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Treatment of premature ejaculation

According to Dr Helen Kaplan (the expert sex therapist) the key to learning how to stop premature ejaculation is learning penile sensory awareness.

The Masters and Johnson squeeze technique is a classic treatment to stop premature ejaculation.

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Medication to stop premature ejaculation includes selective serotonin reuptake inhibitor SSRI) antidepressants like fluoxetine, citalopram, paroxetine, escitalopram and fluvoxamine. The latest drug specially designed to stop premature ejaculation is dapoxetine (Priligy). An older treatment to stop premature ejaculation is clomipramine (a tricyclic antidepressant) available as capsules and a nasal spray.

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Numbing creams and sprays can help to delay premature ejaculation.

Wearing a condom or specially designed thicker condoms can stop premature ejaculation.

Mental techniques such as thinking distracting thoughts can stop premature ejaculation.

Other devices to stop premature ejaculation include the St. George’s constriction device.

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What causes premature ejaculation? 

It is evolutionary advantageous to ejaculate quickly. In the past a man who came quickly was able to have sex and get a woman pregnant quickly and more reliably than men who came slowly. Imagine if you were a caveman and you took 40-50 minutes to ejaculate. You would be less succesful at fathering children than men who came in 1-2 minutes. Times have changed and now we are fortunate to have plenty of time to enjoy sex and take our time. Men generally however are still programmed to ejaculate quickly.

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So coming quickly is probably normal but times have changed. Like a lot of things in life there is a spectrum or range of time that men take to ejaculate. Some men come in less than a minute, some take much longer. What determines how long each individual man takes? It is thought that our physical and psychological make up determine our time to ejaculate. Our early sexual experiences also play a part.

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There is debate about whether early masturbatory experiences affect a mans time to ejaculation. It is possible that fear of being caught masturbating or anxiety, play a part in the development of premature ejaculation. It is possible to learn to delay ejaculation and it is likely that some men have simply learnt to ejaculate quickly and some slowly during their early experiences of masturbation.

Sexual therapists like Dr Helen Kaplan think that men who have premature ejaculation do not develop a normal sense of how their penis feels when they are highly aroused and excited. They think that this sensory deficit is what lies behind the cause of premature ejaculation. Therefore the key to curing premature ejaculation is learning to overcome this sensory deficit.

You may be puzzled and confused by the above statements. If you suffer from premature ejaculation you may be thinking that you know exactly how you feel when highly aroused and excited sexually.

To explain further we need to look at the science of learning behaviour. In order to control voluntary bodily functions we need to have well developed sensory awareness and feedback. For example if you are deaf as a child it is dificult to learn to speak since you lack the feedback of the sounds of speech. Similarly, if you play a sport such as football or golf you require the feedback from seeing where the ball goes when you kick or hit it. It would be difficult to learn to play sport without the feedback from our senses.

The same principles apply with ejaculation. The first few times that boys masturbate or have sex with a girl they are often so excited that they ejaculate before they fully realise what is happening. This is completely normal. Some boys then become more familiar with their sensations of rising sexual excitement and they are then are able to learn how to make their sexual pleasure last. Some boys do not seem to develop a full awareness of the sensations from their penis and do not learn to control their climax. These boys go on to become men with premature ejaculation problems. This seems to happen for a variety of reasons:

Some men just become too intensely excited to register the sensations from their penis.

The early sexual experiences of some men took place in tense situations such as in the back of a parked car or on the sofa of a girl’s living room whilst her parents were upstairs. These men were listening out for potential interruptions and they “tuned out” everything else, including their sexual feelings. They simply ejaculated as quickly as possible and then never unlearned the habit.

Other men with premature ejaculation are not fully aware of their sensations because they are over concerned with their sexual performance. These are often competitive men who want to get a high grade as lovers rather than relaxing and fully enjoying their sexual experience.

A lot of men with premature ejaculation feel excessively pressured to please their partner. Whilst having sex they are preoccupied with thoughts and fears of being criticized or rejected by their partner and by checking out their partners sexual responses. They are so preoccupied that they are unable to remain in toch with their own sexual feelings.

Some men feel too much guilt about masturbation, about having sex or about their sexual fantasies to be able to or allow themselves to register their feelings of pleasure.

These men who are over excited, anxious or guilty are concentrating too much on their thoughts and negative feelings. They therefore tune out their erotic feelings. They avoid prolonged periods of sexual arousal. They do not learn to become fully familiar or in tune with the natural feelings of intenses sexual pleasure which occur in the time leading up to and particularly just before ejaculation.

In summary men with premature ejaculation have always been quick to climax and not learnt to register fully their sexual sensations. The tendency to come quick as beome a habit and never been unlearned. The good news is that it is possible to develop greater awareness of the sensations from your penis and learn to control and delay ejaculation.

