Premature Ejaculation
Effective, Evidence-Based Treatment — Medical, Behavioral & Combination Approaches
What Causes Premature Ejaculation?
PE has both psychological and biological components. In most men it is a combination of both — which is why the most effective treatments often combine medical and behavioral approaches.
Anxiety & Performance Pressure
Performance anxiety is one of the most common triggers for PE — especially in younger men or those with a new partner. The worry about ejaculating too quickly can actually make it happen faster, creating a cycle.
Serotonin Levels
Serotonin is a neurotransmitter that plays a direct role in ejaculation control. Men with PE often have lower serotonin activity in the areas of the brain that regulate ejaculation — which is why SSRIs are effective treatments.
Erectile Dysfunction
Men who struggle to maintain an erection often rush to ejaculate before losing it — creating a habit of rapid ejaculation. Treating the underlying ED often significantly improves PE as well.
Relationship & Psychological Factors
Stress, relationship conflict, guilt, or a history of sexual trauma can all contribute to PE. In these cases, a combined approach with behavioral therapy produces the best outcomes.
Treatment Options for Premature Ejaculation
Dr. Kashani offers a comprehensive, individualized approach — combining the treatments most likely to work for your specific situation. Most men see significant improvement within weeks of starting treatment.
Topical
Topical Anesthetic Agents
Topical creams, sprays, or gels containing lidocaine or prilocaine are applied to the penis before sex to reduce sensitivity and delay ejaculation. They are easy to use, work quickly, and have minimal systemic side effects. They can be used as needed without daily medication.
EMLA® Cream
Promescent® Spray
Lidocaine/Prilocaine
As-Needed Use
Oral Medication
SSRIs (Serotonin Medications)
Selective serotonin reuptake inhibitors (SSRIs) are the most effective pharmacological treatment for PE. They increase serotonin activity, which delays ejaculation. They can be taken daily for continuous effect, or as-needed a few hours before sex (off-label use). Dapoxetine is specifically designed for on-demand PE treatment.
Paroxetine
Sertraline
Dapoxetine
Daily or As-Needed
Behavioral
Behavioral Techniques
The stop-start technique and the squeeze technique are well-established behavioral methods that help men build ejaculatory control over time. These exercises can be practiced alone or with a partner and often produce lasting improvements in control without medication.
Stop-Start Technique
Squeeze Technique
Pelvic Floor Exercises
Most Effective
Combination Therapy
Research consistently shows that combining medical treatment (topical agents or SSRIs) with behavioral techniques produces better and more lasting results than either approach alone. Dr. Kashani designs personalized combination protocols tailored to each patient's specific situation, severity, and preferences.
Topical + SSRI
Medical + Behavioral
Individualized Protocol
