Premature Ejaculation Treatment Options: Complete Guide

Premature ejaculation (PE) is one of the most common sexual dysfunctions, affecting 30-40% of men at some point in their lives. Despite its prevalence, many men don’t seek treatment due to embarrassment or lack of awareness about available options. This comprehensive guide covers all evidence-based treatments for PE, from medications to behavioral techniques to online telehealth solutions.

Understanding Premature Ejaculation

Definition: Ejaculation that occurs within 1-2 minutes of penetration (or before desired) with inability to delay and causing personal distress.

Types:

• Lifelong PE: Present since first sexual experiences
• Acquired PE: Develops after period of normal ejaculatory control
• Variable PE: Inconsistent, occurs occasionally
• Subjective PE: Perceived as premature despite normal ejaculatory latency

Treatment Categories

1. Selective Serotonin Reuptake Inhibitors (SSRIs)

Most Effective Medication Option

SSRIs are antidepressants that delay ejaculation as a side effect. While not FDA-approved specifically for PE, they’re the most evidence-backed treatment option.

Paroxetine (Paxil)

Most Effective SSRI for PE

• Dosage: 10-40mg daily
• Effectiveness: Increases ejaculatory latency by 6-8 times
• Time to effect: 2-3 weeks of daily use
• Side effects: Decreased libido (20-30%), mild nausea, fatigue
• Cost: $10-30/month (generic)

Sertraline (Zoloft)

Popular Alternative to Paroxetine

• Dosage: 25-200mg daily
• Effectiveness: Increases ejaculatory latency by 3-5 times
• Time to effect: 2-3 weeks of daily use
• Side effects: Similar to paroxetine but slightly milder
• Cost: $10-25/month (generic)

Fluoxetine (Prozac)

Less Effective but Well-Tolerated

• Dosage: 20-40mg daily
• Effectiveness: Increases ejaculatory latency by 2-4 times
• Note: Less effective than paroxetine or sertraline
• Cost: $10-20/month (generic)

Dapoxetine (Not Available in U.S.)

On-Demand SSRI Designed for PE

• Status: FDA-approved in 60+ countries but NOT in the United States
• Dosage: 30-60mg taken 1-3 hours before sex
• Effectiveness: Increases ejaculatory latency by 3-4 times
• Advantage: On-demand use (not daily)
• Why unavailable: FDA has not approved despite multiple applications

SSRI Treatment Considerations:

• Must be taken daily, not on-demand (except dapoxetine abroad)
• Takes 2-3 weeks to reach full effectiveness
• Stopping suddenly can cause withdrawal symptoms
• May decrease libido as trade-off for better control
• Work best for lifelong and acquired PE

2. Topical Anesthetics

Immediate Effect, Applied Before Sex

Topical numbing agents reduce penile sensitivity, delaying ejaculation.

Lidocaine/Prilocaine Cream or Spray

• How to use: Apply 15-30 minutes before sex
• Effectiveness: Increases ejaculatory latency by 2-5 times
• Duration: Effects last 30-60 minutes
• Pros: Works immediately, on-demand use, no systemic side effects
• Cons: May reduce sensation for both partners, requires timing
• Cost: $15-40 per bottle/tube

Benzocaine Wipes/Sprays

• Examples: Promescent spray, Roman Swipes
• Application: 5-15 minutes before sex
• Effectiveness: Similar to lidocaine
• Advantage: Faster absorption than creams
• Disadvantage: Can transfer to partner

Topical Treatment Tips:

• Wash off excess before intercourse to prevent partner numbness
• Use condoms to prevent transfer
• Start with lower amounts and increase as needed
• Works best for occasional PE, not daily use

3. PDE5 Inhibitors (ED Medications)

Helpful When PE Co-Exists with ED

Sildenafil (Viagra) and Tadalafil (Cialis)

• Primary use: Erectile dysfunction
• PE benefit: Increases ejaculatory latency by 2-3 times when PE occurs with ED
• Mechanism: Improved erections reduce performance anxiety
• Dosage: Standard ED doses (sildenafil 25-100mg, tadalafil 5-20mg)
• Best for: Men with both PE and ED
• Cost: $4-12 per dose (generic)

Evidence:

• Studies show PDE5 inhibitors can help PE, especially when combined with psychological factors
• Less effective than SSRIs for PE alone
• Most effective when PE is secondary to ED or performance anxiety

