Premature Ejaculation Treatment: Medicines, Diet & Management

How is Premature Ejaculation Diagnosed?

Premature ejaculation is usually diagnosed based on the sexual and medical history, ejaculation timing, perceived control, distress and relationship impact. A focused physical examination may be performed, especially in acquired premature ejaculation or when erectile dysfunction is suspected. Blood glucose, thyroid or other tests are generally ordered only when the history or examination suggests an underlying condition.

How is Premature Ejaculation Treated Based on Severity?

There is no single severity grade that determines treatment for everyone. Premature ejaculation treatment depends on symptom frequency, perceived control, distress, underlying conditions and previous response.

The table below summarises a practical treatment approach for premature ejaculation according to clinical impact:

Clinical Impact	Typical Treatment Approach
Occasional or mild symptoms	Education, reassurance, behavioural techniques and management of stress or situational factors may be sufficient.
Persistent premature ejaculation causing distress	Behavioural or psychosexual therapy may be combined with topical treatment or prescription medicines.
Severe or treatment-resistant symptoms	Combination treatment may be considered after reassessing the diagnosis, erectile dysfunction and other contributing factors.
Acquired premature ejaculation with an underlying condition	Treatment should first address contributing problems such as erectile dysfunction, prostatitis, urinary symptoms, anxiety or thyroid disease, with additional premature ejaculation treatment when needed.

Types of Premature Ejaculation and Their Treatment

Premature ejaculation may be lifelong, acquired, variable or subjective. The table below summarises the different approaches to treatment for premature ejaculation based on types:

Type	Treatment Approach
Lifelong premature ejaculation	Dapoxetine or a lidocaine/prilocaine topical preparation may be considered, with daily SSRIs, clomipramine, behavioural techniques or combination treatment used when appropriate.
Acquired premature ejaculation	Identify and treat contributing conditions such as erectile dysfunction, prostatitis, urinary symptoms, anxiety or thyroid problems, followed by medication or psychological treatment when needed.
Variable premature ejaculation	Reassurance, education and behavioural advice are usually more appropriate because occasional early ejaculation can be a normal variation.
Subjective premature ejaculation	Education, counselling and psychosexual support may help when ejaculation timing is within a normal range but the person remains distressed about perceived early ejaculation.

Topical Treatments for Premature Ejaculation

Below are the topical treatments for premature ejaculation that may be considered:

Lidocaine/Prilocaine Spray A metered-dose lidocaine/prilocaine spray may be used shortly before sexual activity in regions where it is approved.
Lidocaine/Prilocaine Cream Topical creams containing lidocaine, prilocaine or both may delay ejaculation by reducing penile sensitivity. Excess product should be removed according to product instructions to reduce numbness or transfer to a sexual partner.

Topical anaesthetics must be used according to medical or product instructions because using too much can lead to numbness and transfer of the anaesthetic to a sexual partner.

Other Treatments for Premature Ejaculation

Below are the other treatments for premature ejaculation often recommended by doctors:

Behavioural Therapy Behavioural techniques such as the start-stop method may be used to improve arousal awareness and provide better control over ejaculation, especially when used with medical treatment.
Psychosexual Therapy Psychological or psychosexual therapy may be used to deal with performance anxiety, difficulties in relationships and other factors linked to premature ejaculation and may be used together with medication.
Treatment of Erectile Dysfunction Erectile dysfunction should be evaluated and treated since it may lead to acquired premature ejaculation.
Phosphodiesterase-5 Inhibitors PDE5 inhibitors may be considered when erectile dysfunction and premature ejaculation occur together. They may also be considered in selected people without erectile dysfunction or combined with other premature ejaculation treatments.
Treatment of Underlying Conditions Acquired premature ejaculation may require treatment for conditions such as anxiety, prostatitis, lower urinary tract symptoms or hyperthyroidism.

Oral Medications for Premature Ejaculation

Below are the oral medicines that may be prescribed for premature ejaculation:

Dapoxetine: A short-acting SSRI taken on demand before sexual activity, where it is available and appropriate.
Daily SSRIs: Medicines such as paroxetine, sertraline or fluoxetine may be prescribed off-label to delay ejaculation.
Clomipramine: May be prescribed daily or on demand in selected patients when other options are unsuitable or ineffective.
PDE5 Inhibitors: May be useful when premature ejaculation occurs with erectile dysfunction and can sometimes be combined with other treatments.
Tramadol: May delay ejaculation but is generally reserved for selected cases because of side effects and the risk of dependence or addiction.

Prescription treatment should be selected after considering medical conditions, other medicines and possible side effects.

Ayurvedic and Alternative Treatments for Premature Ejaculation

There is not enough evidence to support the use of Ayurvedic medicines as a standard treatment for premature ejaculation. However, the following therapies can be helpful to maintain overall health and well-being:

Yoga and meditation may serve as supplementary methods for managing stress
Herbal supplements from a qualified AYUSH practitioner

Herbal and Ayurvedic products should not replace established treatment and should be discussed with a doctor, as they may interact with prescribed medicines.

Home Care for Managing Premature Ejaculation

Home-based measures can support formal treatment and behavioural training. The following home care points can be useful to support treatment and manage premature ejaculation:

Carry out the prescribed stop-start exercises consistently
Stick to the suggested schedule for behavioural therapy
Only use topical medicines according to the instructions
Make sure to get enough sleep and stay physically active
Reduce excessive alcohol consumption
Avoid recreational drugs
Talk openly with your partner about sexual matters
Take the medicine as prescribed and attend your follow-up appointments

Latest Treatment for Premature Ejaculation

According to recent research, hyaluronic acid injections into the glans penis are being studied for premature ejaculation that has not responded to established therapies. A 2022 study evaluated a repeated-injection protocol for refractory lifelong premature ejaculation.

