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.

Dapoxetine has a rapid onset, typically within 1-3 hours.
Topical anesthetics should be applied in small amounts to avoid overdose.
SSRI side effects may include sleep disturbances or gastrointestinal upset.
Tramadol can cause dizziness, dry mouth, and nausea as side effects.
Behavioral techniques teach men to recognize early signs of ejaculation.
Pelvic floor training can enhance ejaculatory control.
Counseling sessions help address performance anxiety and stress.
Medications should be used as prescribed to minimize risks.
Some men respond better to combination therapies.
Abstaining from excessive masturbation may help in some cases.
Lifestyle changes and psychological support are important adjuncts.
Any medication or supplement should be discussed with a healthcare professional.

Stress could be coming from work, other relationships, life changes or other events in your life. This could range from history of sexual abuse to hostile feelings about your partner. These could include feeling guilty or overwhelmed. This includes body image issues or lack of confidence. 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.

Drug Name	Approval Year	Primary Use	Recommended Dosage	Prescription Needed	Monitor Required	Typical Side Effects
Dapoxetine	2009	Premature ejaculation	30 mg before sex	Yes	Yes	Nausea, dizziness
Paroxetine	Approved for other uses, off-label for PE	20 mg/day	Yes	Yes	Yes	Fatigue, sexual dysfunction
Sertraline	Approved for depression, off-label for PE	50 mg/day	Yes	Yes	Yes	Insomnia, digestive issues

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.

Dapoxetine is effective when taken 1-3 hours before intercourse.
Topical anesthetics can reduce sensation but risk partner numbness.
SSRIs may take several weeks to reach full efficacy for PE.
Tramadol's use for PE is off-label; consult a doctor before use.
Combining medication with therapy can optimize outcomes.
Avoiding excessive alcohol and stress can improve sexual performance.
Pelvic exercises increase muscle strength and ejaculatory control.
Psychological support can address anxiety-related PE.
Devices like constriction rings may be used as mechanical aids.
Open communication with partner improves treatment success.
Regular follow-up with healthcare provider is recommended.
Natural remedies lack solid clinical proof but are popular.

Your healthcare provider can help determine the best treatment for you depending on the cause of your premature ejaculation. 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 pills to get her in the mood instantly 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. Lab tests are usually not needed unless your healthcare provider suspects that an underlying health condition is contributing to the problem.

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Write down questions in advance to make the most of your time with your provider. 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?

Vardenafil (Levitra®) for PE

How much improvement can I reasonably expect? 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.

Italian Society of Andrology and Sexual Medicine

To help your provider determine the cause of your problem and the best course of treatment, be ready to answer questions, such as: How often do you have premature ejaculation? 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? 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.

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The goal is to teach you how to control your body and your feelings. 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.

Alternative medicine

Premature ejaculation occurs when you ejaculate (cum) earlier than you or your partner would like during sex. 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.

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Advertising on our site helps support our mission. 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.

Competing interests

PE can be lifelong, meaning you’ve had it since your first sexual experience. 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. The exact timing for premature ejaculation varies and only your healthcare provider can make a diagnosis. Most healthcare organizations consider men enhancement pills ejaculation “premature” if it: Occurs sooner than you or your partner desires. Repeat this “start and stop” approach three or four times before allowing yourself to orgasm. 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.

Therapy Type	Description	Typical Duration	Success Rate	Noted Benefits	Noted Drawbacks
SSRI Medications	Selective serotonin reuptake inhibitors, delay ejaculation	4-12 weeks	70%	Long-term control	Possible side effects
Behavioral Therapy	Techniques like start-stop and squeeze method	Several sessions	60-80%	No medication needed	Requires patient commitment
Topical Anesthetics	Numbing creams or sprays applied to glans penis	As needed	65-75%	Fast onset	Reduced sensation, partner sensitivity
Pelvic Floor Exercises	Exercises to strengthen pubococcygeus muscles	6-12 weeks	50-65%	Improves control	Time-consuming

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

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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 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. 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. Naming sequences are a good way to focus your attention. For example, visualize naming all the businesses you pass on your drive to the gym or naming all the players on your favorite sports team. If the cause of your premature ejaculation is psychological, emotional or due to relationship issues — like performance anxiety, depression, stress, guilt or a troubled relationship — seek the help of a psychologist, psychiatrist or sex therapist.

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.

Your urologist can help direct you to these health professionals. Your provider may recommend certain medications to help with PE. Antidepressants are one of the first-line therapies for PE as they can help delay ejaculation. This is an “off-label” use (not approved by the Food and Drug Administration). Be sure to discuss the side effects of this medication with your urologist to be sure it’s appropriate for you. Antidepressants your provider might prescribe include the tricyclic antidepressant clomipramine (Anafranil®) or selective serotonin reuptake inhibitors (SSRIs), for example: Anesthetic (numbing) creams and sprays you apply to the head and shaft of your penis is another potential first-line medication option to delay ejaculation. Your penis absorbs the anesthetic cream or spray in about 10 to 30 minutes.

When to call a professional

How much are you bothered by premature ejaculation? 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?

Lidocaine (4%) Cream for PE

Deciding to talk with your health care provider is an important step. 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.

When to see a doctor

Pelvic floor muscle training improves erectile dysfunction and premature ejaculation: A systematic review. 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. It causes you to experience less sensitivity in your penis. It’s important to wash your penis before sex to prevent numbness to your partner’s genitals. Erectile dysfunction medications, which include sildenafil (Viagra®), tadalafil (Cialis®), vardenafil (Levitra®) and avanafil (Stendra®), may help treat premature ejaculation, particularly in people with underlying erectile dysfunction. In certain cases, your provider may prescribe tramadol, an opiate medication.