Drugs for Premature Ejaculation: Most Men Soon Quit Them

Drugs to treat PE help only a minority of men.

Posted Jan 15, 2020

Rapid, involuntary “premature” ejaculation (PE) is men’s number-one sex problem. Erectile dysfunction gets more publicity, but few men develop it until after age 50. Meanwhile, from the teen years to late adulthood, the best research shows that PE plagues one-quarter to one-third of sexually active men.

There are two treatments for PE—low-dose antidepressants or the program developed by sex therapists that tinkers with how men make love. Advocates of drug treatment claim it’s effective. But a recent study shows that the drugs eliminate PE in fewer than half of men and that within one year almost three-quarters of users—72 percent—stop taking them. The sex-therapy training approach works better, costs less, has no side effects, usually produces permanent cure, and increases women’s pleasure, not just because men last longer, but because the sex therapy program reorients lovemaking in ways most women prefer.

The Little-Known Downsides of PE Medication

The drugs used to treat PE belong to the most popular class of antidepressants: selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Zoloft, Paxil, Lexapro, Luvox, Celexa, Viibri, and Brintellix. 

Few PE sufferers are actually depressed. But soon after the FDA’s 1987 approval of the first SSRI, Prozac, it became clear that the SSRIs have a side effect—delay of orgasm, and possibly loss of ability to climax at all. Drug makers discovered that in men with PE, lowering the dose could delay but not totally suppress orgasm/ejaculation. Several analyses of low-dose SSRIs show the drugs help men last one to five minutes longer.

The review authors call this “significant effectiveness.” Actually, that’s an exaggeration that borders on medical irresponsibility. Say a man lasts a few seconds to half-a-minute on his own. SSRIs typically extend that into the range of 90 seconds to five or six minutes. But many men hope to last much longer. So even when the drugs “work,” they don’t deliver what many men want.

Low-dose SSRIs may also cause side effects: drowsiness (8 percent of users), headache, nausea, and nervousness (5 percent each), and dizziness (4 percent). Around half of men who experience side effects call them moderate to severe, which may interfere with sexual function, pleasure, and satisfaction. 

Most men don’t want the hassle of managing pill use. And they don’t want to depend on costly, potentially problematic medication for life. They’d rather learn reliable ejaculatory control once and for all. But SSRIs don’t teach it.

The new study makes SSRIs look even less attractive. The researchers, urologists at Memorial Sloan Kettering in New York, prescribed low-dose SSRIs to 130 PE sufferers, then tracked them for one year. Self-rated “poor” control dropped to 41 percent of the men—that is, 59 percent reported lasting at least a little longer. But after a year, only 28 percent were still taking the pills. Almost three-quarters—72 percent—had quit for the reasons just mentioned: side effects, the hassles of pill-taking, and not lasting as long as they’d hoped. 

The Better Way: Learning Reliable Ejaculatory Control

During the 1960s, pioneering sexologists William Masters and Virginia Johnson discovered that a quick, easy self-training program could cure most PE and teach the large majority of men dependable ejaculatory control. Over the past 60 years, other sexologists have refined their program. It includes:

Deep relaxation. Some people call erotic arousal “sexual tension,” but the word “tension” is counterproductive. Tension, anxiety, and emotional stress prime the nervous system to climax quickly. The first step to curing PE is deep relaxation—not the kind that combines beer, a recliner, and football, but the emotional release that results from exercise, deep breathing, hot baths or showers, meditation, yoga, and similar regimens. Deep relaxation calms the nervous system, and helps prevent involuntary ejaculation. Many men find that simply breathing slowly and deeply during sex improves their ejaculatory control.

Whole-body massage. Many men believe “sex” is what’s depicted in pornography—mostly fellatio and intercourse; in other words, penis worship. Actually, preoccupation with the penis primes the nervous system to ejaculate quickly. 

Of course, in sex, the penis is important, just as fuel is important in cars. But it takes more than fuel to keep cars running smoothly. The moving parts must also be lubricated so they don’t burn up in the heat. When the heat is sexual arousal, the activity that “lubricates” the moving parts is gentle, patient, whole-body caressing from head to toe. 

That’s why showers/baths feel so relaxing. Immersion in hot water is only part of it. In addition, soaping up involves gentle self-touch all over. Whole-body touch distributes arousal. When the penis is the sole focus of arousal, the little guy can’t take the pressure, and men come quickly. But whole-body arousal takes pressure off the penis and helps men last as long as they want.

Self-sexing. If male sexuality isn’t just fellatio and intercourse, what is it? Whole-body massage that eventually includes the genitals. Once men feel deeply relaxed, it’s time to include the penis by masturbating. Many young men self-sex in a hurry, which trains them to come quickly. But slow, playful solo sex can retrain them to last as long as they’d like. 

Start by masturbating with a dry hand. Tune into what you’re feeling. When you approach your point of no return, when ejaculation feels inevitable, stop stroking until the urge to come subsides. Then return to self-sexing. Sex therapists call this the “stop-start technique.” Practice stop-start—approaching ejaculation and backing away from it—until you can reliably last 30 minutes. Then practice stop-start with a lubricated hand until you can last 30 minutes.

As you practice, you may lose control and come before you want. Don’t despair. When learning to ride a bike, most people fall a few times. Wait a bit, then return to practicing stop-start. 

Add a partner. If you’re partnered and that person is willing to help, the next step involves adapting the above to playing together. Breathe deeply as you kiss, cuddle, and gently touch each other all over, but postpone genital touch for 20 minutes or so. Next, your partner strokes your erection with a dry hand. When you approach your point of no return, signal your lover to stop so you can back away from coming. Practice stop-start together until you can reliably last 30 minutes. Next your partner strokes you with a lubricated hand until you can last 30 minutes. Then do the same with fellatio and intercourse. (For more on self-training for ejaculatory control, see my e-booklet, The Cure for Premature Ejaculation.)

What If Self-Training Doesn’t Provide Sufficient Relief?

Try working with a professional, a sex coach or therapist. Sex coaches can help when the problem is just sexual. Consult sex therapists when sexual issues become complicated by relationship strife.

A small proportion of men don’t benefit from professional help. They’re free to use low-dose SSRIs. But with the self-help program or professional counseling, few men need drugs.

References

Ciocanel, O et al. “Interventions to Treat Erectile Dysfunction and Premature Ejaculation: An Overview of Systematic Reviews.” Sexual Medicine (2019) 7:251.

Cooper, K. et al. “Interventions to Treat Premature Ejaculation: A Systematic Review Short Report,” Health Technology Assessment (2015) 19:1.

Jenkins, L.C. et al. “Compliance with Fluoxetine Use in Men with Primary Premature Ejaculation,” Journal of Sexual Medicine (2019) 16:1895.

McMahon, C.G. et al. “Oral Agents for Treatment of Premature Ejaculation: Review Of Efficacy And Safety In The Context Of The Recent International Society For Sexual Medicine Criteria For Lifelong Premature Ejaculation,” Journal of Sexual Medicine (2011) 8:2707.