Managing Side Effects of PE Medications

Getting to the root cause of PE is the first step in finding the best treatment. Sometimes, treating the underlying cause — like depression or hormonal disorders — can be all you need to stop ejaculating early. Be sure to discuss all your options with a healthcare provider.

Therapy Type	Description	Typical Duration	Success Rate	Noted Benefits	Noted Drawbacks
SSRI Medications	Selective serotonin reuptake inhibitors, delay ejaculation	4-12 weeks	70%	Long-term control	Possible side effects
Behavioral Therapy	Techniques like start-stop and squeeze method	Several sessions	60-80%	No medication needed	Requires patient commitment
Topical Anesthetics	Numbing creams or sprays applied to glans penis	As needed	65-75%	Fast onset	Reduced sensation, partner sensitivity
Pelvic Floor Exercises	Exercises to strengthen pubococcygeus muscles	6-12 weeks	50-65%	Improves control	Time-consuming

Premature ejaculation is often easily treated with a few simple steps, so it’s important to see your provider if you’re experiencing premature ejaculation. Although it may be uncomfortable to talk about sexual problems, know that your providers want you and your partner to have a satisfying sex life.

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Your urologist can help direct you to these health professionals. Your provider may recommend certain medications to help with PE. Antidepressants are one of the first-line therapies for PE as they can help delay ejaculation. This is an “off-label” use (not approved by the Food and Drug Administration). Be sure to discuss the side effects of this medication with your urologist to be sure it’s appropriate for you.

Ejaculation Problems: Too Fast, Too Slow or Not at All

Antidepressants your provider might prescribe include the tricyclic antidepressant clomipramine (Anafranil®) or selective serotonin reuptake inhibitors (SSRIs), for example: Anesthetic (numbing) creams and sprays you apply to the head and shaft of your penis is another potential first-line medication option to delay ejaculation. Your penis absorbs the anesthetic cream or spray in about 10 to 30 minutes. It causes you to experience less sensitivity in your penis. It’s important to wash your penis before sex to prevent numbness to your partner’s genitals. Erectile dysfunction medications, which include sildenafil (Viagra®), tadalafil (Cialis®), vardenafil (Levitra®) and avanafil (Stendra®), may help treat premature ejaculation, particularly in people with underlying erectile dysfunction. Your healthcare providers can come up with a plan to treat your premature ejaculation. Remember, this is a common problem and you’re not alone.

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Levitra Professional	20mg	120 + 4 Pills	348.44€ 331.85€	Buy
Kamagra Polo	100 mg	180 + 8 Pills	446.52€ 425.26€	Buy
Viagra Super Active	100mg	10 Pills	28.76€ 27.39€	Buy
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Levitra Generic	40mg	60 + 4 Pills	162.37€ 154.64€	Buy
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Guidelines for Management of Premature Ejaculation

It’s common for people with PE to experience depression and frustration. For this reason, it’s important to seek help for PE. It’s a common condition that frustrates many people. Your healthcare provider can help determine the best treatment for you depending on the cause of your premature ejaculation. If you have frequent premature ejaculations or if premature ejaculation is causing you anxiety or depression and affecting your relationship, make an appointment to see a urologist.

Stop-start technique

Your urologist will begin an exam by asking about your sexual experiences. How long have you had this problem? Does premature ejaculation happen at every sexual encounter? Does premature ejaculation occur when you masturbate? Do you have trouble maintaining an erection? Cleveland Clinic’s health articles are based on evidence-backed information and review by medical professionals to ensure accuracy, reliability and up-to-date clinical standards.

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While the questions are personal, it’s important that you answer your urologist honestly so they can best diagnose the source of your problem. Your urologist will also ask about any other medical conditions you may have and any medications, including over-the-counter medications, supplements and herbal products you’re taking. They’ll also ask you about any alcohol and drug use. Lab tests are usually not needed unless your healthcare provider suspects that an underlying health condition is contributing to the problem. There are many different treatment options for premature ejaculation depending on the cause.

