Managing Side Effects of PE Medications

It can also be acquired, which means you’ve had sex previously where PE wasn’t an issue. Many healthcare providers would define premature ejaculation as ejaculating within one minute of beginning intercourse.

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 exact timing for premature ejaculation varies and only your healthcare provider can make a diagnosis. Most healthcare organizations consider ejaculation “premature” if it: Occurs sooner than you or your partner desires. Causes distress to one or both partners. Happens during all or almost all sexual activity. Has been occurring for longer than six months to one year. Between 30% and 40% of people experience premature male enhancement pill ejaculation at some point in their lives. It’s the most common type of sexual dysfunction in people with a penis, with about 1 in 5 people between the ages of 18 and 59 reporting premature ejaculation.

Preparing for your appointment

The list below suggests questions to ask your health care provider about premature ejaculation. Don't hesitate to ask more questions during your appointment. What may be causing my premature ejaculation? How soon after I begin treatment can I expect improvement? How much improvement can I reasonably expect?

Medication Options to Reduce Sensitivity and Improve Control

Am I at risk of this problem recurring? Is there a generic alternative to the medicine you're prescribing? Are there any brochures or other printed material that I can take home with me? Your health care provider might ask very personal questions and might also want to talk to your partner. To help your provider determine the cause of your problem cost of vardenafil and the best course of treatment, be ready to answer questions, such as: How often do you have premature ejaculation? Anxiety/psychological factors are most often the cause of premature ejaculation. Extra sensitive penile skin is also a common cause. It could come from the nervousness of being with a new partner, the anxiousness of having sex again after a long period of abstinence, being overly excited or other reasons. Stress could be coming from work, other relationships, life changes or other events in your life.

Product	Dosage	Quantity + Bonus	Price
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This could range from history of sexual abuse to hostile feelings about your partner.

Rights and permissions

The information below should help you prepare to make the most of your appointment. When you make your appointment, ask if there are any restrictions you need to follow in the time leading up to your visit. How often do you ejaculate before you or your partner would wish? How long after you begin having intercourse do you typically ejaculate? Think back on your relationships and sexual encounters since you became sexually active.

Behavioral techniques

Have you had problems with premature ejaculation before? Write down any other medical conditions with which you've been diagnosed, including mental health conditions. Also note the names and strengths of all medications you are currently taking or have recently taken, including prescription drugs and those you buy without a prescription. Questions to ask your health care provider. Write down questions in advance to make the most of your time with your provider. These could include feeling guilty or overwhelmed. This includes body image issues or lack of confidence.

Remedy	Type	Usage Description	Reported Benefits	Common Side Effects	Notes
Kegel Exercises	Physical activity	Repeatedly contracting pelvic muscles	Improved control	Muscle soreness	No medication involved
Herbal Supplements	Plant-based extract	Taken orally, e.g., ginseng, yohimbe	Possible enhancement of control	Interactions with medications	Evidence varies
Acupuncture	Traditional therapy	Stimulating specific body points	Stress reduction	Mild soreness	Limited scientific evidence

A hormonal problem involving oxytocin levels, which has a role in sexual function — other hormone levels that play a role in sexual function include luteinizing hormone (LH), prolactin and thyroid stimulating hormone (TSH) Low serotonin or dopamine levels, which are chemicals in your brain that are involved in sexual desire and excitement A penis that’s extra sensitive to stimulation It’s worth noting that premature ejaculation isn’t typically due to an underlying penile disorder, disease, infection or problem with your reproductive organs. Most of the time, everything is working as it should and the problem comes from stress, nervousness and anxiety. The only symptom of premature ejaculation is ejaculating too soon. Premature ejaculation can have a significant effect on your relationship with your partner, making the complications psychological rather than physically harmful. You may feel embarrassed or that you can’t satisfy your partner. This can lead to issues with intimacy and impact your relationship as a whole. 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.

Treatments for premature ejaculation

It’s a common problem, affecting 30% to 40% of people with a penis. Causes include physical problems, chemical imbalances and emotional/psychological factors. Treatments include learning techniques to delay ejaculation, counseling and medications. Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission.

Clomipramine (Anafranil)

We do not endorse non-Cleveland Clinic products or services. Premature ejaculation (PE) is a type of sexual dysfunction that occurs when a person has an orgasm and ejaculates sooner than they or their partner would like. It often happens before or shortly after penetration during intercourse. Premature ejaculation can be a frustrating experience for both you and your sexual partner and make your sex lives less enjoyable. PE can be lifelong, meaning you’ve had it since your first sexual experience. Your healthcare provider can help determine the best treatment for you depending on the cause of your premature ejaculation.

