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Premature Ejaculation: Causes and Treatment

Premature ejaculation is the most common male sexual dysfunction affecting men and their partners. Approximately 20-30% of the male population may have symptoms at any one time, but the condition remains largely untreated.

Currently, only 1-12% of males who tell their doctors they have problems with premature ejaculation receive treatment. This is due to a number of factors including:

  • The personal nature of the condition
  • Hesitancy of both men and physicians to approach and discuss the topic
  • Lack of awareness of treatment options

Premature ejaculation is commonly thought of as a lack of control over ejaculation, but it also includes the resulting:

  • Stress
  • Difficulty talking with your partner
  • Poor sexual satisfaction
  • Impact on the partner


Treatment of premature ejaculation can include medications, exercises done by couples, psychotherapy. For the most effective treatment, coaching, which is a combination of these treatments, seems to be the most effective.


There is no currently FDA-approved treatment for PE.

Oral Medication-SSRI (Selective Serotonin Reuptake Inhibitor)

Most clinicians commence therapy with an oral SSRI. These drugs can be used on an as-needed basis, taken a few hours before planned sexual activity, or on a daily basis. Most men prefer the daily regimen instead of the as-needed basis because it does not interfere with the spontaneity of sexual activities. Which SSRI to use for PE treatment remains unclear. Dapoxetine has been proposed for FDA approval for PE, but has not been approved by the FDA. It is important to note that the FDA has issued a “black-box” warning for SSRI drugs with respect to suicide.

Topical Creams and Aerosols

Topical anesthetic spray and cream therapy, such as the topical eutectic mixture for premature ejaculation (TEMPE), for PE is under study. Most men who have used these treatments considered the spray and the cream easy to use, while mild to moderate local numbness occurred in some individuals. Topical treatment with TEMPE resulted in better ejaculatory control and improved quality of life. Lidocaine cream and a variety of other agents have been used for PE with limited success.


Psychotherapy is an integral part of treating premature ejaculation. Working with a counselor helps couples:

  • Make better use of the medical therapies recommended by their doctor
  • Overcome their resistances to making use of a medical treatment
  • Continue to practice the therapies more consistently

A counselor may address the following topics and help patients with:

  • Learning techniques to control and/or delay ejaculation
  • Gaining confidence in sexual performance
  • Reducing performance anxiety
  • Modifying rigid sexual patterns
  • Overcoming issues with intimacy
  • Resolving issues between the couple that make the situation worse
  • Resolving feelings or thoughts that interfere with sexual function
  • Increasing communication between partners


Coaching combines medical and psychological treatment for premature ejaculation. It is different from psychotherapy alone. It is more directive and involves giving advice, and providing patients with educational materials and techniques. The goals of coaching are:

  • Reducing or eliminating performance anxiety
  • Gaining sexual confidence
  • Understanding the context in which men/couples make love
  • Helping couples to change their sexual routine

In addition, as men are taken off medications used to treat premature ejaculation, continued work with a coach may reinforce the progress made and uncover new techniques for continuing improvement.

What You Can Do – Talk to Your Doctor

The most effective way to treat premature ejaculation is under the care of a doctor.

Specialists who treat premature ejaculation include: 

  • Urologists
  • Psychologists
  • Psychiatrists
  • Social Workers

Finding a specialist

It is often difficult to find a specialist in your area who treats premature ejaculation, particularly one who treats both the physical and emotional sides of the problem. For an accredited professional in your area, these sites may help:

What your doctor needs to know

In order to get the best treatment possible, be prepared for the initial appointment. The following is a list of some information that you should know for your appointment that will help your doctor to find your best path of treatment.

  • How long have you’ve had the problem and when it began
  • The situations or circumstances in which the problem occurs
  • When the last time was that you had any sexual activity
  • If the problem is bothersome to you and your partner
  • If the problem arose suddenly or if it arose more gradually
  • Any new medications you are taking
  • If the problem occurs with your partner only, or if it also occurs without your partner, for example, with masturbation
  • If you do not have a partner or you have an uninterested partner
  • If you have a partner outside of your main relationship
  • Any problems you may be having with sexual desire
  • If you feel fatigue or have sleep issues
  • If you have a loss of stamina or loss of strength
  • If you have a loss of muscle mass or a loss of muscle tone
  • If you have had a recent weight gain
  • If you feel depressed

Portions of this article were originally reviewed by , formerly of Case Western Reserve University, and published on NetWellness with permission.

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Go to the Erectile Dysfunction (ED) health topic.