Your health care provider asks about your sex life and your health history.
So it’s important to use a condom whenever possible and to talk with your partner about the treatment. It's also important to know that if the medication is applied more than 20 minutes before having sex, the penis may become so numb that it’s temporarily impossible to have an erection. One alternative is condoms that already contain a local anesthetic. Impotence treatments are also an option for men who have both erection problems and premature ejaculation. These include various drugs known as PDE-5 inhibitors, such as sildenafil.
German statutory health insurers don’t cover the costs of this treatment. Sometimes, other medications may be mentioned as well, such as the painkiller tramadol, tricyclic antidepressants or selective norepinephrine re-uptake inhibitors (SNRIs). But it is not advised to take these medications, due to possible side effects or the lack of evidence supporting their effectiveness. An Update of the International Society of Sexual Medicine's Guidelines for the Diagnosis and Treatment of Premature Ejaculation (PE). Interventions to treat premature ejaculation: a systematic review short report.
Health Technol Assess 2015; 19(21): 1-180, v-vi. Topical anaesthetics for premature ejaculation: a systematic review and meta-analysis. Sex Health 2016; 13(2): 114-123. Selective serotonin re-uptake inhibitors for premature ejaculation in adult men. IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. Your provider might also do a physical exam. If you have both early ejaculation and trouble getting or keeping an erection, your provider might order blood tests. The tests may check your hormone levels. In some cases, your care provider might suggest that you go to a urologist or a mental health provider who specializes in sexual problems. Common treatment options for premature ejaculation include behavioral techniques, medications and counseling. It might take time to find the treatment or combination of treatments that work for you.
| Product | Dosage | Quantity + Bonus | Price | |
|---|---|---|---|---|
| Cialis Generic | 60mg | 10 Pills | 41.22€ 39.26€ | |
| Cialis Generic | 40mg | 10 Pills | 37.79€ 35.99€ | |
| Cialis Generic | 5mg | 90 + 6 Pills | 115.91€ 110.39€ | |
| Tadalista Super Active | 20mg | 180 + 20 Pills | 521.59€ 496.75€ | |
| Cialis Generic | 5mg | 20 Pills | 41.99€ 39.99€ | |
| Cialis Generic | 40mg | 60 + 6 Pills | 130.98€ 124.74€ | |
| Cialis Generic | 10mg | 10 Pills | 31.41€ 29.91€ | |
| Cialis Generic | 10mg | 90 + 6 Pills | 146.17€ 139.21€ | |
| Cialis Generic | 20mg | 30 + 4 Pills | 68.05€ 64.81€ | |
| Cialis Generic | 5mg | 120 + 6 Pills | 132.92€ 126.59€ | |
| Tadalista Super Active | 20mg | 270 + 30 Pills | 661.49€ 629.99€ | |
| Cialis Generic | 5mg | 30 + 4 Pills | 53.56€ 51.01€ | |
| Cialis Generic | 2.5mg | 90 + 6 Pills | 112.43€ 107.08€ | |
| Cialis Generic | 5mg | 10 Pills | 29.39€ 27.99€ | |
| Cialis Generic | 10mg | 120 + 6 Pills | 178.49€ 169.99€ | |
| Cialis Generic | 20mg | 180 + 10 Pills | 254.09€ 241.99€ |
Behavioral treatment plus drug therapy might be the most effective.
| Medication Type | Effect | Clinical Advice |
|---|---|---|
| Nitrates | Severe hypotension | Avoid concurrent use |
| Alpha-blockers | Additive blood pressure lowering | Monitor blood pressure |
| Antifungals (e.g., ketoconazole) | Altered tadalafil levels | Dose adjustment may be necessary |
| Other PDE inhibitors | Increased side effects | Do not combine without medical approval |
In some cases, therapy for premature ejaculation involves simple steps. They may include masturbating an hour or two before intercourse.
This means that because they are not approved for this purpose, they are not being used as intended. How often you take the medication and the dose you use may also vary from what is used when treating depression. According to previous research results, dapoxetine is not only less effective; it is also considerably more expensive than other SSRIs, which are available as generics. SSRIs are only available with a prescription from the doctor, but in Germany the costs aren't covered by statutory health insurers – regardless of whether the medication is approved for this use or not. Depending on the active ingredient, SSRIs can be taken daily or as needed.
When taken as needed, the medication is used a few hours before having sex. When taken daily, you start at a low dose and then increase it over the course of several weeks, if necessary. It may take 2 to 3 weeks to reach the full effect. The following table shows all of the SSRIs that studies have shown to help: The most suitable drug will depend on your individual situation – for instance, how often you have sex. Some men would rather not take medication every day – also because that increases the risk of side effects.
