Premature ejaculation is when a man ejaculates earlier during sexual intercourse than he or his partner thought he would. It usually causes stress for both the man and his partner as neither of them gets satisfaction from the intercourse.

Weak pelvic floor muscles may make it difficult to delay ejaculation. Pelvic floor exercises (Kegel exercises) help to strengthen these muscles.

To perform these exercises to improve sexual performance:

Find the right muscles. To find where the pelvic floor muscles are, stop midway through urination. Or tighten the muscle that stops the anus from passing gas. Both of these movements use the pelvic floor muscles. Once you have found the pelvic floor muscle, you can perform the exercise in any position. You may find it easier to do it lying down at first, though.
Perfecting the technique. Tighten the pelvic floor muscles, hold for three seconds, then relax for three seconds. Try this several times in a row. As the muscles get stronger, try performing Kegel exercises while sitting, standing or walking.
Stay focused. For best results, focus on tightening only your pelvic floor muscles. Be careful not to contract your abdominal, thigh or buttock muscles. Do not hold your breath. Instead, breathe freely during the exercise.
Repeat three times a day. Perform at least three sets of 10 repetitions per day.
Pause-squeeze technique
Your healthcare provider can instruct you and your partner in a pause-squeeze technique. The process is as follows:

Begin sexual intercourse, including stimulating the penis, until you feel almost ready to ejaculate.
You or your partner can then squeeze the end of the penis (where the head meets the body). Keep squeezing for a few seconds until the feeling of wanting to ejaculate disappears.
Repeat the squeezing process as needed.
After several repetitions, you can successfully enter your partner without ejaculating. After several practices, delayed ejaculation may become a habit and the pause-squeeze technique may no longer be necessary.

If the Pause-Squeeze technique causes pain or discomfort, you can try the Stop-Start technique. This technique stops sexual stimulation before ejaculation. It then waits until the sexual urge wears off before starting again.

Use condoms to prevent premature ejaculation

Condoms may help delay ejaculation by reducing the sensitivity of the penis. Specially designed “orgasm control” condoms are available without a prescription. These condoms contain an anesthetic, such as benzocaine or lidocaine, and are designed to delay ejaculation. These condoms may also be made of thicker latex. Examples include Trojan Extended Pleasure and Durex Prolong.

Medication for premature ejaculation

Local anesthetics

Anesthetic creams, gels, and sprays containing anesthetic agents such as benzocaine, lidocaine, or proparacaine are sometimes used to treat premature ejaculation. These products are applied to the penis 10 to 15 minutes before sex to reduce sensation and help delay ejaculation. These medications are available without a prescription. However, creams containing lidocaine and proparacaine (EMLA) require a prescription.

Although local anesthetics are effective and well tolerated, there are potential side effects that may reduce sensation and sexual pleasure for both partners.

Oral medications

Many medications can delay orgasm. Although these medications are not approved by the U.S. Food and Drug Administration for the treatment of premature ejaculation, some may be used for this purpose, including antidepressants, analgesics, and anti-erectile dysfunction medications.

These medications can be prescribed for on-demand or daily use and can be used alone or in combination with other therapies.

Antidepressants. A side effect of certain antidepressants is delayed orgasm. For this reason, premature ejaculation can be treated with selective serotonin reuptake inhibitors (SSRIs).SSRIs include paroxetine (Paxil, Pexeva, Brisdelle), escitalopram (Lexapro), citalopram (Celexa), sertraline (Zoloft) or fluoxetine (Prozac).

In some countries, the SSRI dapoxetine is often used as first-line treatment for premature ejaculation. It is not currently available in the United States.

Of the medications approved for use in the United States, paroxetine appears to be the most effective. These medications usually take 5-10 days to start working. However, it may take 2 to 3 weeks of treatment to see the full effect.

If an SSRI does not improve ejaculation time, medical personnel may prescribe the tricyclic antidepressant clomipramine (Anafranil). Antidepressants may have side effects such as nausea, sweating, drowsiness, and loss of libido.

Pain medications. Tramadol (Ultram, Conzip, Qdolo) is a medication used to treat pain. It also has the side effect of delaying ejaculation. Tramadol may be prescribed if an SSRI does not work. Tramadol should not be used in combination with an SSRI.

Side effects may include nausea, headache, drowsiness, and dizziness. Tramadol can be addictive when taken for long periods of time.

Phosphodiesterase-5 inhibitors.

Some medications used to treat erectile dysfunction may also help treat premature ejaculation. Such medications include sildenafil (Viagra), tadalafil (Cialis, Adcirca), avanafil (Stendra), and vardenafil. Side effects may include headache, facial flushing, and indigestion. These medications may be more effective when combined with an SSRI.
Possible future treatments
Research suggests that a variety of medications may help treat premature ejaculation, but more research is needed on this. These medications include:

Modafinil (Provigil).

This is a treatment for the sleep disorder episodic somnolence.
Serodosin (Rapaflo). This medicine treats enlarged prostate.
Botulinum toxin type A (Botox). Researchers are studying whether injecting botulinum toxin into the muscles that help ejaculation can treat premature ejaculation.