4. Combination Therapy

Often Most Effective Approach

Combining multiple treatments can enhance results:

SSRI + Behavioral Techniques

• Effectiveness: Up to 80-90% improvement
• Benefits: Addresses both biological and psychological factors
• Timeline: 4-8 weeks for full effect

PDE5 Inhibitor + SSRI

• Best for: Men with both PE and ED
• Effectiveness: Better than either alone
• Monitoring: Requires medical oversight

Topical + Behavioral Techniques

• Best for: On-demand treatment without daily medication
• Effectiveness: 60-75% improvement
• Advantage: No systemic side effects

5. Behavioral Techniques

Free, Effective with Practice

Stop-Start Technique

1. Stimulate penis until close to ejaculation
2. Stop all stimulation and wait for arousal to decrease
3. Resume stimulation after 30-60 seconds
4. Repeat cycle 3-4 times before allowing ejaculation
5. Effectiveness: 45-60% with consistent practice

Squeeze Technique

1. Stimulate penis until close to ejaculation
2. Squeeze glans firmly for 10-20 seconds
3. Wait for arousal to decrease
4. Resume after 30 seconds
5. Effectiveness: 50-65% with consistent practice

Pelvic Floor Exercises (Kegels)

• How: Contract pelvic floor muscles as if stopping urination
• Routine: 3 sets of 10 reps, 3x daily
• Timeline: 8-12 weeks for results
• Effectiveness: 40-50% improvement in some studies

Behavioral Technique Tips:

• Requires consistent practice over weeks/months
• Partner involvement improves success
• Often combined with medication for best results
• No cost, no side effects

6. Counseling and Sex Therapy

Addresses Psychological Factors

• Cognitive Behavioral Therapy (CBT): Addresses anxiety and negative thought patterns
• Sex therapy: Teaches techniques and improves communication with partner
• Couples counseling: Involves partner in treatment process
• Effectiveness: 40-70% when psychological factors are primary cause

Best for:

• Performance anxiety-related PE
• Relationship issues contributing to PE
• Men who prefer non-medication approaches

Online Telehealth Options for PE Treatment

Hims

• Treatments: Sertraline (SSRI), sildenafil (for PE + ED)
• Consultation: Free online questionnaire
• Cost: From $25/month for sertraline
• Shipping: Fast, discreet delivery
• Best for: Affordable, comprehensive platform

RexMD

• Treatments: Prescription medications and topical options
• Focus: Men’s sexual health specialization
• Consultation: Online health assessment
• Best for: Men preferring specialized men’s health platform

Ro (Roman)

• Treatments: PE medications and combination therapy
• Consultation: $15 fee, includes unlimited follow-ups
• Products: Roman Swipes (topical) and prescription options
• Best for: Flexible payment options and innovative products

Choosing the Right Treatment

Consider Daily SSRI If:

• PE occurs most or all of the time
• Willing to take daily medication
• Want most effective medication option
• Can tolerate 2-3 weeks to see results
• Okay with potential libido decrease

Consider Topical Treatment If:

• PE is occasional or situational
• Prefer on-demand treatment
• Want immediate effect
• Avoiding systemic medications
• Don’t mind application timing

Consider PDE5 Inhibitors If:

• Have both PE and ED
• Performance anxiety is a factor
• Want on-demand treatment
• SSRIs haven’t worked or aren’t tolerated

Consider Behavioral Techniques If:

• Want no medications
• Willing to practice consistently
• Partner is willing to participate
• PE is mild to moderate
• Prefer free, natural approach

Treatment Timeline Expectations

Week 1-2 (SSRIs):

• Minimal PE improvement
• Possible side effects (nausea, fatigue)
• Continue daily use despite lack of immediate results

Week 3-4:

• Noticeable improvement in ejaculatory control
• Side effects typically decrease
• May need dosage adjustment

Week 8-12:

• Maximum benefit achieved
• Consider maintenance dose
• Evaluate if treatment is working

Topical Treatments:

• Work immediately (15-30 minutes)
• Each use provides 30-60 minute window
• No need for daily use

Behavioral Techniques:

• Require 4-8 weeks of consistent practice
• Gradual improvement over months
• Long-term maintenance needed

