Q. I’m a 34-year-old man. I’m in good shape and watch my diet, but I’ve always had a problem with early ejaculation. It’s gotten so bad that I sometimes avoid sex because I’m afraid I won’t “do the job well.” I don’t talk about it because it feels petty, but it’s been bothering me for a long time. Do you have any suggestions?
A. First, well done for speaking up—naming the problem is the first step. Premature ejaculation (PE) is common and very treatable. The two biggest traps are secrecy and self-blame: keeping it hidden can fuel performance anxiety, which in turn makes PE more likely. Open conversation with your partner and (ideally) a clinician can break that cycle and get you on a plan that works.
What causes PE?
PE can have several contributors: a sensitive ejaculatory reflex, performance anxiety, relationship stress, or (less commonly) medical issues. Sometimes PE co-exists with erectile difficulties or mood concerns. When anxiety is a part of the picture, addressing it directly can help—see also our note on how social anxiety often co-exists with premature ejaculation.
Behavioral techniques that work
Behavioral methods retrain the ejaculatory reflex and are a strong first line. They’re most effective when practiced consistently and paired with good communication.
- Stop–start: When you feel close to climax, pause stimulation until the urge subsides, then resume. Repeat several cycles.
- Squeeze technique: Apply gentle pressure to the glans (or use a comfortable constriction band) to reduce the urge, then continue when the feeling eases.
- Pelvic floor training: Strengthening and learning to relax pelvic floor muscles can improve control.
- Broaden the script: Focus on varied touch, pacing, and arousal breaks. This reduces “all-or-nothing” pressure and often increases satisfaction for both partners.
These approaches can take weeks to months to show durable results. Patience and practice matter.
Medication options (evidence-based)
Several medications can lengthen time to ejaculation by modulating serotonin pathways in the brain. They can be used as needed or daily, depending on guidance from your clinician:
- SSRIs (off-label): Paroxetine, sertraline, and fluoxetine have the best evidence. They’re usually started at low doses and adjusted to balance benefit and side effects (e.g., nausea, mild fatigue, decreased libido in some men). For more on how antidepressants can affect ejaculation—sometimes delaying it—see Antidepressants & Ejaculation Problems and Prozac & Delayed Orgasm.
- Dapoxetine: A short-acting SSRI approved for PE in some countries (not all). Taken 1–3 hours before sex; discuss availability and suitability with your clinician.
- Topical anesthetics: Lidocaine/prilocaine creams or sprays applied to the glans (with proper timing and condom use) can reduce sensitivity without significant systemic effects.
Helpful lifestyle and partner strategies
- Stress and sleep: Managing stress and getting adequate sleep can reduce arousal overshoot and performance anxiety.
- Condoms and thicker condoms: These reduce sensation slightly and can extend duration.
- Warm-up pacing: Alternate intense and gentle stimulation; change positions to ease arousal spikes.
- Whole-body intimacy: Expanding the definition of satisfying sex takes pressure off penetration alone and often improves outcomes as training progresses.
For a concise medical overview of PE—including causes, diagnosis, and treatments—see the Mayo Clinic guide to premature ejaculation.
When to see a clinician
Consider booking an appointment if PE has been persistent for months, is causing distress, or co-occurs with erectile trouble, pelvic pain, or mood symptoms. A clinician can screen for medical factors, tailor a behavioral plan, and prescribe treatment if appropriate. If libido or erection quality is also a concern, you might find our overview on improving male sex drive a useful companion read.
The bottom line
PE is common and highly manageable. Combine practice (stop–start/squeeze), open communication, and—when needed—medications or topical options. With a bit of structure and support, most men see meaningful improvement and greater confidence.