Ejaculation problems - Treating ejaculation problems

If you have ejaculation problems caused by physical conditions, your GP should be able to suggest possible treatment options.

Treating ejaculation problems caused by psychological factors can be more challenging, but most men who persevere with treatment have successful outcomes.

Premature ejaculation

Self-help

There are a number of things you can try yourself before seeking medical help, such as:

masturbating an hour or two before having sex
using a thick condom to help decrease sensation
taking a deep breath to briefly shut down the ejaculatory reflex (an automatic reflex of the body during which ejaculation occurs)
having sex with your partner on top (to allow them to pull away when you are close to ejaculating)
taking breaks during sex and thinking about something boring

Couples therapy

If you are in a long-term relationship, you may benefit from having couples therapy. The purpose of couples therapy is two-fold.

First, couples are encouraged to explore issues that may be affecting their relationship, and given advice about how to resolve them.

Second, couples are shown techniques that can help the man to ‘unlearn’ the habit of premature ejaculation. The two most popular techniques are the ‘squeeze technique’ and the ‘stop-go technique’.

In the squeeze technique, the woman begins masturbating the man. When the man feels that he is almost at the point of ejaculation, he signals to the woman. The woman stops masturbating him, and squeezes the head of his penis for between 10 to 20 seconds. She then lets go and waits for another 30 seconds before resuming masturbation. This process is carried out several times before ejaculation is allowed to occur.

The stop-go technique is similar to the squeeze technique except that the woman does not squeeze the penis. Once the man feels more confident about delaying ejaculation, the couple can begin to have sexual intercourse, stopping and starting as required.

These techniques may sound simple, but they do require a lot of practice.

Medication to treat premature ejaculation

Selective serotonin reuptake inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) are primarily designed to treat depression, but they also have the useful side effect of delaying ejaculation. Although SSRIs are not licensed to treat premature ejaculation, they are increasingly being prescribed for this use.

SSRIs used for this purpose include:

paroxetine
sertraline
fluoxetine

Some men with premature ejaculation may experience an improvement in their symptoms as soon as treatment begins. However, you will usually need to take the medication for one to two weeks before you notice the full effects of the treatment.

Common side effects of SSRIs include:

fatigue
feeling sick and being sick
diarrhoea
excessive sweating

However, these are usually mild and should improve after two to three weeks.

Dapoxetine

An SSRI, known as dapoxetine, has been specifically designed to treat premature ejaculation.

From November 2013, dapoxetine (Priligy) became the first medication to be licensed for premature ejaculation in the UK and local NHS authorities can choose to prescribe it on the NHS.

Dapoxetine acts much faster than the SSRIs mentioned above and can be used 'on demand'. If you are prescribed dapoxetine, you will usually be advised to take it one to three hours before having sex, but not more than once a day.

Dapoxetine is not suitable for all men diagnosed with premature ejaculation. For example, it is not recommended for some men with heart, kidney and liver problems. Dapoxetine can also interact with other medications, such as other antidepressants.

Common side effects of dapoxetine include headaches, dizziness and feeling sick.

Topical anaesthetics and condoms

The use of topical anaesthetics such as lidocaine or prilocaine can be helpful but can be transferred and absorbed to the vagina, causing decreased sensation. Condoms can also be used and are effective, particularly when combined with local anaesthesia.

Delayed ejaculation

Sex therapy

Sex therapy is a form of counselling that uses a combination of psychotherapy and structured changes in your sex life. This can help to increase your feeling of enjoyment during sex, and help make ejaculation easier.

Some clinical commisioning groups (CCGs) provide a sex therapy service on the NHS, but others do not. Therefore, levels of availability can vary widely depending on where you live.

You can also pay privately for sex therapy. Prices for a single session can vary from around £50 to £80. For information about private sex therapists in your local area you should visit the College of Sexual and Relationship Therapists website.

The relationship counselling service Relate also offers sex therapy at a number of its centres; you would be expected to pay for each session.

During sex therapy, you will have the opportunity to discuss any emotional or psychological issues related to your sexuality and relationship, in a non-judgemental way.

Activities may also be recommended for you to try at home while you are having sex with your partner (you should never be asked to take part in any sexual activities during a session with the therapist).

These may include:

viewing erotic material before having sex, such as videos and magazines, to increase the feeling of sexual stimulation
erotic fantasies and ‘sex games’ to make your lovemaking more exciting
using lubricating creams or gels to make the physical act of sex more comfortable and relaxing
using sexual aids, such as vibrators, to increase pleasure

Read more information about what a sex therapist can do.

Switching medication

There are a number of medications that can be used if it is thought SSRIs are responsible for causing delayed ejaculation. These include:

amantadine – a medication originally designed to treat viral infections
buproprion – a medication originally designed to help people stop smoking
yohimbine – a medication originally designed to treat erectile dysfunction

These medications help block some of the chemical effects of SSRIs that are thought to contribute towards delayed ejaculation.

Retrograde ejaculation

Most men do not require treatment for retrograde ejaculation because they are still able to enjoy a healthy sex life and the condition does not have adverse effects on their health.

If retrograde ejaculation is caused by using a certain medication then normal ejaculation will usually return once the medication is stopped. Speak to your GP before you stop taking prescibed medication.

If treatment is required (usually because of wanting to father a child), medicines can be used to strengthen the muscles around the bladder neck. Pseudoephedrine (a medicine commonly used as a decongestant) has proved to be effective in treating retrograde ejaculation caused by diabetes or surgery.

However, if the retrograde ejaculation has been caused by significant muscle or nerve damage, treatment may not be possible.

Men who want to have children can have sperm taken from their urine for use in artificial insemination or in-vitro fertilisation (IVF).

Glossary

Local anaesthetic: A local anaesthetic is a drug injected by needle or applied as a cream, which causes a loss of feeling in a specific area of the body.