Premature Ejaculation – Diagnosis and Treatment

Diagnosis

Doctors usually start by asking about your sexual history and symptoms, like trouble during intercourse or ejaculating too quickly.

They’ll likely ask about ejaculatory latency time and check if you have other issues, such as erectile dysfunction. Next, the doctor might do a physical exam to look for possible causes, like penile hypersensitivity or hormone imbalances.

If both premature ejaculation and erection problems are present, they might order blood tests to check hormone levels.

Checklist for Diagnosis:

• Review of sexual history and symptoms
• Physical exam
• Blood tests (if needed)
• Referral to a urologist or sexual medicine specialist

Sometimes, the doctor recommends seeing a urologist or mental health professional to dig deeper into the causes or to rule out emotional factors, especially if the problem has been around for a long time or started suddenly.

Treatment

Changes to Sexual Habits

Many people manage premature ejaculation by tweaking their sexual routines. Masturbating an hour or two before sex sometimes helps delay ejaculation during intercourse.

Taking breaks during sex and focusing on things like touching or kissing can ease anxiety and take the pressure off. Experimenting with different types of sexual stimulation can help you spot triggers that make you finish faster.

Over time, you get better at recognizing these cues and controlling the urge to ejaculate. It helps to slowly increase the time spent on sexual activities without rushing to orgasm.

Couples can try out different approaches together to find what works best for them.

Strengthening Pelvic Muscles

Weak pelvic floor muscles can make it tough to delay ejaculation. Doing Kegel exercises regularly can improve control.

Steps for Pelvic Floor Exercises:

1. Find the Right Muscles: These are the muscles you use to stop urinating midstream or to hold in gas.
2. Tighten and Hold: Squeeze these muscles, hold for three seconds, then relax for three seconds.
3. Repeat: Aim for at least 10 repetitions in a row, three times per day.
4. Focus: Don’t tense your stomach, thighs, or buttocks, and remember to breathe normally.

Starting these exercises while lying down usually feels easier. As you get stronger, try doing them while sitting, standing, or walking.

Benefits Table:

Benefit	How it Helps
Strong pelvic muscles	More control during ejaculation
Improved sexual function	May enhance sexual satisfaction
Simple and private exercise	Can be done almost anywhere

Pause-and-Hold Method

This method helps delay ejaculation during sex by following a few steps. Start sexual activity and keep going until you feel close to ejaculating. Then, squeeze the end of the penis (where the shaft meets the head) for several seconds.

Wait for the urge to fade, then start again. Repeat as often as needed. With practice, some people build enough control that they don’t need to use the technique anymore.

If squeezing feels uncomfortable, you can just pause all stimulation until the urge passes, then resume. Both approaches teach your body to recognize and manage arousal.

Tip: Patience and honest communication with your partner really make a difference here.

Using Special Condoms

Condoms sometimes help delay ejaculation by reducing sensitivity. Some are thicker or have numbing agents like benzocaine or lidocaine inside.

Types of Condoms:

• Standard Latex Condoms: These reduce sensation a bit.
• “Climax Control” Condoms: They contain a small amount of numbing cream to help you last longer.

Always read the instructions and check for allergies before using them.

Medications

Numbing Creams and Gels

Creams, sprays, and gels with local anesthetic lower sensitivity. Apply them 10 to 15 minutes before sex.

Things to know:

• If you don’t use them correctly, both partners might feel less pleasure.
• Most are available over the counter, but a few need a prescription.
• Wash the product off before intercourse to avoid numbing your partner.

Oral Medications

Some oral medicines can help delay ejaculation, though not all countries officially approve them for this use.

1. Antidepressants (SSRIs and TCAs):

• SSRIs (Selective Serotonin Reuptake Inhibitors): Can delay orgasm as a side effect.
• Tricyclic Antidepressants: An option if SSRIs aren’t effective. Nausea, sweating, drowsiness, and sometimes lower sex drive are the common side effects.

