What is the most effective way to treat premature ejaculation?

DEAR DOCTOR K:

I’ve been experiencing premature ejaculation. What is the most effective way to treat this?

DEAR READER:

Premature ejaculation (PE) occurs when a man reaches orgasm and ejaculates too quickly and without control. In other words, ejaculation occurs before a man wants it to happen.

Several factors may contribute to this problem. Diabetes, problems with the thyroid gland or inflammation of the prostate are common culprits. Stress, depression and other emotional factors can also play a role. But most men with PE are healthy.

Sometimes, PE goes away on its own. Finding ways to relieve stress or other psychological issues may help. If PE continues, treatment may involve behavioral techniques, medication or both.

My colleague Dr. Harvey Simon recommends starting with behavioral therapy. It is safe and simple, and helps about 60 to 90 percent of men. Here are three methods you can try, alone or in combination. Many people find that consulting an experienced sex therapist is helpful in learning the behavioral therapy techniques:

  1. ┬áThe “pause and squeeze” technique is the most effective method. When you feel an orgasm developing too early, stop sexual activity. Then either you or your partner gently squeezes the shaft of the penis between the thumb and two fingers for about 20 seconds. You relax the squeeze and start sexual activity again. This technique somehow leads the body to learn how to delay ejaculation without the squeeze. Several of my patients say that this technique has also worked for them when the sexual activity is not actual sex with a partner, but self-stimulation.
  2. The “start-stop” method. Bring yourself close to orgasm with the aid of a partner or by self-stimulation. Before climaxing, stop, relax, and then begin again. Repeat the cycle until you can no longer prevent ejaculation. The goal is to recognize when orgasm is about to happen and to put on the brakes.
  3. Kegel exercises. Women and men use these exercises to treat urinary incontinence. They can also help men with PE. You can identify the pelvic muscles by stopping the flow of urine in midstream. Once you’ve learned to control these muscles, you practice tightening them while your bladder is empty. You should hold each contraction for 10 seconds, then relax for 10 seconds, then repeat the cycle 10 times, three or four times a day.

As for medications, selective serotonin reuptake inhibitors (SSRIs) are particularly effective. SSRIs include citalopram (Celexa) and fluoxetine (Prozac). Some men don’t respond to an SSRI alone. If this is the case, you may get good results by also taking one of the medicines for erectile dysfunction medicine: sildenafil (Viagra), vardenafil (Levitra), tadalafil (Cialis) and avanafil (Stendra).

Another option is to apply an anesthetic (numbing cream) to the head of the penis. This decreases sensation and reduces the stimulation you experience during sex. Some “climax control” or “extended performance” condoms apply a mild anesthetic to the penis.

It is likely that one or more of these treatments will work for you.