Side Effects and Safety

SSRI Side Effects

Common (10-30%):

• Decreased libido
• Mild nausea (first 1-2 weeks)
• Fatigue
• Slight erectile difficulties

Less Common (<10%):

• Headache
• Sweating
• Insomnia

Serious (Rare):

• Serotonin syndrome (when combined with other serotonergic drugs)

When to Avoid SSRIs

• Taking MAO inhibitors
• History of mania or bipolar disorder
• Seizure disorders (use caution)
• Liver disease (dose adjustment needed)

Topical Anesthetic Side Effects

• Temporary penile numbness (intended effect)
• Partner numbness if transferred
• Allergic reaction (rare)
• Mild irritation

Cost Comparison

Treatment	Monthly Cost	Type
Sertraline (generic)	$10-30	Daily pill
Paroxetine (generic)	$15-35	Daily pill
Topical sprays/creams	$20-50	As-needed
Sildenafil (if needed for ED)	$4-12/dose	As-needed
Behavioral techniques	Free	Self-practice
Sex therapy	$100-250/session	Weekly sessions

Insurance: Most insurance plans cover SSRIs for depression but may not cover for off-label PE use. Telehealth platforms offer cash-pay pricing that’s often competitive.

Success Rates Summary

Treatment	Success Rate	Time to Effect
Paroxetine	70-80%	2-3 weeks
Sertraline	65-75%	2-3 weeks
Topical anesthetics	60-70%	Immediate
PDE5 inhibitors (with ED)	55-65%	30-60 min
Behavioral techniques	45-65%	4-12 weeks
Combination therapy	80-90%	3-8 weeks

Where to Get PE Treatment

Online Telehealth Services (Most Convenient)

Best Overall: Hims offers comprehensive PE treatment with SSRIs (sertraline, paroxetine) and topical treatments starting at $44-85/month. Same-day consultations, discreet delivery, and ongoing physician support. Great for convenient, affordable PE care.

Best for Comprehensive Care: Ro provides PE treatment with flexible medication options, physician consultations, and treatment tracking. Ideal if you want structured medical supervision and don’t mind paying slightly more.

Best for Privacy: Manual (UK) specializes in discreet men’s sexual health care with comprehensive PE treatment programs. Perfect for UK residents seeking specialized care.

Compare all sexual health services to find the best option for your needs.

Benefits of telehealth:

• No embarrassing in-person conversations
• Medications delivered discreetly to your door
• Licensed physician consultations
• Often more affordable than traditional doctor visits
• Easy prescription refills

Traditional Healthcare Options

• Primary care doctor: Can prescribe SSRIs off-label for PE
• Urologist: Specialist in male sexual dysfunction
• Sex therapist: For behavioral therapy and relationship counseling
• Psychiatrist: If mental health factors are primary cause

When to See a Doctor

Consult a healthcare provider if:

• PE is causing relationship distress
• Self-help techniques haven’t worked after 3 months
• PE developed suddenly (acquired PE)
• Considering medication treatment
• Experiencing erectile dysfunction alongside PE
• Psychological factors (anxiety, depression) are present

Summary

Premature ejaculation is highly treatable with multiple evidence-based options:

Most Effective: SSRIs (paroxetine, sertraline) with 70-80% success rates Fastest Acting: Topical anesthetics working within 15-30 minutes Best Overall: Combination of medication + behavioral techniques Most Convenient: Online telehealth platforms like Hims and Ro No Cost: Behavioral techniques with consistent practice

The key is finding the right treatment (or combination) for your specific situation, preferences, and goals. Online telehealth has made accessing PE treatment more convenient and discreet than ever before.

Related Resources

Sexual Health Guides:

• Understanding Erectile Dysfunction - Comprehensive ED guide
• Sildenafil vs Tadalafil: Which ED Med Is Best? - Compare ED medications
• When to See a Doctor About ED - When to seek help

Service Reviews:

• Hims Review - Best overall for PE treatment
• Ro Review - Premium sexual health care
• Manual Review - UK specialists in men’s health
• Sexual Health Services Comparison - Compare all options

Popular Comparisons:

• Hims vs Ro - Which offers better value?
• Hims vs BlueChew - Comprehensive vs budget
• Hims vs Manual - US vs UK options

Consult with a healthcare provider to determine the best treatment plan for your individual needs.