Behavioral therapy can play a key part in the usual treatment of premature ejaculation. Certain sexual maneuvers can be effective; however, they may not always provide a lasting solution to the problem. Also, they rely heavily on the cooperation of the partner, which in some cases, may be a problem. With the squeeze method, an exercise developed by Masters and Johnson, the partner stimulates the man’s penis until he is close to ejaculation. At the point when he is about to ejaculate, the partner squeezes the penis hard enough to make him partially lose his erection. The goal of this technique is to teach the man to become aware of the sensations leading up to orgasm,and then begin to control and delay his orgasm on his own.
With the stop-start method, the partner stimulates the man’s penis until just before ejaculation. The partner should then stop all stimulation until the urge to ejaculate subsides. As the man regains control, he instructs the partner to begin stimulating his penis again. This procedure is repeated three times before allowing the man to ejaculate on the fourth time. The couple repeats this exercise three times a week, until the man has gained good control.
Although not approved by the U.S. Food and Drug Administration (FDA) for this purpose, pills used for depression and anesthetic creams have been shown to delay ejaculation in men with premature ejaculation. Medications are a relatively new form of treatment for premature ejaculation. Doctors first noticed that men and women who were taking drugs for the treatment of depression (antidepressants) also had delayed orgasms. Doctors then began to use these drugs “offlabel” (this implies using a medication for a different illness than what it was originally manufactured for) to treat premature ejaculation. These medications include antidepressants that affect serotonin such as fluoxetine (Prozac®, Sarafem®), paroxetine (Paxil®), sertraline (Zoloft®), and clomipramine (Anafranil®).
If one medication fails to work, a second one is usually recommended. If the second one fails, trying a third medication is not likely to be beneficial. An alternative is to combine medication with behavioral therapy and/ or creams.
For use in premature ejaculation, the doses of antidepressants are usually lower than those recommended for the treatment of depression. Though side effects are not inevitable, when they do occur, the most common side effects of antidepressants include nausea, dry mouth, drowsiness, erectile dysfunction and reduced desire for sexual activity.
These drugs can be taken either every day or only taken before sexual activity. Your doctor will decide how you should take the medication based on the frequency of intercourse and the effect that they produce for you. The best time for taking the antidepressant medications before sexual activity has not been established, but most doctors will recommend from two to six hours depending on the medication. Because premature ejaculation can recur when the medication is not taken, you most likely will need to take it on a continuing basis.
Local anesthetic creams can be used to treat premature ejaculation. These creams are applied to the head of the penis about 20 to 30 minutes before intercourse to lessen the sensitivity. Prior to sexual intercourse, a condom (if used) may be removed and the penis washed clean of any remaining cream. A loss of erection can occur if the anesthetic cream is left on the penis for a longer period of time than recommended. Also, the anesthetic cream should not be left on the exposed penis during vaginal intercourse since it may cause vaginal numbness.