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Summary Of Treatments

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The following is a summary of the various treatments available for premature ejaculation. These are covered in greater detail in other articles on this website.

Mild premature ejaculation

If you have “mild” premature ejaculation then it may be possible to cure this yourself by improving your sexual sensory awareness. Some authorities and articles suggest using distraction techniques to help stop premature ejaculation. The disadvantage of distraction techniques and thoughts is that they reduce your sexual enjoyment. Thinking boring or unpleasant thoughts in order to delay or stop premature ejaculation may help but it is not very romantic and diminishes your enjoyment of sex.

It is much better to learn to stop premature ejaculation by acquiring good sexual sensory awareness and learning to delay the point of coming until you and your partner desire.

Numbing topical anaesthetic creams, sprays and gels.

There are many local anaesthetic agents available which are advertised as a treatment to stop premature ejaculation. They contain as their active ingredient an anaesthetic agent such as lidocaine (lignocaine). These drugs are normally used by doctors and dentists as local anaesthetics. For example to numb a tooth or area of skin to enable a surgical procedure to be carried out. Most of us are familiar with the sensation of numbness experienced by injections given by dentists.

These numbing agents may help some men in delaying ejaculation. There are several drawbacks to numbing creams. Firstly they can make sex less enjoyable by reducing the sensations from the penis. Secondly they can also affect your partner and may numb the woman’s genital area. This will reduce the woman’ enjoyment and pleasure and she will probably not thank you for this. Thirdly it is quite common to develop allergic reactions to anaesthetic agents if they are used repeatedly. This could affect either the man or the woman and result in an unpleasant itchy rash. Again you will not be thanked for causing your partner to develop an allergic rash in her genital area.

Wearing a condom, condoms or condom with anaesthetic gel.

It is possible to delay premature ejaculation by wearing a condom. Clearly a significant number of men will be using a condom for other reasons, such as to prevent infection or pregnancy. Thus the condom can have dual benefits. If you do not need to wear a condom for other reasons then a condom may be enough to reduce the sensations from the penis and stop premature ejaculation. Many men however do not like to wear a condom because of the reduced sensory awareness. By reducing the sensations from the penis then sex becomes less pleasurable. For this reason condoms are not an ideal solution to the problem of premature ejaculation.

There are a variety of condoms available and some are designed and marketed specifially as a treatment to stop premature ejaculation. They tend to be made with thicker latex. Some even contain an anaesthetic agent to numb the penis.These are marketed as “long love condoms”.

Some men will try wearing more than one condom to further reduce the penile sensations in order to try to stop premature ejaculation.

There are also penile add ons available which will stop all sensations from the penis but have the obvious drawback of making sex not at all enjoyable for the man.

Treatments for more severe premature ejaculation

If you have severe premature ejaculation it is ideal to seek advice on treatment from a sex therapist. This is not always practical and many men will want to deal with their problem without seeking professional advice.

Some treatments may be best taught by a sex therapist and some treatments require a doctors prescription.

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Masters and Johnson treatment

First described by pioneering sex researchers and therapists Masters and Johnson. This is generally known as the “squeeze technique”. It involves the woman squeezing the penis just prior to ejaculation. There is a particular grip which was developed by Masters and Johnson. Many sex therapists advice that the grip is taught by a sex therapist. The grip and treatment is described in this article: Masters and Johnson technique

The woman masturbates the man until he is about to ejaculate. When he feels he is about to reach the point of ejaculatory inevitability (but not after as then it is too late), he signals to the woman to squeeze is penis firmly as described. This is not painful. The squeeze has the effect of reducing the man’s level of arousal and avoids ejaculation. After a short time (30 sec) the woman stimulates the man again. Again the man signals to his partner just before the point of ejaculatory inevitabilty. The woman again waits about 30 seconds and stimulates the man again. This is repeated 3-4 times. On the fourth exercise the man is allowed to come. This series of exercises is repeated 2-3 times a week. Gradually the man learns to delay his ejaculation.

The next step is to proceed to sexual intercourse and the woman is instructed to apply the squeeze when the man feels that he is about to come.

The squeeze technique requires the man to have a partner.

The Masters and Johnson squeeze technique is described in greater detail in a separate article on this site: Masters and Johnson technique

Cognitive behavioural treatments
Stop start technique.

This was first described by the urologist Dr James Semans in 1955. It was again described and further developed by Dr Helen Singer Kaplan in her book “The New Sex Therapy”. She describes the technique in her book “How to overcome premature ejaculation”. Kaplan was a pioneering sex therapist until her untimely death in 1995.

Dr Kaplan emphasises that “the active therapeutic ingredient of the modern treatment of premature ejaculation and the key to its success is the acquistion of full sexual sensory awareness.”