Chatbots’ performance in premature ejaculation questions: a comparative analysis of reliability, readability, and understandability

These include behavioral therapy, counseling and medications. Most causes of premature ejaculation are usually treated first with behavioral therapy and/or counseling to help with emotional concerns, performance anxiety or stressors that may be contributing. You can try more than one treatment approach at the same time, and in fact, combinational therapy may be more effective than any one treatment alone. Behavioral therapy involves trying different practical methods to delay your orgasm. The goal is to teach you how to control your body and your feelings. Crowdis M, Leslie SW, Nazir S. Premature Ejaculation ( [Updated 2023 Feb 7]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. Accessed 9/27/2023. Guidelines on premature ejaculation (PE) have been published by the following organizations: American Urological Association (AUA) and Sexual Medicine Society of North American (SMSNA) Italian Society of Andrology and Sexual Medicine (SIAMS) The ISSM has developed evidence-based guidelines for patients suffering from lifelong PE.

Strategy	Description	Expected Outcome	Time Frame	Additional Notes
Mindfulness Meditation	Practice focusing on the present moment to reduce anxiety	Reduced performance anxiety	Weeks to months	Complements other treatments
Sensate Focus Exercises	Partner-based touching exercises to build comfort	Increased control and intimacy	Several weeks	Requires partner cooperation
Cognitive Behavioral Therapy	Therapy addressing thoughts and anxiety related to sex	Better sexual confidence	Several sessions	Often part of a comprehensive plan

The guidelines were most recently reviewed and revised in 2013. Discussions of the epidemiology and etiology of PE Recommended and optional questions to establish the diagnosis of PE and direct treatment Psychological/behavioral, combined medical and psychological, and educational interventions A flow chart for the management of PE The AUA/SMSNA published joint guidelines on disorders of ejaculation in 2020. Guideline statements regarding the definition of PE were as follows [61] : Lifelong PE is defined as poor ejaculatory control, associated bother, and ejaculation within about 2 minutes of initiation of penetrative sex that has been present since sexual debut.

Treatment Options for Premature or Rapid Ejaculation at UCLA

In certain cases, your provider may prescribe tramadol, an opiate medication. While alternative therapies also exist for PE treatment, there isn’t enough evidence to prove they’re effective. Most people find relief using one or more of the treatments above. Behavioral therapy and using different methods to delay ejaculation tend to be the most helpful. No, it actually worsens the problem because it makes you more sensitive to sexual stimulation.

Premature ejaculation prognosis

By involving your partner and seeing the appropriate healthcare professionals, you may be able to control your ejaculations and enjoy your sex life again. Yes, you can prevent PE depending on what’s causing it. It’s best to discuss your feelings with your healthcare provider ed medications so they can help you determine a cause and recommend the appropriate treatment. There are many treatment methods you can use to avoid PE. Premature ejaculation itself isn’t harmful but other health problems may contribute to the development of premature ejaculation. Acquired PE is defined as consistently poor ejaculatory control, associated bother, and ejaculation latency that is markedly reduced from prior sexual experience during penetrative sex. Other guideline statements on the diagnosis of PE included the following [61] : The diagnosis of PE is based on medical, relationship, and sexual history and a focused physical examination.

• Dapoxetine is specifically designed for on-demand use in PE.
• Topical anesthetics require minimal use to avoid excessive numbness.
• SSRIs impact neurotransmitters involved in ejaculation control.
• Tramadol's side effects limit its routine use for PE.
• Non-drug approaches include psychological counseling and exercises.
• Pelvic strengthening exercises aid in delay of ejaculation.
• Partner education enhances understanding and support.
• Managing stress and anxiety can significantly improve PE.
• Some therapies combine medication with sex therapy sessions.
• Medical evaluation is essential before initiating treatment.
• Lifestyle factors like smoking can influence sexual performance.
• Patient adherence to treatment plans improves outcomes.

Validated patient-reported questionnaires may be useful in diagnosis but are not required.

