How does one treat premature ejaculation?
Depending on severity, premature ejaculation symptoms can be significantly reduced. In mundane cases, treatments are focused on gradually training and improving mental habituation to sex and physical development of stimulation control. In clinical cases, various medications are being tested to help slow down the speed of the arousal response.
Most sex therapists and sex educators prescribe a series of exercises to enable the man to gain ejaculatory control. These are considered the first line of treatment and are usually recommended to be tried before other methods.
One of the most common exercises is the “Start-Stop” technique in which during sex when he feels that he is getting too close to orgasm, he stops and does not move, to avoid more stimulation. He may withdraw his penis, or stay inside and request that the partner also not move. He waits seconds or minutes until his arousal lessens, and then resumes sex. He may stop and then re-start as many times as necessary.
Another technique is the “Squeeze Technique”, in which during sex(or masturbation if he wants to practice it) when he feels the urge to ejaculate, he would withdraw his penis and squeeze at the tip of the shaft below the glans of his penis near the frenulum of his penis, until the feeling subsides. To be more specific, the proper hand position for this technique is for him to place his thumb on frenulum, and his index and middle fingers above and below the coronal ridge(which is on the other side of the head of his penis), and then squeeze his penis from to back. He may consult a sex therapist for more directions to this technique.
The male’s partner plays an essential role in enabling him to overcome premature ejaculation. Without understanding and emotional support, the male is unlikely to obtain the level of relaxation required for sexual satisfaction. Both the male and his partner should communicate their feelings openly and with sensitivity. The partner may also be integrated into the exercises to keep her involved. She can learn to deliver the squeeze technique, and she can encourage the stop-start technique. Both partners should also aware of the sexual positions that make the male most likely to ejaculate quickly. They should avoid those positions if they want to prolong sex. Some men ejaculate quickly in any position, however, so the other methods would be more effective.
In cases where the chief concern is reaching simultaneous orgasm, it is also possible to simply work around the premature ejaculation problem by changing positions frequently(which studies have shown delays male orgasm by a factor of 2-3), using lubrication to reduce friction(friction stimulates the male but it is not as important in female orgasm), or switching to cunnilingus for awhile when close to ejaculation, and then switching back when ejaculation is no longer imminent.
SSRI antidepressants have been shown to delay ejaculation in men treated for different psychiatry disorders. SSRIs are considered the most effective treatment currently available for PE. These include paroxetine, fluoxetine, sertraline and more. The use of these drugs, that require chronic therapy, is limited by the neuropsychiatric side effects. New SSRI drugs specifically targeted to treat premature ejaculation(e.g. dapoxetine) can be taken on an ‘as needed’ basis have recently shown positive results in large phase III studies. Nevertheless, dapoxetine is not yet approved by any regulatory authority around the world. There is speculation that some of the associated effects are caused by lowered libido and blood pressure as well as lowered anxiety levels. Other pharmaceutical products known to delay male orgasm are opioids, cocaine, and diphenhydramine.
Local anesthetic creams(like lidocaine, prilocaine, and combinations) have shown to be effective in clinical trials and are being used for the treatment of PE. Their use is limited by their own anesthetic effect, that reduces sensation on the penis and vagina.