatments increases your chances of success.

In our Plus and Premium packages for the PE program, we offer a combination of treatments. You can choose from relationship consultation with sex therapy experts and personal exercise plans to achieve your goals.

Alternative Treatments

a bottle of supplements for premature ejaculation

Alternative treatment methods such as yoga, acupuncture, zinc supplements, Ayurvedic herbal medicine, Chinese herbal medicine, dietary changes and certain foods have been suggested. Unfortunately, there is not sufficient scientific evidence at this time to show that they help.

Masturbate Before Sex

Masturbating for 1-2 hours before sex may help you delay ejaculation by helping you to release sexual pressure and reduce sensitivity. Remember that the older you get, the longer it will take you to get an erection after orgasm.

It is important to pay attention to the sensations when you masturbate — try not to ejaculation too quickly. You may be accidentally training yourself to ejaculate prematurely.

For more information read our guide for healthy masturbation.

When to See a Doctor

Usually there is no need to see a doctor about premature ejaculation because the causes are typically not medical in nature. Cases in which PE is caused by an underlying medical condition is when you should see a doctor.

This most commonly occurs in men who notice a rapid onset of premature ejaculation, associated with other symptoms, like:

  • Painful ejaculation
  • Changes in sensation
  • Erectile dysfunction

Erectile dysfunction, a condition that is associated with many medical problems.

Many men may feel embarrassed or apprehensive to talk about this issue. Don’t let this keep you from consulting your doctor. A doctor will be able to reassure you and help you find the best treatments that will work for you, while also ensuring that your symptoms are not caused by a potentially dangerous medical condition.

Premature Ejaculation is Treatable

Premature ejaculation is a very common sexual dysfunction, and it is nothing to be ashamed of. Luckily, it is also one of the most treatable sexual conditions.

The squeeze technique and the Stop-Start exercises are two solutions that can help. The PE Program or a trained sex therapist can teach you to use these methods effectively.

Topical creams or sprays and antidepressants can treat the symptoms of premature ejaculation. Combining treatments might be even more effective.

Don’t let this issue discourage you! Take action sooner rather than later, and this could all be behind you.

Click here to learn more about the PE Program.

About Daniel Sher

Clinical Psychologist

Daniel Sher is a registered clinical psychologist practicing in Cape Town, South Africa. Daniel completed his master’s degree in clinical psychology at the University of Cape Town (UCT) in 2014. A component of his training and practice involves working in the context of sexual and sex-related issues.

Daniel serves as a professional consultant for the Between Us Clinic, where he writes, edits, and reviews, professional materials and articles.