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Guide to premature ejaculation therapy: where is the way out?

While on a way to effective treatment strategy, you need to find out, if you need to consult a doctor or work it with your partner, as practice makes perfect. Or maybe you need a counseling.

Firstly, it would be better to try at least one consultation and test if you have erectile dysfunction or not. As quite often, these troubles come together, and they are likely to be mixed up. If it turns to be ED, you will need different treatment. If you are lucky to have only PE, it will be easier to get rid of it.
During consultation, do not be ashamed to answer honestly about your sexual experiences. If not sure, think and analyze your problem:

• How long does it exist?
• How often do you have sex?
• How often do you masturbate?
• Does it occur during masturbation?
• Does it occur during intercourse?
• With only one partner or with every partner?
• Are you bothered about PE?
• Is your partner bothered by it?
• How satisfied are you with your current relationship?
• Do you take any medications?
• When does premature ejaculation often happen?
• Under what circumstances?
• Does it occur every time you have sex, or from time to time?

By the way, if you can cum of masturbation, and you have morning wood, it is a PE and it is likely to be the common type that is treated easily.

So, what a doctor may prescribe?

Some behavioral techniques:

Pelvic floor exercises

(no pelvic trainers - that's for ladies).

Pelvic muscles are the muscles under the uterus, bladder, and bowel (large intestine). To feel them, you should do as if you want to stop urination or tighten the anus. These exercises are composed of two steps: tightening for 3 seconds, relaxing for three. So, by strengthen these muscles day to day, you may get more control over your ejaculation.

The squeeze technique

is sometimes recommended as a therapy for PE. Just before ejaculation, the shaft of the penis is firmly squeezed between the thumb and forefinger. Have no way to ejaculate, the urge to it passes.

The start-stop technique

for PE involves learning to identify what is often referred to as "mid-level excitement." It is when you just stop intercourse or masturbation and wait, calm down, allow the excitement level to diminish before beginning again.

Using special condoms

that decrease penis sensitivity is the easiest way to avoid PE. "Climax control" condoms contain numbing agents such as benzocaine or lidocaine or are made of thicker latex to delay ejaculation.

Anesthetics.

Topical anesthetics in form of a cream with benzocaine, lidocaine or prilocaine, applied to the penis 15 minutes before sex, decrease its sensitivity.
Both benzocaine and lidocaine are traditionally used as topical anesthetics to reduce pain or irritation. However, you may be one of those who has hypersensitivity to these anesthetics.
The greater the exposure to a potential allergen, the more likely sensitization is to occur. Benzocaine sensitivity produces a classic allergic contact dermatitis in the area of topical application. A reaction will occur approximately 12–24 hours after re-exposure to the allergen. So, first apply a little bit on your hand and wait at least 5 hours. It will not save you much time, but it is better to know if you have allergy in advance. If nothing happens, you can use the cream.

However, usually when such allergies are suspected, with the help of patch testing, it can be diagnosed. Local anesthetics are also usually tested. If you are not sure if you have it or not, ask your doctor to test.
Lidocaine and prilocaine are local anesthetics (numbing medicines), which usually come together in one medication. They work by blocking nerve signals in your body. In allergy cases, the typical symptoms are severe burning, stinging, or irritation where the medicine was applied, swelling or redness, bruising or purple appearance of the skin, or unusual sensations of temperature. So if test on hand causes such effects, Do not use it. It is better for your female partner to check it, too.