• Dapoxetine is taken as needed, usually 1-3 hours before sex for rapid action.
• Topical anesthetics should be used sparingly to avoid numbness of partner.
• SSRIs may cause side effects like nausea, dizziness, or decreased libido.
• Tramadol carries potential for abuse and should only be used under medical supervision.
• Daily use of certain medications may be recommended for persistent PE.
• Psychological counseling helps address performance anxiety contributing to PE.
• Pelvic floor exercises improve control and delay ejaculation naturally.
• Partner involvement in therapy can improve treatment adherence.
• Discontinuing medication abruptly may cause withdrawal symptoms or rebound.
• For some men, combining therapy with lifestyle changes yields better results.
• Over-the-counter remedies should be approached cautiously and discussed with a doctor.
• Research continues into new pharmacological and non-pharmacological treatments.

Laboratory testing should not be routinely used for the diagnosis of lifelong PE.

What Are the Signs and Symptoms of Premature Ejaculation?

Erectile dysfunction (you can’t maintain a firm erection for intercourse) Chronic pelvic pain syndrome (long-term pain and cramping in your pelvic area plus long-term urinary tract symptoms and sexual dysfunction) Talk to your healthcare provider if you believe you have premature ejaculation or if ejaculating too soon is affecting your sex life. It’s normal to feel embarrassed about discussing sex with your healthcare provider, but know that PE is a common condition and that your provider isn’t there to judge you. Wearing a condom can decrease sensitivity to your penis and help delay ejaculation. If you have erectile dysfunction, you can’t get or maintain an erection. If you have premature ejaculation, you have an erection, but you reach orgasm and ejaculate earlier than you or your partner would like.

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Erectile dysfunction can lead to premature ejaculation. This happens because you know you can’t maintain an erection, leading to quick ejaculation so you don’t lose your erection. Because of this connection between these two conditions, your urologist will want to figure out if you have erectile dysfunction and, if so, treat that first. While it’s true that drinking alcoholic beverages can delay orgasm, it’s not a recommended treatment for premature ejaculation. There can be many reasons for premature ejaculation. Laboratory testing may be useful when clinically indicated for the diagnosis of acquired PE.

Drug Name	Approval Year	Primary Use	Recommended Dosage	Prescription Needed	Monitor Required	Typical Side Effects
Dapoxetine	2009	Premature ejaculation	30 mg before sex	Yes	Yes	Nausea, dizziness
Paroxetine	Approved for other uses, off-label for PE	20 mg/day	Yes	Yes	Yes	Fatigue, sexual dysfunction
Sertraline	Approved for depression, off-label for PE	50 mg/day	Yes	Yes	Yes	Insomnia, digestive issues

Patients should be advised that circumcision status is unrelated to PE.

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With this technique, you or your partner stimulates your penis close to the point of orgasm, then stops the stimulation for about 30 seconds until you regain control of your response. Repeat this “start and stop” approach three or four times before allowing yourself to orgasm. Continue practicing this method until you have gained good control. With this technique, you or your partner stimulates your penis close to the point of orgasm then gently squeezes the head of your penis for about 30 seconds so that you begin to lose your erection. Repeat this technique a few times before allowing yourself to orgasm.

When to see a doctor

Continue practicing this technique until you’ve gained control in delaying your orgasm. With this technique, the idea is to focus your attention on ordinary nonsexual things during sexual activity. Naming sequences are a good way to focus your attention. For example, visualize naming all the businesses you pass on your drive to the gym or naming all the players on your favorite sports team. If the cause of your premature ejaculation is psychological, emotional or due to relationship issues — like performance anxiety, depression, stress, guilt or a troubled relationship — seek the help of a psychologist, psychiatrist or sex therapist. Consider referral to a mental health professional with expertise in sexual health; patients should be advised that combination behavioral and pharmacologic therapy is more effective than either therapy alone. In patients with concomitant PE and erectile dysfunction (ED), the ED should be treated according to AUA guidelines on erectile dysfunction.