There are 2 types of premature ejaculation:
primary premature ejaculation – where you have always had the problem
secondary premature ejaculation (or "acquired premature ejaculation") – where you recently developed the problem
The causes of primary premature ejaculation are often psychological, such as having a traumatic sexual experience at an early age. Secondary premature ejaculation can be caused by both psychological and physical factors. Physical causes can include drinking too much alcohol and inflammation of the prostate gland (prostatitis).
Treatment
If your premature ejaculation is caused by a physical condition, treating the underlying condition should help. A GP can suggest possible treatment options.
Treating premature ejaculation caused by psychological factors can be more challenging. But most men who persevere with treatment find the problem resolves.
Self-help
There are a number of self-help techniques you can try before getting medical help.
These include:
masturbating 1 to 2 hours before having sex
using a thick condom to help decrease sensation
taking a deep breath to briefly shut down the ejaculatory reflex (an automatic reflex of the body, during which you ejaculate)
having sex with your partner on top (to allow them to pull away when you're close to ejaculating)
taking breaks during sex and distracting yourself by thinking about something completely different
If you're in a long-term relationship, you may benefit from having couples therapy.
You'll be encouraged to explore issues that may be affecting your relationship and be given advice on how to resolve them. You may also be shown techniques that can help you "unlearn" the habit of premature ejaculation.
Medicine
Selective serotonin reuptake inhibitors (SSRIs) can be used if self-help techniques do not improve the problem. SSRIs are mainly used to treat depression, but one of their side effects is delaying ejaculation.
Dapoxetine is an SSRI specifically designed to treat premature ejaculation. It can be used "on demand". You'll usually be advised to take it between 1 and 3 hours before sex, but not more than once a day.
If dapoxetine does not work, your GP may recommend trying another SSRI on an "off-label" basis. This is when a medicine is used for a different purpose than it was licensed for. Doctors can prescribe an off-label medicine if they decide it's in the patient's best interest.
Other SSRIs that may be prescribed for premature ejaculation include paroxetine, sertraline or fluoxetine. You'll usually need to take these types of SSRIs for 1 or 2 weeks before gaining the full effects.
Anaesthetic creams and sprays such as lidocaine or prilocaine cream can help by making your penis less sensitive. Using an anaesthetic cream with a condom can be particularly effective. A GP should be able to recommend a suitable cream.
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