• Dapoxetine is contraindicated with certain medications and health conditions.
• Topical creams should be used sparingly to prevent partner numbness.
• SSRI treatment may cause emotional blunting or decreased libido.
• Tramadol's risk of dependency requires careful medical supervision.
• Mechanical devices can provide temporary ejaculation delay.
• Behavioral training involves specific sex exercises for control.
• Mindfulness and relaxation techniques benefit PE management.
• Proper diagnosis is essential to rule out underlying disorders.
• Incorporate partner feedback to improve treatment results.
• Avoid abrupt discontinuation of prescribed medication.
• Lifestyle modifications can include weight management.
• Ongoing research aims to develop more effective PE treatments.

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. 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? 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.

Selective Serotonin Reuptake Inhibitors

When did you first experience premature ejaculation? Do you have premature ejaculation only with a specific partner or partners? Do you experience premature ejaculation when you masturbate? Do you have premature ejaculation every time you have sex? How much are you bothered by premature ejaculation?

Tramadol (Ultram, Rybix ODT, ConZip, Ryzolt)

How much is your partner bothered by premature ejaculation? How satisfied are you with your current relationship? Are you also having trouble getting and keeping an erection (erectile dysfunction)? If so, what medications have you recently started or stopped taking? Deciding to talk with your health care provider is an important step. 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. 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.

Further information

In the meantime, consider exploring other ways in which you and your partner can connect. Although premature ejaculation can cause strain and anxiety in a relationship, it is a treatable condition. Premature ejaculation — Current concepts in the management: A narrative review. Disorders of ejaculation: An AUA/SMSNA guide. Pelvic floor muscle training improves erectile dysfunction and premature ejaculation: A systematic review.

Topical Treatments for Premature Ejaculation

In: Diagnostic and Statistical Manual of Mental Disorders DSM-5-TR. National Institute of Diabetes and Digestive and Kidney Diseases. Khera M. Treatment of male sexual dysfunction. Premature ejaculation occurs when you ejaculate (cum) earlier than you or your partner would like during sex. The goal is to teach you how to control your body and your feelings.

See also

If you are a Mayo Clinic patient, we will only use your protected health information as outlined in our Notice of Privacy Practices. You may opt out of email communications at any time by clicking on the unsubscribe link in the email. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. Please, try again in a couple of minutes Several alternative medicine treatments have been studied, including yoga, meditation and acupuncture. However, more research is needed to determine their effectiveness.

Citalopram (Celexa)

It's typical to feel embarrassed when talking about sexual problems. But you can trust that your health care provider has had similar conversations with many others. Premature ejaculation is a very common condition. And it's one that can be treated. Being ready to talk about premature ejaculation will help you get the treatment you need to put your sex life back on track. 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.

Side Effect	Medication Type	Incidence Rate	Severity Level	Management Strategies	Notes
Nausea	SSRIs, topical anesthetics	10-15%	Mild to Moderate	Dose adjustment, timing	Usually transient
Dizziness	SSRIs, topical anesthetics	8-12%	Mild	Standing slowly, hydration	Common with beginning treatment
Headache	SSRIs, topical anesthetics	5-10%	Mild	Analgesics, time to adjust	Typically diminishes over time
Reduced Sensation	Topical anesthetics	10-20%	Mild	Reduced dose, application timing	Can affect partner satisfaction

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.

• Topical anesthetic creams temporarily desensitize the penis to delay ejaculation.
• SSRI medications like paroxetine are prescribed off-label for premature ejaculation.
• Dapoxetine is a short-acting SSRI specifically approved for PE treatment.
• Tramadol, an opioid, can help delay ejaculation but carries dependency risks.
• Topical sprays offer quick, localized numbing effects to control ejaculation timing.
• PDE5 inhibitors like sildenafil may improve performance in men with PE and ED.
• Behavioral therapies include the stop-start and squeeze techniques to extend duration.
• Kegel exercises strengthen pelvic muscles, potentially delaying ejaculation.
• Counseling and sex therapy can address psychological causes of PE.
• Combining medication with behavioral techniques enhances treatment effectiveness.
• Herbal supplements lack robust clinical evidence but are used by some for PE.
• Consultation with a healthcare provider is essential to tailor appropriate therapy.

Repeat this technique a few times before allowing yourself to orgasm. 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.