These Solutions for Premature Ejaculation Actually Prolong Sex

You've seen the ads for pills and similar products, either late at night or early in the morning, depending on your TV-viewing habits. They're loud. They're obnoxious. Maybe they feature a semi-famous pitch person.

"Last longer in bed!"

"Increase your stamina!"

What can it hurt, you wonder. Fortunately, your credit card is out of reach and you're not in the mood to move.

Supplements that purport to treat premature ejaculation (PE) should be approached with caution, said Andrew Cohen, M.D., director of trauma and reconstructive urologic surgery at Johns Hopkins Bayview Medical Center in Baltimore. These supplements are not evaluated by the Food and Drug Administration (FDA), which means no one has reviewed the possible risks and benefits of the products.

"Buyer beware," he said. "We just don't know how that would interact with other medicines you take, and we don't know if it's effective or not."

While you should be wary of sex pills advertised online and on television, prescription medications are available to effectively treat premature ejaculation. But what is it, exactly? PE is commonly defined as when a man ejaculates sooner than he or his partner would like during sexual intercourse. It's also defined more specifically as ejaculation that occurs less than one minute after intercourse begins.

Unrealistic expectations are the cause for many perceived cases of premature ejaculation, Cohen said, citing a study of 500 couples from five countries that found the average time for a man to reach orgasm is only 5.4 minutes.

"A lot of men come in with these unrealistic expectations on themselves, or perhaps their partners put them on them," he said. "It leads to a lot of challenges that are unnecessary."

Many PE patients benefit from behavioral modifications, such as the start-stop and squeeze techniques. Working with a sex counselor or therapist may also help. Medications are generally used in particularly severe cases of PE for which modifications and therapy do not seem to work.

Prozac for PE?

Medical treatments for PE are off-label, meaning they are not FDA-approved to specifically treat PE. The medications commonly prescribed for PE are selective serotonin reuptake inhibitors (SSRIs), which include the antidepressants Lexapro, Zoloft, Prozac and Paxil, and phosphodiesterase 5 (PDE5) inhibitors, such as Viagra and Cialis.

"[SSRIs] can be used on a daily basis or on-demand for premature ejaculation," said Neel Parekh, M.D., clinical assistant professor of urology at the Cleveland Clinic Foundation. "The ones that are used less often are tramadol or benzodiazepines. Those have addictive potentials."

Cohen pointed out the dosing for SSRIs for PE can be "very variable," meaning some people take it a few hours before intercourse, while others take it daily.

"It requires a little bit of nuance to do correctly," he said. "You have to be careful if you stop the medicines, because you can't stop an SSRI cold turkey—there are risks with that."

Anyone who wants to discontinue the medicine needs to develop a plan with their doctor.

SSRIs were found to delay ejaculation by up to five minutes when compared to a placebo, according to research published by the German agency Institute for Quality and Efficiency in Health Care. Citalopram (Celexa) and paroxetine (Paxil) were found to be the most effective, with increases of three to five minutes.

Cohen said the reasons SSRIs work for PE are complicated, but it essentially involves how they affect the brain's neurotransmitters, which are chemical messengers that carry signals between nerve cells. Affecting those different receptors is "essentially the methodology by which it is thought to have its effect," he said, adding that SSRIs were found to work for PE because delayed ejaculation was a side effect researchers noticed when treating depression.

Spray it on before sex

Local anesthetic creams, gels and sprays are also commonly used to treat PE.

The instructions for one brand of numbing spray that urologists often recommend state to apply 3 to 10 sprays directly to the penis and wait 15 minutes until the treated area has dried completely. This should be done 20 to 30 minutes before sex.

"Promescent spray is probably the one I [recommend] most commonly," Parekh said. "It's something patients can purchase online. The downside is it needs to be wiped off because it can cause numbness for the partner."

Another option is using condoms with a local anesthetic in them. This can decrease the sensitivity for the man and potentially prolong sex.

Is the problem actually ED?

Both Parekh and Cohen said that in many cases, men do not actually have PE but rather erectile dysfunction (ED), or the consistent inability to get and maintain an erection during sex. ED can often lead to PE because men develop a rush to reach orgasm before they lose their erection.

The most important step is to treat any underlying ED before using SSRIs, numbing sprays or other treatments for PE, Parekh said.

"A lot of these guys come in thinking they have premature ejaculation, but really the underlying cause is their erections," Parekh said. "They're so afraid that they're going to lose their erection during sexual activity or they're not maintaining their erection or it's not as rigid as it needs to be, so they're ejaculating too quickly."

Parekh found that for a lot of guys, treating their ED resolves premature ejaculation.

Cohen said medications such as sildenafil (Viagra) and tadalafil (Cialis) effectively treat ED, and if ED is the primary problem, they're going to take care of both issues.

So keep the credit card out of reach and seek help that doesn't include a cheesy soundtrack and more disclaimers than actual claims.