Before treatment of premature ejaculation (PE), doctors will typically check for:

• More major diseases (e.g. heart disease, cancers). These illnesses will be treated first
• Erectile dysfunction (ED). ED may be treated before or together with PE

Some common treatment options for PE include lifestyle changes, psychotherapy, behavioural techniques and medication (drugs). Do note that it will take time to find the treatment or combination of treatments that will work for you. If you have a partner, do consult your partner’s opinions before selecting the most appropriate treatment method.

How can I delay ejaculation naturally?

Research has shown that some health supplements may help males learn to control their ejaculation. Although these supplements are not official treatment methods, they are still taken by many people with PE as they do not have any harmful side effects.

• Zinc
  • According to an article in the International Journal of Molecular Sciences, males with infertility have reduced quantities of zinc found in semen
  • Although there is no research that proves the direct correlation between zinc and improving PE, taking zinc supplements can:
    • Increase testosterone levels in the body
    • Improve libido in general
    • Improve sexual dysfunction, which includes PE
• Magnesium
  • According to a review in the Asian Journal of Andrology, magnesium increases certain muscle contractions common in orgasms (which commonly occur with ejaculation simultaneously)
  • Low levels of magnesium may result in premature ejaculation

Eating healthily allows people to maintain a healthy weight, as well as to have enough energy for sexual intercourse. Frequent exercise also ensures that our muscles are well-developed, providing people with the stamina necessary for sexual intercourse.

Should I go for therapy?

Therapists usually consider the possible psychological causes of premature ejaculation, and examine its psychological effects. The goals of therapy may then be:

• Learning techniques to control ejaculation (Behavioural methods)
• Reducing anxiety
  • Getting rid of self-deprecating thoughts that could lead to premature ejaculation
• Learning better communication skills
  • Place less emphasis on ejaculation to increase satisfaction in their love life and reduce performance anxiety
  • Solving conflicts in the relationship
• Reduce the impact of PE on the relationship

Therapy can be divided into two categories: Individual therapy and couple’s therapy

A. Individual Therapy (Cognitive Behavioural Therapy)

This method aims to strengthen an individual’s self confidence and to eradicate any harmful thoughts from their minds. This reduces performance anxiety and depression, helping to stabilise a man’s hormones and reduce the occurrence of PE.

In cognitive therapy, harmful thoughts are often reformulated into positive thoughts or replaced with different perspectives.

B. Couples Therapy (Sensate Focus)

Sensate focus is one method of couples therapy, involving a series of exercises in which a couple undresses one another while touching, embracing, kissing, petting and talking. However, the touches should remain chaste, and genitals should remain off-limits. The exercises gradually grow more sexual in nature over the weeks, and sexual intercourse is only an option at the final step.

This method helps improve intimacy and communication between partners during sexual activity, reducing performance anxiety as the goal of sexual intercourse is shifted from climaxing to experiencing and understanding their partner’s body.

What are some methods that can be used to delay ejaculation?

A. Kegel Exercises (Pelvic Floor Exercises)

Men with weak pelvic floor muscles might be less able to delay ejaculation. Kegel exercises can help strengthen these muscles.

1. How to identify your pelvic floor muscles

Pelvic muscles are used when you stop urination in midstream or try not to pass gas. Try doing these two actions and you will be able to identify where your pelvic floor muscles are.

2. How to do Kegel exercises

• Kegel exercises can be done standing up, on your knees, lying on your back or lying on your stomach
• Tighten your pelvic floor muscles, then hold tight and count for 3-5 seconds. Do note not to tighten the muscles in your abdomen, thighs or buttocks
• Relax the muscles and count for 3-5 seconds
• Repeat 10 times, 3 times a day

B. Pause-squeeze Technique

This technique can be done by you and your partner. This is how it works:

• Carry out sexual activity as usual, until you feel almost ready to ejaculate
• Have your partner squeeze your penis (where the head joins the shaft) to decrease the level of arousal
• Maintain the squeeze for about 30 seconds until the urge to ejaculate passes
• Have your partner repeat the squeeze process as necessary, until you can enter your partner without ejaculating

Carrying out this method for a few times will help you develop the habit of delaying ejaculation, and the pause-squeeze technique will no longer be required.

C. Stop-start Technique

This technique, also known as edging, can help you delay a climax. This is how it works:

• Stimulate the penis until just before orgasm, and then stop all sexual simulation until the sensation has passed
• Then, begin sexual simulation again and repeat this technique a few times
• Doing so will help you recognise the phase of sexual arousal that occurs before organism – during that phase, ejaculation can still be delayed for some time

D. Condoms

Condoms help to decrease penis sensitivity, which subsequently will help to delay ejaculation. “Climax condoms” can also be used during sexual intercourse, which contain numbing agents (see below) or are made of thicker latex to delay ejaculation.

What are some drugs that help with delaying ejaculation?

A. Topical Anesthetics

Anesthetic creams that contain a numbing agent, such as benzocaine, lidocaine or prilocaine, can be used to treat PE. Apply these products to the penis about 10 to 15 minutes before sexual activity to reduce sensitivity of the penis and delay ejaculation.

However, do note that these anesthetic creams may have potential side effects, such as temporary loss of sensitivity and decreased sexual pleasure.

B. Oral Medication

Antidepressants

Taking certain antidepressants may result in delayed orgasm, so selective serotonin reuptake inhibitors (SSRIs), such as escitalopram, sertraline, paroxetine and fluoxetine are used to help to delay ejaculation.

Dapoxetine is another type of antidepressant that is used to delay ejaculation, thus effectively treating PE. It is usually taken around 1-3 hours before sexual activity with a starting dose of 30 mg, which may then be increased to 60 mg after 4 weeks. Your doctor will advise you on the dosage.

However, some side effects of dapoxetine include: nausea, diarrhea, dizziness and headache.

Analgesics

Tramadol (sold under the name Ultram) is an analgesic that is commonly used to relieve pain. It also has a side effect of delayed ejaculation, and thus can treat PE. It may be prescribed when SSRIs are ineffective, and cannot be used together with SSRIs.

Some side effects of tramadol include nausea, headache, sleepiness and dizziness.

Phosphodiesterase-5 inhibitors (PDE5i)

Sildenafil (sold under the name Viagra) is a type of PDE5i. It helps to control blood flow, allowing the blood vessels in the penis to relax. More blood flows more easily to the penis, filling up the erectile tissue, causing an erection. These drugs are commonly used to treat ED. Since ED is one of the main causes of PE, most patients with PE regain control of ejaculation once their ED has been treated.

Some side effects include: headaches, flushing, indigestion, nasal congestion, cold-like symptoms, vision issues.

For more information or if you require a medical consultation, please contact My Healthcare Collective here.