Premature Ejaculation

Diagnosis

Your healthcare provider will inquire about your sexual activity and medical history during your consultation. A physical examination may also be conducted. If you experience both premature ejaculation and erectile difficulties, your doctor may suggest blood tests to evaluate hormone levels. Depending on your specific circumstances, you may be referred to a urologist or a mental health specialist specializing in sexual concerns for further assistance.

Treatment

Common treatments for premature ejaculation include behavioral techniques, medications, and counseling. Finding the most effective treatment or combination of treatments for your situation may take time. Combining behavioral therapy with medication could be the most effective approach.

Behavioral techniques

In certain instances, therapy for premature ejaculation may involve straightforward measures. These may entail engaging in masturbation an hour or two prior to intercourse. This practice could help in delaying ejaculation during sexual activity with your partner. Your doctor might suggest abstaining from intercourse for a period, redirecting focus towards alternative forms of sexual exploration to alleviate any pressure felt during intercourse.

Pelvic floor exercises

Weak pelvic floor muscles may hinder the ability to delay ejaculation. Pelvic floor exercises, commonly known as Kegel exercises, can aid in strengthening these muscles.

To execute these exercises:

• Locate the appropriate muscles. Stop midway urination to locate your pelvic floor muscles. Alternatively, tense the muscles preventing you from exhaling gas. Your pelvic floor muscles are used in both actions. You may work on your pelvic floor muscles in any posture after you’ve recognized them. At first, though, you might find it easier to perform them while lying down.
• Get the technique just right. Your pelvic floor muscles should be taut for three seconds, then released for the same amount of time. Repeat a couple times after that. Try performing Kegel exercises while sitting, standing, or walking as your muscles become stronger.
• Remain concentrated. Concentrate solely on contracting your pelvic floor muscles for optimal outcomes. Take cautious not to flex your buttocks, thighs, or abdomen muscles. Do not hold your breath. Breathe freely instead while performing the exercises.
• Carry out three times daily. Try to complete three sets of ten repetitions or more each day.

The pause-squeeze technique

Your doctor may recommend utilizing the pause-squeeze technique, which functions as follows:

1. Start engaging in sexual activities, such as penile stimulation, when you are nearly ready to ejaculate.
2. Next, you or your partner can apply pressure to the point where the head and shaft of your penis meet. Squeeze for a few more seconds, or until the impulse to ejaculate subsides.
3. If necessary, repeat the squeezing procedure.

You can get to the point where you penetrate your partner without ejaculating by repeating as many times as necessary. Delaying ejaculation may become automatic after some practice and no longer require the pause-squeeze method.

Try the stop-start approach if the pause-squeeze method hurts or is uncomfortable for you. It entails ceasing all sexual activity right before ejaculation. Then pausing till the excitation has subsided before proceeding once more.

Condoms

By lessening penile sensitivity, condoms may assist delay ejaculation. Condoms with a special “climax control” design can be purchased over-the-counter. To delay ejaculation, these condoms contain numbing substances like lidocaine or benzocaine. They may also be composed of more robust latex. Durex Prolong and Trojan Extended Pleasure are two examples.

Medications

Topical numbing agents

For the treatment of premature ejaculation, numbing agents such prilocaine, lidocaine, or benzocaine are occasionally used in creams, gels, and sprays. Ten to fifteen minutes prior to intercourse, they are placed to the penis to lessen sensation and aid in delaying ejaculation. You can get them without a prescription. On the other hand, EMLA, a cream with prilocaine and lidocaine combined, is only available with a prescription. Topical numbing medications have possible negative effects despite being safe and effective. They might result in reduced sensation and sexual pleasure for both partners.

Oral medications

Several medications have the potential to delay orgasm. While not specifically approved by the Food and Drug Administration for treating premature ejaculation, some medications are employed for this purpose. They encompass antidepressants, pain relievers, and drugs for erectile dysfunction.

These medications may be prescribed for either on-demand or daily use and can be administered alone or in conjunction with other treatments.

• Antidepressants. Certain antidepressants, such as Selective Serotonin Reuptake Inhibitors (SSRIs), have a side effect of delayed orgasm, making them useful in treating premature ejaculation. Common SSRIs utilized for this purpose include paroxetine, escitalopram, citalopram, sertraline, and fluoxetine.
  If SSRIs fail to improve ejaculation timing, your doctor might prescribe the tricyclic antidepressant clomipramine. Common side effects of antidepressants may include nausea, sweating, drowsiness, and decreased libido.
• Pain relievers. Tramadol is a pain medication known to have side effects that can delay ejaculation. It may be prescribed if SSRIs have not proven effective. However, tramadol cannot be used simultaneously with an SSRI.
  Common side effects of tramadol may include nausea, headache, drowsiness, and dizziness. Long-term use of tramadol may lead to dependence.
• Phosphodiesterase-5 inhibitors. Certain medications prescribed for erectile dysfunction may also offer benefits in treating premature ejaculation. These drugs encompass sildenafil, tadalafil, avanafil, and vardenafil. Potential side effects may include headache, facial flushing, and indigestion.

Combining these medications with an SSRI might enhance their effectiveness in managing premature ejaculation.

Potential future treatment

Studies indicate that various medications may hold promise in the treatment of premature ejaculation. However, further research is warranted to ascertain their efficacy. These medications include:

• Modafinil. This is a therapy for the sleep disorder known as narcolepsy.
• Silodosin. This medication addresses enlarged prostate glands.
• OnabotulinumtoxinA (Botox). Investigations are underway to determine if injecting Botox into the muscles involved in ejaculation could serve as a treatment for premature ejaculation.

Counseling

This approach involves having conversations with a mental health professional about your relationships and personal experiences. These sessions aim to address performance anxiety, develop healthier coping mechanisms for managing stress, and improve intimacy. Counseling is most effective when used alongside medication therapy.

Premature ejaculation can lead to feelings of anger, shame, and distress, resulting in a sense of disconnection from your partner. Similarly, your partner may experience emotional turmoil due to changes in sexual intimacy, feeling less connected or hurt. Open communication about the issue is crucial. Relationship counseling or sex therapy can provide valuable support and guidance in addressing these concerns.