No single premature ejaculation treatment is shown to be best for everyone, but reviews agree that several work to some degree. A 2019 overview of 30 systematic reviews found that oral drugs, topical anaesthetics and combined drug and behavioural treatment each improved the time to ejaculation by 1 to 5 minutes, while evidence for behavioural and psychological approaches alone was weaker. [ciocanel-2019] This guide covers what each family of treatment has shown, where the reviews disagree, what they could not show and what to bring to a doctor. Our overview of sexual dysfunction covers the wider picture.
What counts as premature ejaculation, and what counts as treatment?
Premature ejaculation is defined by a short time to ejaculation and an inability to delay it, causing distress. Treatment falls into two broad groups, behavioural and drug, and the two can be combined. [cooper-2015] The usual outcome measure is the intravaginal ejaculatory latency time (IELT), the time from penetration to ejaculation, alongside sexual satisfaction, ejaculatory control and anxiety. [cooper-2015]
That definition matters for reading the research. Because the problem is defined partly by distress, reviews track how people feel about sex as well as the clock, and some treatments move the second without moving the first much.
Do medications help premature ejaculation?
Yes, reviews find that several do, and they find side effects too. In the 2019 overview, oral pharmacotherapy (SSRIs, PDE5 inhibitors, tricyclic antidepressants and opioid analgesics), topical anaesthetics and combined drug and behavioural therapies each showed significant improvements of 1 to 5 minutes in IELT. Most drug treatments were associated with adverse effects. [ciocanel-2019]
A 2019 network meta-analysis compared the oral drugs more directly. It pooled 25 studies, mainly of SSRIs and PDE5 inhibitors (the drug class better known for erectile difficulty). For IELT at 4 to 6 weeks, the ranking from best to worst was an SSRI plus a PDE5 inhibitor, a PDE5 inhibitor alone, and other SSRIs alone. [qin-2019]
Despite that ranking, the authors concluded that SSRIs remained the first-line oral drug. PDE5 inhibitors carried side effects, including gastrointestinal and central nervous system complications, which the authors said prevents them from being first-line. [qin-2019] Which drug suits whom is a conversation for a doctor, since it depends on side effects and on any other condition or medication.
Do behavioural techniques work?
There is limited evidence that they do, and the best review we could verify says so plainly. A 2015 systematic review included 10 randomised trials with 521 participants. All of them tested physical techniques: squeeze, stop-start (pausing stimulation when ejaculation feels close, then resuming), sensate focus, a stimulation device and pelvic floor rehabilitation. The review judged the overall risk of bias unclear. [cooper-2015]
Results were split. Four trials compared a behavioural therapy with a waitlist. Two, involving squeeze, stop-start and sensate focus, reported differences in IELT of 7 to 9 minutes, while two, a web-based sensate focus programme and a stimulation device, reported no difference in latency afterwards. [cooper-2015]
Number of waitlist-controlled trials by reported outcome, from the 2015 systematic review of behavioural therapies for premature ejaculation (Cooper et al.), 10 randomised trials, 521 participants. Two trials reported IELT differences of 7 to 9 minutes; two reported no difference in ejaculatory latency after treatment.
For other outcomes, including sexual satisfaction, desire and self-confidence, some waitlist comparisons significantly favoured behavioural therapy and others were not significant. Direct comparisons of behavioural therapy against drug treatment gave mixed results, mostly favouring drug treatment or finding no significant difference. No adverse effects were reported, though safety data were limited. [cooper-2015]
Is combining behavioural and drug treatment better?
It did better than drugs alone in the trials that tested it, though the gain in time was small. Three trials in the 2015 review favoured combined behavioural and drug treatment over drug treatment alone, with a small but significant difference in IELT of 0.5 to 1 minute and significantly better sexual satisfaction, ejaculatory control and anxiety. [cooper-2015] The 2019 overview likewise counted combined drug and behavioural therapy among the treatments with 1 to 5 minute gains. [ciocanel-2019]
| Question | What the reviews found |
|---|---|
| Oral drugs and topical anaesthetics | Each improved IELT by 1 to 5 minutes; most drugs carried side effects (2019 overview) |
| Behavioural techniques | Limited evidence; 7 to 9 minute gains in two of four waitlist trials, none in the other two (2015 review) |
| Combined with drugs | Small extra gain in latency (0.5 to 1 minute) plus better satisfaction and anxiety outcomes (2015 review) |
| Talking therapy | Only one of 10 trials included a psychotherapeutic approach; further trials needed (2015 review) |
What can these reviews not show?
They cannot say which treatment will work for you, and they cannot settle whether drugs or behavioural techniques are better. Five limits matter most:
- Behavioural evidence is weaker than drug evidence. The 2019 overview concluded that evidence for behavioural and psychological interventions is insufficient compared with drug trials, and called for larger and better randomised trials. [ciocanel-2019]
- Talking therapy has barely been tested. Only one of the 10 behavioural trials included a psychotherapeutic approach, so the research says little about therapy that addresses worry, confidence or the relationship. [cooper-2015]
- The reviews are not recent. The behavioural review searched to August 2014 and the overview to July 2018, so newer trials are not covered here. [cooper-2015] [ciocanel-2019]
- A higher ranking is not a recommendation. The network meta-analysis put the SSRI and PDE5 inhibitor combination first for latency, and the same authors still kept SSRIs as first-line because of side effects. [qin-2019]
- Minutes are not the whole outcome. The combined-treatment gain was 0.5 to 1 minute, yet satisfaction, control and anxiety also improved, so the clock alone understates what changed. [cooper-2015]
What to bring to an appointment
Bring a plain description of what happens and how it feels, because the definition rests on distress as well as timing. The rest of this section is our suggestion and is not something the reviews tested.
Note whether it has always been like this or began recently, whether it happens with every partner and in every situation, and whether anything else has changed, such as a new medication, low mood or erection difficulty. Mention any worry about performance too: our guide to sexual performance anxiety covers how that worry keeps a problem going, and antidepressants and sex drive covers sexual side effects if you already take one.
No screener on this site covers premature ejaculation yet. The self-assessment hub lists the seven we do have, and none is built for this question.
When to seek help
Speak to a doctor if ejaculating sooner than you want is causing you distress, if it began suddenly, or if it comes with erection difficulty, pain or a change in medication. There are several treatments, and raising it early is easier than living around it. If you feel unable to keep yourself safe, contact your local emergency services or a crisis helpline.
How MyFreud can help
It helps to see a pattern before an appointment. Daily mood tracking in MyFreud shows how your days run, and the notepad is somewhere to note stress, sleep and worry alongside how things went. It does not replace a doctor.
Download MyFreud and start today: App Store or Google Play.