Ejaculatory Dysfunction Patient Information

Premature ejaculation is a very common sexual problem. It is the inability to delay ejaculation to a point when it is mutually desirable for both partners and causes distress.  Some men have premature ejaculation from the point in life that they start having orgasms (lifelong), and some men develop it over time (acquired). The definition of when ejaculation is premature is subjective. While some men have trouble controlling orgasm upon entry, others consider 5 to 10 minutes of penetration prior to orgasm too little time as well. The important factor in diagnosing premature ejaculation is not how long a man can last, but rather whether he and his partner are satisfied with how long intercourse lasts.

Most men have experienced this problem at some time in their life. Premature ejaculation can be psychological in nature, be impacted by varying levels of penile sensitivity, or even hormone levels. The exact cause of premature ejaculation is not known yet, however.  Some other potential influences on how quickly a man reaches orgasm include the following:

  • Early Sexual Experiences

    Some men have had early sexual experience that required sex to be over quickly (such as masturbating to avoid getting caught by parents, having sex in a car, etc.) that still persist and result in rapid ejaculation. Most men gradually learn to control their orgasm, and these prior experiences have no lasting effect.

  • Performance Anxiety

    Some men will develop a longer-term anxiety regarding sex, which can result in persistent premature ejaculation as a result of a vicious cycle of performance pressures. Frequently this pattern is seen in new relationships.

  • Missing Interal Cues

    Researchers interviewed men who could last a long time prior to orgasm to discover their secrets. Unlike premature ejaculators, these men were better able to identify that point where ejaculation cannot be stopped and take corrective action before that point is reached.

  • Low Sexual Arousal Or Desire

    The sexual response cycle is made up of 3 phases: desire, arousal, and orgasm. With premature ejaculation, sometimes the underlying problem is a low initial sexual desire, or a lack of sexual arousal. Believe it or not, it is possible for a man to have a good erection without strong sexual desire and even without being fully aroused. In these cases, the premature ejaculator actually needs to be MORE turned on, which will allow him more control over his ejaculation. Sexual behavior is also a factor – the longer the period since a man’s last ejaculation, the quicker orgasm is often reached.

What Can A Man Do To Delay Ejaculation?

Psychotherapy & Physical Therapy

There are a number of psychological, behavioral, and physical therapies that can be used to slow ejaculation. One way to reduce premature ejaculation is to learn how to identify and control the sensations leading up to orgasm. The “Masters and Johnson method” is a way that you can do this at home; while it requires a great deal of patience and practice, it is also very effective.

An excellent way to practice this method is with a caring lover. With your partner, you should engage in stimulation other than penetration (like masturbation or oral sex) and gradually allow yourself to reach the point just before ejaculation. At that point, have your partner stop and allow yourself to partially lose your erection, and also allow yourself to relax before starting again. Each time you do this, bring yourself closer and closer to orgasm until you cannot hold it back any longer. Doing this a number of times on different occasions will help you learn where your point of climax is, and more importantly, will help you control it. Once you are ready to try intercourse, lie on your back and direct your partner to slowly allow you to penetrate. As soon as you feel that you are about to climax, signal to your partner to stop stimulating you. Relax for a bit, then start again. This process should help you gain more control over ejaculation. But remember, be patient and try not to put too much pressure on yourself or the situation. If you don’t get it the first time, shrug it off and remember that you are working towards something that takes time.

The “Squeeze Technique” is a variation of the Masters and Johnson method, except that the assisting partner squeezes the tip or base of the penis just before the point of climax to essentially cancel the orgasm. The "squeeze" forces blood out of the penis and reduces the erection. The Squeeze Technique can work alone or in combination with other approaches such as the Masters and Johnson method. Men can also be taught to increase their level of control through masturbation training, changing positions during sex, and in some men, ejaculation prior to sex to increase how long they last. 

It can also be helpful for men to learn to focus more on the non-genital aspects of the sexual experience and to feel pleasure in other parts of the body. Some men claim that focusing their thoughts on something mundane like sports scores or a math problem helps them reduce sensation and hold out longer.

Anesthetic Topical Gels, Sprays, And Creams

Anesthetic gels, creams, and sprays decrease penile sensation so that a man can last longer. There are a number of these available, and most do not need a prescription and can be purchased over the counter. The limitation that many men feel with these topical treatments is that they make intercourse less pleasurable by decreasing penile stimulation. They can also be transferred to a female partner and decrease her sensation as well.


Certain medications often used for depression, called selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCAs) can cause a delay in ejaculation.  Other medications that can be used to slow orgasm include tramadol, which is a weak narcotic painkiller. Some men, particularly those with erectile dysfunction as well as premature ejaculation, can potentially benefit from using phosphodiesterase 5 inhibitors (i.e. Viagra, Cialis).   


Condoms, like topical anesthetics, can reduce the penile stimulation experienced during sex. Some men find that a condom helps them reduce early ejaculation by decreasing sensation. If one condom does not decrease stimulation enough, then additional condoms can be used, together with topical desensitizing gels, creams, or sprays. Some condoms even come pre-treated with such preparations. Condoms also provide excellent protection against sexually transmitted diseases and pregnancy, so they are certainly worth a try.

Other Treatment Options

There are a number of other treatment options that you might come across when researching treatments for premature ejaculation. These include oxytocin antagonists, herbal medicines or nutraceuticals (i.e. yohimbine), other drugs such as amantadine, cyproheptadine, pseudoephedrine (Sudafed), hormone therapies, Botox injections, penile nerve ablation, and acupuncture.  At this time, there is no good evidence that these work well in men with premature ejaculation.  As more research is done on these treatments, that may change.