Premature Ejaculation Treatment & Management

  • Author: Aaron Benson, MD; Chief Editor: Edward David Kim, MD, FACS   more...
 
Updated: Jan 20, 2012
 

Medical Care

Medical treatment for premature ejaculation (rapid ejaculation) includes several options. Any serious primary medical condition (eg, angina) should be treated; for the purpose of the following discussion, the male is assumed to be healthy and premature ejaculation is assumed to be his only problem. In addition, any accompanying erection problem can be treated with various methods with excellent success (see Erectile Dysfunction); thus, only passing reference is made to treatment of erectile dysfunction (ED) that may accompany the premature ejaculation problem.[12]

Include the female partner as much as possible in the treatment and counseling sessions in order to achieve the best outcome.

1. Relieve any underlying performance pressure on the male.

  • Assuming that premature ejaculation occurs when intercourse is attempted, the couple should be instructed that intercourse should not be attempted until premature ejaculation is treated. The male may use manual stimulation, oral sex, or other means to satisfy the female partner in the meantime.
  • If the male always experiences ejaculation with initial sexual excitement or early foreplay, this is a serious problem and probably indicates primary premature ejaculation (the history should reveal this), which then most likely requires treatment in conjunction with a mental health care professional. These more difficult cases should be screened out.

2. The couple should then be instructed on sexual therapy, such as the stop-start or squeeze-pause technique popularized by Masters and Johnson.[13]

  • The female partner should slowly begin stimulation of the male and should stop as soon as he senses a feeling of excessive excitement that may lead to ejaculatory inevitability.
  • Then, she should administer a firm compression of the penis just behind the glans, pressing mainly under the penis. This should be uncomfortable but not painful.
  • Stimulation then should begin again after the male has a feeling that the ejaculation is no longer imminent.
  • The process should be repeated and practiced at least 10 or more times.
  • Gradually, most males find this technique helps decrease the impending inevitable need to ejaculate.
  • After a period of practicing this method, the couple can sit facing each other, with the woman's legs crossing on top of the male's legs. She can stimulate him by manipulating his penis close to, then with friction against, her vulval area. Each time he senses excessive excitement, she can apply the squeeze and stop all stimulation until he calms down enough for the process to be repeated.
  • Finally, coitus may be attempted, with the female partner in the superior position so that she may withdraw immediately and again apply a squeeze to remove his urge to climax.
  • Most couples find this technique to be highly successful. It can also help the female partner to be more aroused and can shorten her time to climax because it constitutes a form of extended foreplay in many cases.

3. Another therapeutic modality is the use of desensitizing cream for the male.

  • In Korea and other areas of the Far East, SS cream (a combination of 9 ingredients, mainly herbal; SS stands for Super Secret) has been shown to desensitize the penis, decrease the vibratory threshold, and help men with premature ejaculation to significantly delay their ejaculatory response.[14, 15]
  • Unfortunately, SS Cream is not yet approved by the US Food and Drug Administration (FDA), but simple combinations of lidocaine cream or related topical anesthetic agents can be used with similar effects and they are safe as long as the patient has no history of allergy to the substance.[16, 17]

4. If the male is relatively young and can achieve another erection in a few minutes following an episode of premature ejaculation, he may find that his control is much better the second time.

  • Some therapists advise young men to masturbate (or have their partner stimulate them rapidly to climax) 1-2 hours before sexual relations are planned.
  • The interval for achieving a second climax often includes a much longer period of latency, and the male can usually exert better control in this setting.
  • In an older man, such a strategy may be less effective because the older man may have difficulty achieving a second erection after his first rapid sexual release. If this occurs, it can damage his confidence and may result in secondary impotence.

5. The most effective pharmacologic modality found to aid men with premature ejaculation is a drug from the selective serotonin reuptake inhibitors (SSRIs) class, drugs which are used normally as antidepressants in the clinical setting.

  • Some tricyclic antidepressants with SSRI-like activity yield the same result.
  • As a side effect, many of these agents have been found to cause a significant delay in reaching orgasm in both male and female patients.
  • For this reason, medications with SSRI side effects have been used in men who experience premature ejaculation.
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Surgical Care

No recommended surgical treatment exists for premature ejaculation.

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Consultations

  • Consultation with a sex therapist, psychologist, or psychiatrist may prove helpful if the primary care physician or urologist cannot provide successful treatment or does not have the time to explore psychological issues and implement behavioral techniques (eg, squeeze-pause). If the primary care physician or urologist is not experienced in treating premature ejaculation or is uncomfortable with treatment, then early referral should take place (to a sex therapist, psychologist, or psychiatrist). Some physicians are comfortable implementing medication therapy but not behavioral therapy. The patient should be offered all treatment options, as with any medical condition, and the physician should proceed with referral for those option(s) considered to require more specialized help than the physician can provide.
  • For men who may be experiencing a severe emotional disturbance that is an underlying factor to premature ejaculation, referral to a mental health professional is most appropriate. Diagnosis and treatment of the various psychological factors that manifest partly as premature ejaculation are beyond the scope of this discussion.
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Contributor Information and Disclosures
Author

Aaron Benson, MD  Staff Physician, Department of Surgery, Division of Urology, Southern Illinois University School of Medicine

Aaron Benson, MD is a member of the following medical societies: American Medical Association, American Urological Association, and Illinois State Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Loren B Ost, MD  Associate Professor, Department of Surgery, Southern Illinois University School of Medicine; Urologist, SIU Physicians and Surgeons

Loren B Ost, MD is a member of the following medical societies: American Urological Association

Disclosure: Nothing to disclose.

Mark Jeffrey Noble, MD  Consulting Staff, Urologic Institute, Cleveland Clinic Foundation

Mark Jeffrey Noble, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Kansas Medical Society, Sigma Xi, Society of University Urologists, and Southwest Oncology Group

Disclosure: Nothing to disclose.

Milton Lakin, MD  Head, Section of Medical Urology, Urological Institute, Cleveland Clinic

Milton Lakin, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American Diabetes Association, American Medical Association, and American Urological Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Leonard Gabriel Gomella, MD, FACS  The Bernard W Godwin Professor of Prostate Cancer Chairman, Department of Urology, Associate Director of Clinical Affairs, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University

Leonard Gabriel Gomella, MD, FACS is a member of the following medical societies: American Association for Cancer Research, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Urological Association, Sigma Xi, Society for Basic Urologic Research, Society of University Urologists, and Society of Urologic Oncology

Disclosure: GSK Consulting fee Consulting; Astra Zeneca Honoraria Speaking and teaching; Watson Pharmaceuticals Consulting fee Consulting

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

J Stuart Wolf Jr, MD, FACS  The David A Bloom Professor of Urology, Director, Division of Endourology and Stone Disease, Department of Urology, University of Michigan Medical School

J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology

Disclosure: Nothing to disclose.

Chief Editor

Edward David Kim, MD, FACS  Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, Sexual Medicine Society of North America, and Tennessee Medical Association

Disclosure: Lilly Consulting fee Advisor; Astellas Consulting fee Speaking and teaching; Watson Consulting fee Speaking and teaching; Allergan Consulting fee Speaking and teaching

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