The up-and-up on treating premature ejaculation

The Bottom Line

  • Premature ejaculation—the most common male sexual disorder—can have a negative impact on both the person experiencing it and their partner.
  • Many different treatment options are available that increase the time to ejaculation, including behavioural therapies, creams, sprays, medications, acupuncture, Chinese herbal medicine, and delay devices.
  • Speak with your health care provider to find out what treatment options might be best for you.

Dealing with premature ejaculation can really bring you…um…down. Although it can be frustrating and stressful, it’s not an unusual occurrence. In fact, about one in three men will experience premature ejaculation at some point in their life, making it the most common sexual disorder in males (1;2-4).

Premature ejaculation is when a man experiences ejaculation before they wish to, with very little sexual stimulation (1;5-6). It can occur before, at the time of, or shortly after penetration. Not only does premature ejaculation put a damper on sexual satisfaction—it can also take a toll on relationships and quality of life (1;7-8).

This condition can affect a man at any age, and no one knows why it happens. For some, it’s a lifelong problem, whereas for others it may creep up later in life (1;9-10). The bottom line is that health, not age, is a key factor that affects a person’s sexuality, and premature ejaculation is one condition that can play a role (11).

Although there is no cure for premature ejaculation, there is hope. From behavioural techniques to creams, sprays, medications, acupuncture, Chinese herbal medicine, and delay devices, there are plenty of treatment options available to help. One systematic review explored the pros and cons of each (1).

What the research tells us

Overall, the findings of the review were promising! Many of the treatments showed that they have the potential to increase the time from vaginal penetration to ejaculation by 1 to 6 minutes, and improve sexual satisfaction. But, just which treatments worked for each outcome, and what side effects need to be considered?

Well, behavioural therapy was one treatment that increased both time to ejaculation and improved sexual satisfaction, without any negative side effects.

A huge number of drugs were also tested, including opioid-based painkillers (tramadol), anti-depressants (citalopram, escitalopram, fluoxetine, paroxetine, sertraline, fluvoxamine, dapoxetine, duloxetine, and clomipramine), drugs for erectile dysfunction (vardenafil, tadalafil, and sildenafil), and drugs used to treat high blood pressure (terazosin). All of these drugs were found to be effective in increasing time to ejaculation, except for fluvoxamine and sildenafil (1). Some also appeared to assist with improving sexual satisfaction—including citalopram, paroxetine, dapoxetine, tramadol, and erectile dysfunction drugs. However, despite these desired benefits, many drugs were associated with side effects like nausea, dry mouth, headache, dizziness, nose irritation, flushing, palpitations, low blood pressure, and drowsiness (1;12).

What’s more, it turns out that behavioral therapy and medication may be a ‘dynamic duo’, with reports that their combined use could provide greater benefits than using either alone.

For those looking for non-drug options outside of behavioral therapies, time to ejaculation may also be improved by anesthetic creams and sprays, delay devices (e.g., numbing band with a stop–start technique), acupuncture, and Chinese herbal medicine. But, it’s worth noting that after about 20 minutes or more of using creams and sprays, loss of sensation, irritation, and loss of erection can occur. Reports of soreness from overusing delay vices were also seen. Side effects of treatments such as acupuncture and Chinese medicine were not adequately reported in the included studies.

For those experiencing premature ejaculation, the news is good—there is an arsenal of treatment options out there that can work. Individual preferences and side effects vary, so it’s important to speak with your health care provider about which option might be optimal for you. Future research will need to explore whether these treatment options are safe and effective over the long-term and which ones work best (1).

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  1. Cooper K, Martyn-St James M, Kaltenthaler E, et al. Interventions to treat premature ejaculation: A systematic review short report. Health Technol Assess. 2015; 19(21):1-180. doi: 10.3310/hta19210.  
  2. Porst H, Montorsi F, Rosen RC, et al. The premature ejaculation prevalence and attitudes (PEPA) survey: Prevalence, comorbidities, and professional help-seeking. Eur Urol. 2006; 51:816–823. doi: 10.1016/j.eururo.2006.07.004. 
  3. Laumann EO, Nicolosi A, Glasser DB, et al. Sexual problems among women and men aged 40–80 y: Prevalence and correlates identified in the global study of sexual attitudes and behaviors. Int J Impot Res. 2005;17(1):39–57. 
    doi: 10.1038/sj.ijir.3901250.  
  4. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: Prevalence and predictors. JAMA. 1999; 281(6):537–544. doi: 10.1001/jama.281.6.537.  
  5. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th edn. Text revision. Washington, DC: American Psychiatric Association; 2000. 
  6. World Health Organization (WHO). International classification of diseases and related health problems. 10th edn. Geneva: WHO; 1994.
  7. Rowland DL, Patrick DL, Rothman M, et al. The psychological burden of premature ejaculation. J Urol. 2007; 177(3):1065–1070. doi: 10.1016/j.juro.2006.10.025. 
  8. Byers ES, Grenier G. Premature or rapid ejaculation: Heterosexual couples’ perceptions of men’s ejaculatory behavior. Arch Sex Behav. 2003; 32(3):261–270. 
  9. Wespes EC, Eardley I, Giuliano F, et al. Guidelines on male sexual dysfunction: Erectile dysfunction and premature ejaculation. Arnhem: European Association of Urology. 2013.
  10. Godpodinoff ML. Premature ejaculation: Clinical subgroups and etiology. J Sex Marital Ther. 1989;15(2):130–134. doi: 10.1080/00926238908403817. 
  11. Gewirtz-Meydan A, Hafford-Letchfield T, Ayalon L, et al. How do older people discuss their own sexuality? A systematic review of qualitative research studies. Cult Health Sex. 2019; 21(3):293-308. doi: 10.1080/13691058.2018.1465203. 
  12. Sathianathen NJ, Hwang EC, Mian R, et al. Selective serotonin re-uptake inhibitors for premature ejaculation in adult men. Cochrane Database Sys Revs. 2021; 3:CD012799. doi: 10.1002/14651858.CD012799.pub2.

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