There is a long list of treatment strategies that are effective at treating PE, including:
Sertraline: Sertraline is in a category of medication called SSRIs and is indicated for anxiety and/or depression. It was quickly realized that depressed men on SSRIs like sertraline had a side effect that many of them considered bothersome: it took more time and stimulation to reach ejaculation. The side effect that was so bothersome to depressed men became a much needed treatment for men who had premature ejaculation. This is considered an “off-label” use of these medications, but they are recommended by the American Urological Association (AUA) as a first-line treatment for PE
Sildenafil: Sildenafil (and tadalafil) is primarily thought of as an erectile dysfunction (ED) medication, but it can be extremely effective for PE, as well. What is most interesting is that ED often is an underlying cause of PE. Sometimes, the same stress that causes either one can cause both. However, ED itself can begin a cascade of changes that results in PE.
Men with ED often attempt to keep themselves erect with increasing levels of stimulation either with a partner or when masturbating. This intense stimulation can inadvertently result in ejaculation before they would like and can occur even when the penis is not fully erect. When a full erection is supported by a PDE5i like sildenafil, the need to maintain an erection with overly energetic stimulation is no longer necessary and a more well-timed orgasm can follow.
Sildenafil works especially well when there is some degree of ED as well as PE.
Topical Anesthetics: Topical anesthetics can be applied to the penis just before sexual activity. They come as creams, lotions, or sprays and are available over-the-counter. The advantage of topical applications is that the side effect rate is low and they are effective to some degree in almost everyone. Some men like the creams, lotions, and sprays because they feel they give them the sensations they want without becoming too desensitized. Other men find that they feel so little that their enjoyment of sex is affected. It is a very individual response and it can take practice to learn which agent works best.
The good news is that there are an abundance of topical anesthetics available. The ones most often used with positive results are Promescent Spray and K-Y Duration Spray.
Condoms: Condoms can help with PE by decreasing penile sensitivity and have the added benefit of reducing the likelihood of transmission of sexually transmitted infection or unwanted pregnancy. Since they are always recommended to prevent transmission of sexually transmitted infections, they are usually the first thing men have tried for PE. Using a spray, cream, or lotion with a condom is surprisingly effective for some men. It delays orgasm, gives some men just the right amount of pleasurable sensation, and when used with a topical anesthetic prevents the spread of the anesthetic to a partner.
Behavioral modification: The squeeze and start-stop techniques are 2 different strategies that can be practiced during masturbation or sexual activity and, over time, can improve control over the timing of ejaculation. As an ongoing method of prolonging sex it has some significant drawbacks. Interrupting sex or focusing on when to squeeze so as to avoid an orgasm is not a practical way to stay “in the moment” during sex. However, as a training method during masturbation or as a playful exercise with a partner, they can lead to an improved control over orgasming.
Psychotherapy: Counseling, whether in person, by telephone, or by text messaging, may increase the likelihood of success for some patients. The reality is that men who have had lifelong issues have often suffered silently with a burden that weighs on them every time they consider developing a physical and emotional attachment to another person. They face disappointing the very person they hope to please the most. For many men, it terminates relationships before they begin and can lead to isolation and a loss of companionship. Men with PE face increased risks of divorce and relationship stress often more as a result of the emotional consequences of having PE than from the PE itself.
Men who develop PE later in life may have developed it as a result of an underlying condition but often it is related to some relationship or personal stress. Uncovering the reasons the PE developed are as important as breaking the cycle with medical interventions.
Also, psychotherapy can be enormously helpful in restoring a man’s sense of value and worth beyond the ability to delay an orgasm, which often restores their capacity to experience sex as they had before PE developed.
Combination Therapy: Any of the above treatments can be combined with any one or more of the other treatments. Although it’s often best to keep things simple, the good news is that combination therapy can help treat men who don’t respond satisfactorily to single mode therapies.
Other management options for PE that are less common and have not been as well-studied include acupuncture, alternative medicines, pelvic floor exercises, and psychiatric medications other than SSRIs.