Delay ejaculation medication-Premature ejaculation - Diagnosis and treatment - Mayo Clinic

Back to Sexual health. Premature ejaculation is where a man ejaculates comes too quickly during sexual intercourse. It is a common ejaculation problem. A study involving couples found the average time for ejaculation was about five-and-a-half minutes after starting sex. This time could be longer in the case of men who have sex with men.

Delay ejaculation medication

Midodrine is usually given in flexible doses, starting with 7. International guidelines define premature ejaculation as regularly ejaculating within one minute of entering your partner. PLoS One ; 5 :e For many pharmacological treatment options the evidence is still limited for small trials, case series or case reports. Delay ejaculation medication Assist Reprod Genet ; 18

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Yohimbine reverses the exhaustion of the coital reflex in spinal male rats. Q: What dietary choices can I make to help treat delayed ejaculation? Footnotes Conflicts of Interest: The authors have no Delay ejaculation medication of interest to declare. FDA alerts. Given Thong swimsuit topless small numbers of studies, the small sample size, no conclusions could be drawn at this time regarding the role of buspirone in DE. Findings In medciation retrospective study of 21 patients complaining of antidepressant-induced sexual dysfunction, yohimbine Delay ejaculation medication found to be superior to both cyproheptadine and amantadine in improving the sexual function Occasionally, we hear complaints of delayed orgasm from men on intracavernosal injection ICI therapy for ED. Wein AJ, et al. Int J Impot Res ; 16 The mechanism of antidepressants-induced DE and ejaculatin orgasm is thought to involve stimulation of post synaptic 5-HT 2A and 5-HT 2C receptors by the increased synaptic levels of serotonin If you're able to ejaculate, how long does it take after Delay ejaculation medication activity starts? Eur J Pharmacol ; Due to the heavy influence of the nervous system on ejaculation, it makes sense that Chat rooms pregnant dating condition that affects the brain, spinal cord, or peripheral nerves may interfere with this function. Pharmacol Biochem Behav ; 86

Delayed ejaculation DE is an uncommon and a challenging disorder to treat.

  • Delayed ejaculation DE is a common medical condition.
  • Medically reviewed by Drugs.

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Click here to return to the Medical News Today home page. Delayed ejaculation affects around 1 to 4 percent of men. It can result in distress for both the man and his partner.

It can trigger anxiety about general health, low libido, and sexual dissatisfaction. Relationship problems include a fear of rejection for both parties and concern for couples who wish to start a family.

Here are some key points about delayed ejaculation. Delayed ejaculation can have a psychological or biological cause. There can also be overlap between the two. An acquired case is usually determined as having a psychological cause if it only happens in specific situations.

One specialist in delayed ejaculation found a relationship between the condition and the following masturbatory patterns:. Some men with the condition needed to employ an "idiosyncratic" form of self-manipulation to reach orgasm, such as rubbing the penis against the bed sheets, masturbating with pressure on a particular spot when reading erotic books, and even masturbating by "urethral instrumentation" - inserting a foreign body down into the opening of the penis.

To reach a diagnosis, a doctor will speak with the individual about symptoms and how often they occur. They will then rule out other potential medical problems, such as infections, hormonal imbalance, and so on. This may involve using blood and urine tests.

Treatment for delayed ejaculation depends on the cause. For instance, if SSRIs are the issue, an alternative drug may be prescribed. If excessive alcohol or non-prescription drug use are factors, reducing or eliminating these may help. If there are other medical conditions, managing the primary condition, such as a neurological problem, may help resolve the delayed ejaculation.

Primary cases of delayed ejaculation may not be straightforward to treat. They often require the help of professional counselors such as psychologists, psychotherapists, psychosexual counselors, sex therapists, or couple's therapists. Psychologists recognize that there is no single intervention that works for all patients and that the key to successful treatment is to identify the source of the problem and to use appropriate, targeted therapy to deal with the psychological factors that trigger or contribute to the problem.

Some medications may help improve the symptoms of delayed ejaculation, but none have yet been specifically approved to treat it. Anyone who has concerns about sexual function speaks with a doctor so that the right course of action can be taken.

Article last updated by Yvette Brazier on Mon 15 January All references are available in the References tab. Althof, S. Int J Impot Res , 24 4 , Amidu, N.

Perceptions of normal and abnormal ejaculatory latency times: An observational study in Ghanaian males and females. European Journal of Medical Research , 20 1 , Bettocchi, C. Ejaculatory disorders: pathophysiology and management. Nature , 5, Binik, Y. Principles and practice of sex therapy fifth edition. Conditions: Anejaculation.

Conditions: Delayed Ejaculation. Delayed ejaculation. Ejaculatory dysfunction. Hirsch, I. IsHak, W. DSM-5 changes in diagnostic criteria of sexual dysfunctions. McMahon, C. Management of ejaculatory dysfunction. Internal Medicine Journal , 44 2 , Rowland, D.

Waldinger, M. Original research - Ejaculation disorders: A multinational population survey of intravaginal ejaculation latency time. The Journal of Sexual Medicine , 2 4 , What is painful ejaculation? What is Premature Ejaculation? Xia, J. Clinical characteristics and penile afferent neuronal function in patients with primary delayed ejaculation. Andrology , 1 5 , MediLexicon, Intl.

