Summary Of Treatments
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 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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It is possible to stop premature ejaculation in at least 95% of men with the correct treatment plan.
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