However, this approach is less established than standard medicines and topical treatments.

How Long Does Treatment for Premature Ejaculation Take?

The length of the premature ejaculation treatment may vary based on the treatment selected and on whether the problem is lifelong, acquired or linked to another condition.

The table below summarises the approximate timing of commonly used premature ejaculation treatments:

Treatment	Approximate Timing or Duration
Dapoxetine	Used on demand before sexual activity according to the prescription.
Topical anaesthetics	Applied shortly before sexual activity according to product instructions.
Daily SSRIs	Improvement may begin within several days, with a fuller effect often developing over about 2 to 3 weeks.
Clomipramine	May be used daily or on demand depending on the prescribed regimen.
Behavioural techniques	Usually practised regularly for several weeks or longer.
Psychosexual counselling	Often provided over several sessions according to individual needs.
Treatment of an underlying condition	Duration depends on the cause and response to treatment.

Premature Ejaculation Treatment Side Effects

Possible side effects of premature ejaculation treatment are given below:

Nausea
Headache
Dizziness
Diarrhoea
Fatigue
Drowsiness
Dry mouth
Increased sweating
Sexual side effects
Penile numbness or reduced sensation
Temporary numbness in a sexual partner
Flushing
Indigestion
Constipation
Temporary emotional discomfort during counselling or therapy

Lifestyle Changes for Managing Premature Ejaculation

Lifestyle measures can support sexual health alongside premature ejaculation treatment. Some of these useful lifestyle changes are listed below:

Stay physically active and maintain regular sleep.
Limit excessive alcohol and avoid recreational drugs.
Stop smoking when applicable.
Use relaxation techniques to manage stress and performance anxiety.
Communicate openly with a partner and seek counselling when relationship difficulties affect sexual function.

Triggers That Can Worsen Symptoms of Premature Ejaculation

Certain factors may make premature ejaculation more difficult. These include:

Performance anxiety or fear of ejaculating too early
Psychological stress
Relationship conflict or communication difficulties
Erectile difficulties
New or highly anxiety-provoking sexual situations
Excessive alcohol or recreational drug use

Identifying personal triggers can help guide treatment.

Treatment Cost of Premature Ejaculation in India

The cost of premature ejaculation treatment in India depends on the specialist visit, tests conducted, the medication and the counselling needed. The exact cost may vary according to the type of treatment and the investigations involved.

Fees for specialist consultations can vary, often ranging from ₹500 to ₹2,000. On the other hand, counselling or behavioural therapy may cost approximately ₹1,500 to ₹3,500 per session. The overall treatment cost may range from ₹900 to ₹20,000 or more, depending on the treatment plan and number of sessions.

Does Health Insurance Cover Treatment of Premature Ejaculation in India?

Health insurance plans may not provide direct coverage for premature ejaculation. This is because sexual dysfunction treatments are generally excluded. However, coverage for complications associated with premature ejaculation may be covered. It is best to contact the insurance company to know if coverage for premature ejaculation is available.

Frequently Asked Questions (FAQs)

Q1. Can premature ejaculation be cured permanently?

Ans: No, there is no permanent treatment for premature ejaculation. Behavioural or psychological therapy may be considered for long-term improvement in men. Continuous medication or a combination of treatment methods may also be considered in some cases.
Q2. Which medicine is effective for premature ejaculation?

Ans: There is no single effective medicine for premature ejaculation. Dapoxetine or a lidocaine/prilocaine spray are used as a first-line option for treating lifelong premature ejaculation. SSRIs and clomipramine may also be considered to treat selected patients.
Q3. Is dapoxetine a permanent cure for premature ejaculation?

Ans: No, dapoxetine is not a permanent cure for premature ejaculation. It is a short-acting medicine that delays ejaculation while you take it. It should only be taken according to the doctor's advice, but it does not eliminate the condition permanently.
Q4. Can premature ejaculation be treated without medicines?

Ans: Premature ejaculation may be treated by behavioural techniques and psychosexual counselling, along with medication. Evidence supporting behavioural and psychosexual approaches is less consistent than for established pharmacological treatments.
Q5. Which cream is best for premature ejaculation?

Ans: Topical treatments contain local anaesthetics such as lidocaine or lidocaine/prilocaine and can help to treat premature ejaculation. These treatments may delay ejaculation by reducing penile sensitivity. The appropriate formulation and product may vary depending on availability, approval, and individual medical circumstances.
Q6. How long does premature ejaculation treatment take to work?

Ans: The time to benefit may vary depending on the treatment of premature ejaculation. Dapoxetine may be used on demand, while daily SSRIs require regular use and may take around 1 to 2 weeks to achieve their full effects. Behavioural treatment may take several weeks of continuous practice.
Q7. Can premature ejaculation be treated with counselling?

Ans: Yes, psychosexual counselling may be used to address performance anxiety, relationship problems and other psychological or interpersonal factors related to premature ejaculation. It may also be used with pharmacological treatment.
Q8. Can erectile dysfunction treatment improve premature ejaculation?

Ans: Yes, erectile dysfunction treatment may improve premature ejaculation if both conditions occur together.