The Best Way to Cure Premature Ejaculation

Several rigorous studies show that throughout the lifespan, rapid, involuntary, premature ejaculation (PE) is men’s top sexual complaint. In every post-puberty age group, one-quarter to one-third of men —25 to 33 percent—admit problems with ejaculatory control. Given many men’s reluctance to admit sex problems, true PE prevalence is probably greater.

PE can be treated in four ways, but only one teaches reliable ejaculatory control. The four methods:

• Anesthetic creams/sprays.

• Alternative medical therapies.

• Low-dose antidepressant medications.

• The program developed by therapists.

Only the therapy program teaches men dependable ejaculatory control. And it’s the only approach that enhances lovemaking for women—ironically, not because men last longer but because the program advocates sexual adjustments that provide more of the erotic moves most women prefer, notably leisurely, playful, extended whole-body massage.

Topical Anesthetics—Thumbs Down

These over-the-counter creams or sprays are similar to anesthetic sunburn products. They numb the penis. They were developed in the belief that PE sufferers have extra-sensitive penises. The anesthetic reduces this supposed super-sensitivity.

However, Korean researchers assessed the penile sensitivity of men with and without PE, and found no differences. PE sufferers do not have unusually sensitive penises, so delay products are based on a fallacy.

PE anesthetics are not cheap—$17 to $50 on the Internet. Numbing the penis interferes with men’s erotic pleasure. These products must be applied no more than 30 minutes before intercourse, so they may interrupt lovemaking. Their taste may deter men’s lovers from providing fellatio. And they don’t teach reliable ejaculatory control. If men stop using them, PE almost always returns.

Alternative Therapies—Thumbs Down

English investigators reviewed studies of PE treatment using acupuncture and herbal medicines. Most gave men only an extra minute or two. Most PE sufferers want more than that. The alternative therapies don't teach reliable ejaculatory control. And they require the time and expense of visits to practitioners, and the ongoing cost of longterm treatment and herbal medicines.

Low-Dose SSRIs—Thumbs Almost Always Down

When men complain of PE to their doctors, most physicians are quick to offer a low-dose of antidepressant medication, specifically a selective serotonin reuptake inhibitor (SSRI), among them: Prozac, Zoloft, and Paxil. PE sufferers show no higher rate of depression than the general population. But SSRIs often cause a side effect, delayed—sometimes completely inhibited—ejaculation. Doctors prescribe low-dose SSRIs not for their therapeutic action, but in hopes of eliciting this side effect.

Most studies show that SSRIs do, indeed, delay ejaculation, but usually no more than a few minutes. Many men hope to last much longer. Using SSRIs requires regular doctor visits, the expense of the drugs, and possible side effects other than delayed ejaculation. Finally, SSRIs don’t teach men reliable ejaculatory control. If men stop using them, PE usually returns.

I recommend low-dose SSRIs only to the small proportion of men who don’t experience sufficient benefit from the sex therapy program. But SSRIs should be the treatment of last resort. The substantial majority of men can learn dependable ejaculatory control without drugs.

The Sex Therapy Program (Self-Help or Professional)—Thumbs Up

The best, most cost-effective PE treatment is the sex therapy program pioneered during the 1960s by sex researchers William Masters, M.D., and Virginia Johnson, and subsequently refined by other sexologists. In just a few months, this approach teaches at least two-thirds of men to last as long as they’d like, no matter if it’s 10 minutes or two hours.

Sex Essential Reads

The Psychology of Sexual Novelty

Want Accurate Sex Information? Beware Some Social Media

Men’s nervous systems are more excitable than women’s. Why? Largely because of men’s higher blood levels of male sex hormones (testosterone in men, androgens in women). As a result, compared with most women, most men are physiologically primed to come faster (and lose their tempers more easily).

In addition, emotional stress/worry/anxiety—including men’s anxieties about coming too quickly—make the male nervous system even more excitable and prone to ejaculate quickly. The more men stress about PE, the faster they’re likely to come.

Finally, most men get much if not most of their sex education from pornography, which is fixated on the genitals—fellatio and intercourse. If erotic touch focuses only or largely on the penis, it becomes over-stimulated and comes quickly.

To cure PE, men should to jettison penis-fixated, porn-style lovemaking and transition to a sexual style that provides erotic fireworks, while simultaneously reducing the male nervous system’s excitability:

• Before sex, take a hot bath or shower. Both relax the nervous system.

• Breathe deeply throughout sex. Also relaxing.

• Before any penis fondling or attempted intercourse, engage in at least 20 minutes of leisurely, playful, whole-body massage. Whole-body massage spreads erotic excitement around the entire body, which takes pressure off the penis. And many studies show that it’s the style of lovemaking most women prefer. (If you make love to music, 20 minutes is five or six typical songs.)

• Learn to recognize the run-up to your point of no return, the moment when ejaculation feels inevitable. This empowers you to take quick action to prevent coming. The way to do this is with extended solo sex sessions where you approach your point of no return and then back away from it over and over again until you're confident you can. Then do the same with a partner providing hand massage, oral, and intercourse (the stop-start technique).

• And limit alcohol before sex, so you can focus fully on all of the above.

There are two approaches to the therapy program—self-help (cheap) and professional therapy (more costly). But once men learn reliable ejaculatory control, they pay no more—no ongoing expenditures for practitioner visits, drugs, or other products. The program works for men who are single or coupled. It causes no side effects. And it enhances women’s sexual pleasure, not just because men last longer, but also because the program adjusts lovemaking toward the erotic style most women prefer.

Therapy costs $150 to $250 an hour. Curing PE typically takes several sessions.

But most men don’t need professional therapy. Dutch researchers offered PE sufferers 12 weeks of web-based self-training information. Two-thirds reported significant benefit.

You can learn to last as long as you’d like. Even if you've suffered PE for years, the therapy program's modest sexual adjustments can teach you to last as long as you'd like.