Her “New Sex Therapy” taught couples a variety of sexual exercises which the couple carried out in their bedroom. The couple then meet the therapist weekly for a review, discussion and clarification of the exercises. Dr Kaplan was concerned that techniques which men were using to treat their premature ejaculation such as distracting thoughts or having a drink of alcohol were not effective in the long term This is because the men were reducing their sexual pleasure and desire. Dr Kaplan emphasised that what men with premature ejaculation needed to accomplish was prolong their pleasure by learning to stay in control while highly aroused and excited.

Dr Kaplan discusses the Masters and Johnson squeeze technique and the stop-start technique. She prefered to teach the stop-start technique as a treatment for premature ejaculation.

The Kaplan stop-start technique is described in greater detail in a separate article on this site: Kaplan stop-start technique

Dr Kaplan also taught men to stop premature ejaculation by being their own therapist. This has the advantage of not requiring a partner or sex therapist appointments. See this link to an article on this site about solo stop-start tecnique:

Medication to stop premature ejaculation

Selective Serotonin Reuptake Inhibitor (SSRI) antidepressant drugs such as fluoxetine, paroxetine, sertraline, fluvoxamine citalopram and escitalopram have long been known to delay ejaculation. Men who were prescibed these drugs for depression found that their ejaculations were delayed. This was a troublesome side-effect for some men who found that they were unable to ejaculate at all or suffered from retarded ejaculation. The problem of retarded ejaculation is covered in this article:

Clearly those men who were too quick to ejaculate found the “side-effect” of delayed ejaculation a good thing. Selective serotonin reuptake inhibitors are now prescribed by doctors “off label”as a treatment for premature ejaculation. The problem is that they have to be taken daily, require a doctors prescription and can have side-effects such as nausea, day-time drowsiness, anxiety and insomnia, The effect and side-effects of taking these drugs varies from person to person. There are also differences between the drugs within their class. By this I mean that some are more prone to cause anxiety, but paradoxically as a class of drugs they tend to be calming and reduce anxiety.

Dapoxetine (Priligy)

Dapoxetine is a new drug for the treatment of premature ejaculation. It is a short acting selective serotonin reuptake inhibitor (SSRI). SSRI’s are pescribed as antidepressants and they are also used to treat anxiety. It is thought that increasing serotonin levels in the brain is an effective way of treating premature ejaculation. SSRI anti-depressants have been prescribed by doctors ‘off-label’ for many years to help men suffering from PE. Dapoxetine has been very successful in trials. Dapoxetine is a short-acting SSRI, meaning that only a trace of the medication is left in the body after a few hours. This means that the drug remains in the body for only a few hours unlike the antidepresant SSRI’s which remain in the body for varying lengths of time from a few days to a few weeks (in the cae of fluoxetine). This removes the majority of side effects typically associated with SSRI’s and anti-depressant drugs. It is designed to be taken by mouth and only as required, 1-3 hours before sexual activity.

In studies dapoxetine was found to be effective in treating premature ejaculation. It was found to increase the time to ejaculation (Intravaginal ejaculation latency time (IELT) is defined as the time between the start of vaginal intromission and the start of intravaginal ejaculation) by a factor 3 in many cases.

Dapoxetine has been found to have few side effects and is well tolerated. The commonest side effects are nause , headache and dizziness. Due to the short duration of action these side effects are short lived.

Dapoxetine has been approved for use in the following countries: Sweden, Finland, Austria, Italy and Germany, Spain, Portugal, and New Zealand. Approvals for dapoxetine are also anticipated in other European countries as well. In addition, filings for approval have been submitted in Canada, Australia, Mexico, Turkey, and six other countries. In the United States approval is under review by the FDA.

Clomipramine an older tricyclic antidepressant has been found to work as a treatment for premature ejaculation.

Tramadol a synthetic opiate pain killer has been found to be an effective way to delay and stop premature ejaculation.

For more about medication for premature ejaculation see this article: Medication for premature ejaculation

St George’s constriction device.

This was developed at St George’s Hospital, London. A study published in 2000 showed that it may help in delaying ejaculation. I have been unable to find out any more information about this treatment. There is limited information on the web and it may be that it has not been as succesful as originally thought. The treatment involved wearing a slightly constricting ring below the head of the penis for 30 minutes each day. It was hoped that this would make the penis less sensitive. There do not seem to be any up to date results of this treatment. “At the present time the inventors of the device have not been able to publish any results of large scale trials.”
It is not advisable to try any constriction techniques like this outside of a specialist sex therapy clinic. Such a method should only be prescribed by an expert at a sexual problem clinic. The St Georges constriction device may or may not be an effective way to stop premature ejaculation.

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