Another question will be about other drugs that you use. Enumerate these drugs to your doctor, as some of them are not allowed to be taken at the same time. Probably, you will not be prescribed one medicine, or you will have to stop using something for some time. You should pay extra attention to the list that follows:
chloroquine, dapsone, nitrofurantoin, isosorbide dinitrate, nitroglycerin, nitroprusside, quinine,amiodarone, dofetilide, dronedarone, mexiletine, sotalol, tocainide, phenobarbital, phenytoin, primaquine, Bactrim, Septra, SMX-TMP or SMZ-TMP, etc.
Remember, that you should follow all directions on your prescription label. And you mustn't apply benzocaine, or lidocaine and prilocaine topical in larger amounts than recommended.
In other cases, you may need some oral medications. For example, antidepressants. Antidepressants are medicines that traditionally treat depression. However, for those who suffer of PE some of these medicines have a useful side effect: delay of climax. Before accept doctor's prescriptions, you should discuss if you may take any other medicines, vitamins, or herbal supplements.
A doctor may offer low doses of the antidepressants known as selective serotonin reuptake inhibitors (SSRIs). SSRIs increase the production of serotonin, and a side effect, first noted in the treatment of depression, is prolonging the time it takes to reach ejaculation. (Doctors can legally prescribe any medication for conditions other than those approved by the FDA.)
Unlike in other countries, an SSRI pill, Priligy with Dapoxetine active ingredient was licensed for premature ejaculation in Britain in 2013 and is the only one preparation which officially treats PE and has less side effects than other SSRIs group preparations. Researchers conducted a meta-analysis of studies examining SSRIs and clomipramine—an older type of antidepressant—in the treatment of PE. They found that daily use of clomipramine (Anafranil) and the SSRIs paroxetine (Paxil), sertraline (Zoloft) and fluoxetine (Prozac) delayed ejaculation with Paroxetine having the strongest effect.

Other studies have investigated the "on-demand" use of antidepressants for PE, in which men take the drug only before sexual activity instead of taking it daily. Although the study methods used in the research cannot be compared, evidence suggests that on-demand use does not strongly delay ejaculation as much as daily use of antidepressants. The fact that if not daily, the drug should be taken 3-5 hours before intercourse, doesn't make it convenient for the majority of people.
The use of antidepressants should be seriously discussed because of other side effects as well.
If use it on day-to-day basis, you cannot pass a take. As if suddenly stopped taking, you will face withdrawal effects, such as agitation, anxiety, dizziness, insomnia, nausea, nightmares, shock-like sensations, and tremors.
The scariest side effect for people who is bothered by PE is diminished libido. However, it is rarely reported. In contrast, if erection lasts more than it should, call the doctor immediately.

Another way of treatment is analgesics. The most famous analgesic in this case is Tramadol (Ultram). Traditionally it is used to decrease and moderate severe pain, typically following surgery. It is one of a class of drugs called opiates, also including codeine, methadone and heroin.
A prospective study was carried out on 60 patients, and showed that the results of PE treatment with tramadol are similar with both continued and sporadic administration. The sex life of patients improved and they reported greater satisfaction with the sporadic treatment.
Small doses of tramadol two to three hours before sex increased the time between starting sex and orgasm from just 20 to 60 seconds to between three and ten minutes.
Even if it may cause addiction, small doses make it unlikely to happen. While someone with severe pain might regularly take 300mg doses, for premature ejaculation the dose is 25 to 50mg.

The third variant of oral medicine is Phosphodiesterase-5 inhibitors(PDE5). Though, it is used in complicated cases, such as lifelong PE.
An NCBI research found that inhibitors seem to prolong intercourse and the quality of penile rigidity is better with PDE5 inhibitors in post-ejaculatory period. These findings suggest that PDE5 inhibitors might have some beneficial effects in men with lifelong premature ejaculation.

A MedLine search, performed for peer-reviewed articles on the role of PDE5- Is in managing PE, showed that encouraging evidence supports the role of PDE5- Is for treating PE. Possible therapeutic mechanisms of action of PDE5-Is are multiple and complex and include central and peripheral effects.

These are main means to treat PE:

1) behavioral techniques of different kind, which you can practice on your own: Pelvic floor exercises, squeeze technique, start-stop technique
2) behavioral means for which you should check your and your partner's allergic reactions:
Climax control condoms
3) medical anesthetics you need prescription to use:
Benzocaine, lidocaine, prilocaine sprays and creams
4) oral medications you need prescription to use and discuss the point in detail with your doctor: antidepressants(SSRI is typical), analgesics (usually, Tramadol), PDE5 inhibitors.

Conclusion: what is the most effective PE treatment by today?

Even if there are some other drugs that still need more researches, let us stop here. Here we lack only one point, that may save you a lot of time. In most cases the problem is in mental state. Being bothered about sex, you may notice, that there is something that prevent your sexual intimacy. Discuss your wishes and anxieties with your partner or better consult a psychologist. For the fast and most effective solution with least side effects – Dapoxetine group preparations is a choice.
We highly recommend treating this problem as something general. Do not hesitate to go to counseling and discuss it with your partner. In almost all cases there is a simple solution.