Others prefer to use them daily because sex isn’t always something that’s planned, and then they don’t have to worry about the exact time they need to take the medication. In studies, SSRIs delayed ejaculation by up to five minutes when compared to a placebo (fake medication). With increases of 3 to 5 minutes, citalopram and paroxetine helped the most. Dapoxetine had the weakest effect: It increased the time until ejaculation by 1 to 1.5 minutes, depending on the dose. There are hardly any studies that compare the tadalafil in women various medications directly, though. This may allow you to delay ejaculation when you have sex with your partner. Your care provider might recommend avoiding intercourse for a period of time. Focusing on other types of sexual play may remove the pressure you might feel during sexual intercourse. The male pelvic floor muscles support the bladder and bowel and affect sexual function. Kegel exercises can help strengthen these muscles.
Some men already have an orgasm before penetration or shortly afterwards. If this happens almost all the time and becomes a problem for a man, it is considered to be premature ejaculation. The treatment options are medications that can be swallowed or that can be applied to the tip of the penis (glans). In Germany, the costs of these medications aren't covered by statutory health insurers because they are categorized as “lifestyle drugs,” meaning that they don’t meet the legal requirements for reimbursement. Men who decide to have treatment with medication usually choose a type of drug known as selective serotonin re-uptake inhibitors (SSRIs), which are usually taken as tablets.
SSRIs are typically used to treat depression. When treating premature ejaculation, one of their side effects becomes useful: SSRIs also increase the time it takes until ejaculation occurs. Creams, gels or sprays that contain a local anesthetic are an alternative. They are applied to the head of the penis and make it less sensitive. Medications can also interfere with other drugs being taken at the same time.
So it’s a good idea to let your doctor know about any other medication you are using before you start treatment with a new medication. This is also important because of medication intolerances or allergies. The only SSRI approved in Germany for the treatment of premature ejaculation is dapoxetine (trade name: Priligy, among others). Studies have shown that other SSRIs are more effective, though. When doctors prescribe one of these drugs for premature ejaculation, it is known as “off-label” use. Weak pelvic floor muscles might make it harder to delay ejaculation. Pelvic floor exercises (Kegel exercises) can help strengthen these muscles. To find your pelvic floor muscles, stop urinating in midstream. Or tighten the muscles that keep you from passing gas. Both actions use your pelvic floor muscles. Once you've identified your pelvic floor muscles, you can exercise them in any position.
IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services. Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. Our information is based on the results of good-quality studies. Premature ejaculation: Learn More – Does medication work? - InformedHealth.orgPremature ejaculation: Learn More – Does medication work? However, you might find it easier to do them lying down at first.
Tighten your pelvic floor muscles, hold for three seconds and then relax for three seconds.
Try it a few times in a row. When your muscles get stronger, try doing Kegel exercises while sitting, standing or walking. For best results, focus on tightening only your pelvic floor muscles.
These studies also suggested that SSRIs were able to improve control over ejaculation somewhat and increased sexual satisfaction. SSRIs may cause nausea, diarrhea, headaches, dizziness, a dry mouth or sleep problems. They can also lower sexual desire and, in rare cases, cause erection problems. Depending on the active ingredient and the dose, up to 10% of men in the studies stopped the treatment due to these kinds of side effects. But occasional headaches, sleep problems or not wanting to have sex are also a normal part of everyday life.
If these kinds of problems occur during treatment, it doesn’t automatically mean that the medication is to blame. So it might make sense to wait and see if these problems go away. Some side effects occur only at the start of the treatment as well. When they are taken daily, the use of SSRIs should not be stopped abruptly, because that can cause things like sleep problems, nausea and restlessness. To prevent this from happening, the dose is gradually reduced over the course of several weeks.
Creams, gels or sprays containing the local anesthetics lidocaine or prilocaine can be used as an alternative to SSRIs. They are applied to the head of the penis 5 to 20 minutes before having sex. This can increase the time it takes to ejaculate by about 3 to 6 minutes. Local anesthetics may cause numbness and burning sensations in the sensitive skin on the head of the penis. One drawback of these medications is that they can also get inside a woman’s vagina during sex and cause similar side effects there. Be careful not to flex the muscles in your abdomen, thighs or buttocks.
Aim to do at least three sets of 10 repetitions a day. Your health care provider might instruct you and your partner to use the pause-squeeze technique. Begin sexual activity, including stimulating the penis, until you feel almost ready to ejaculate.
The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not 10 mg tadalafil offer individual consultations.Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods. Then you or your partner can squeeze the end of your penis where the head joins the shaft. Keep squeezing for several seconds until the urge to ejaculate passes.