2. Pain Relievers:

• Tramadol sometimes helps with delaying ejaculation, but don’t use it with SSRIs because the combination can be dangerous. Common side effects: nausea, drowsiness, headaches, and risk of dependence if used long-term.

3. Erectile Dysfunction Medicines:

• Phosphodiesterase-5 Inhibitors (ED Drugs): Mainly treats ED, but they might also help with premature ejaculation—especially when combined with an SSRI.

Always talk to your healthcare provider about any medicines you take, since interactions can happen.

Talking Therapy and Emotional Support

Talking with a therapist or counselor can help you manage feelings, anxiety, and relationship issues that might make premature ejaculation worse.

Types of counseling include:

Type of Counseling	Main Focus	Who Benefits
Sex therapy	Sexual performance issues	Individuals/couples
Relationship therapy	Communication, intimacy	Couples
Individual counseling	Stress, anxiety	Any person affected

• Sex Therapy: Sessions focused on understanding and managing sexual concerns, often involving both partners.
• Relationship Counseling: Helps with communication and emotional closeness in your relationship.
• Individual Counseling: Supports you in managing stress, anxiety, or low self-esteem.

Benefits of Counseling:

• Reduces performance anxiety
• Improves communication between partners
• Offers guidance to develop healthier coping methods

Counseling usually works best when you combine it with medical or behavioral treatments. Partner involvement and open conversation often help a lot.

Natural Approaches

Some people try yoga, meditation, or acupuncture as extra ways to handle symptoms.

There isn’t enough research to say for sure how well these methods work.

Getting Ready for Your Visit

Before your doctor’s visit, it helps to get organized. Check if you need to follow any special instructions, like diet or medication restrictions.

Write down your symptoms—how often you experience early ejaculation, and how long sex usually lasts before ejaculation.

Jot down details about your personal history:

• When the problem began and if it happens with certain partners
• Times you’ve felt distress or anxiety about it
• Whether it’s causing relationship issues

List your past health problems and all current medications, including over-the-counter drugs and supplements. Think about any mental health conditions, like anxiety or depression, and add those to your notes.

Keep a list of concerns or symptoms you want to talk about. This helps the appointment go smoothly and makes sure nothing important gets missed. Honesty really helps your doctor find the best solution.

Important Questions for the Health Care Provider

Feeling nervous is normal, but asking questions helps you understand your condition better.

Here are a few you might want to ask:

• What could be causing this problem?
• Are there any tests I might need?
• What treatments are available, and which do you recommend?
• How soon might I see changes after starting treatment?
• Is there a chance this will come back in the future?
• Are there affordable or generic options?

Bringing a list of questions helps you get clear answers and shows the doctor what matters most to you. If you’re in a relationship, you can also ask how treatment might help both you and your partner feel less stressed or frustrated.

How Your Doctor Will Approach the Visit

Doctors often ask personal questions to understand what you’re experiencing. These questions help them know if your early ejaculation happens all the time or just in certain situations.

They may ask:

• How often it happens and with whom
• How much it bothers you or your partner
• If you have sex regularly and what your relationship is like
• If you have other sexual problems, like trouble keeping an erection
• About any recent changes in health, stress, or medications

Doctors might also want to know if your partner is supportive or if this is causing relationship issues. Sometimes, they’ll ask to speak with your partner for more insight, especially if the concern affects both of you.

Helpful Steps to Take Before Your Appointment

While you wait to see the doctor, you’ve got a few things you can try. If it feels right, talk things over with your partner.

Sharing your feelings and worries might take the edge off and help you feel closer. Some couples experiment with intimacy in ways that don’t involve intercourse, which can ease the pressure and cut down on anxiety a bit.

Try jotting down when the issue pops up. Keeping this kind of diary helps you and your doctor get a clearer picture of what’s going on.

If anxiety creeps in, you might find some relief with deep breathing or gentle exercise. Even small steps like these can make you feel a bit more prepared and supported while you look for answers.