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Send securely. Message sent successfully The details of this article have been emailed on your behalf. By Markus MacGill. Table of contents Causes Diagnosis Treatment Outlook. Fast facts on delayed ejaculation Here are some key points about delayed ejaculation.

Delayed ejaculation is a form of sexual dysfunction affecting a man's ability to reach an orgasm. The average time it takes for ejaculation to occur upon stimulation varies between individuals, with no strict figure given for what is "normal".

No pharmacological therapies are available for psychological causes of delayed ejaculation. Men with a persistent problem of delayed ejaculation are likely to be distressed by it.

Professional counselors may try to treat delayed ejaculation by identifying the source of the problem. Related coverage. Additional information. This content requires JavaScript to be enabled. Ejaculatory disorders. Oxford, UK: Blackwell Publishing. Please note: If no author information is provided, the source is cited instead. Latest news Potato puree is a promising race fuel for athletes. In a trial involving trained cyclists, potato puree and carbohydrate gel showed equal ability to sustain blood glucose and racing performance.

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Bupropion in the depression-related sexual dysfunction: a systematic review. Received Feb 6; Accepted Mar Subscribe to Drugs. Virectin is one of the male enhancement supplements which claims to help male sexual performance in a number of ways using an all-natural formula. There is insufficient evidence to recommend amantadine for treatment of DE. Ferraz MR, Santos R. Effect of bupropion-SR on orgasmic dysfunction in nondepressed subjects: a pilot study.

Delay ejaculation medication

Delay ejaculation medication

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The rationale for a pharmacological approach to treating DE by cabergoline [a dopamine DA agonist on D2 receptors] came from the following observations: I DA has been recognized as a pro-sexual neurotransmitter 13 , 14 ; II DA agonists have been demonstrated to facilitate both animal 15 and human sexual behavior 16 ; III acute changes in the normal physiological levels of prolactin may also modify sexual motivation and function 17 ; IV increased prolactin concentrations by protirelin anterior pituitary gland stimulator administration produced significantly longer ejaculation latency during the first sequence of sexual activity in healthy men, whereas, cabergoline-induced hypoprolactinemia significantly enhanced all parameters of sexual drive and function, including ejaculation latency 17 ; and V cabergoline has been shown to activate the 5-HT 2B agonists receptors Activation of 5-HT 2B receptors may have effects on the ejaculation depending on the dose of the agonist Research on cabergoline for treatment of DE is hard to find.

A retrospective study presented at the annual meeting of the American Urological Association 20 evaluated the efficacy of cabergoline 0. The mean age of the patients was 63 whereas the mean duration of therapy for non-responders and responders was and days, respectively.

However, the duration of therapy and the concomitant testosterone replacement therapy were associated with significant response to treatment. In another retrospective study, Kacker et al.

The authors treated these men on the basis of high-normal or mildly elevated prolactin mean Although these studies are promising in male anorgasmia, it is still uncertain if this drug will do the same in DE. On the other hand, ejaculation is the expulsion of semen to outside involving both emission and the ejaculation proper a physical process.

Usually the two conditions occur simultaneously in men 21 , There is weak scientific evidence to suggest that cabergoline could be beneficial for some cases of delayed orgasm. Large-scale randomized controlled trials are necessary to further define the role of the drug in DE apart from hyperprolactinemia.

However, special note must be taken that the drawbacks of cabergoline treatment include a higher risk of cardiac valve regurgitation and heart failure 23 due to activation of 5-HT2B receptors on valvular interstitial cells which is mitogenic 18 , increasing valve leaflet area and causing the poor valve closure. Longer treatment duration and higher dose of cabergoline is associated with these risks These side effects have never been demonstrated in episodic small dosing for sexual dysfunction.

Bupropion is an atypical antidepressant belonging to the chemical class of aminoketones. It is known as a DA and norepinephrine NE reuptake inhibitor used as smoking cessation and antidepressant drug with a lower incidence of male sexual dysfunction. The rationale for using bupropion in DE comes from the following observations: I it has been shown that chronic bupropion administration at high doses alters the function of the spinal generator for ejaculation SGE in rats 24 ; II bupropion produces concentration- dependent increases in the contractile response to nerve stimulation in the rat vas deferens and significantly increases the pressor response to noradrenaline suggesting facilitatory action of the ejaculatory reflex 25 ; III in vitro bupropion increases by eight-fold the NE potency in inducing contractions of the epididymal duct from untreated rats.

The ability of bupropion to enhance epididymal duct contractions to NE is due to its action as a NE transporter blocker as bupropion did not change duct contraction to methoxamine 26 ; IV bupropion has been demonstrated to induce premature ejaculation in 46 years old man after the use of mg bupropion per day for depression and premature ejaculation disappeared two weeks after stopping of bupropion 27 , 28 ; and V bupropion showed prosexual effects when compared with the other antidepressants and no patient taking bupropion complained of delayed orgasm Other studies have found that bupropion can even enhance sexual function in certain individuals The DE and anorgasmia with antidepressants have been attributed to increased serotonergic tone.

This occurs due to suppression of ejaculation at the level of the hypothalamus Noradrenergic tone on the other hand stimulates ejaculation, which concurs with the finding that noradrenergic antidepressants such as bupropion have no or milder degree of sexual dysfunction as compared with selective serotonin re-uptake inhibitors SSRIs. There have been few reports 34 - 36 on the use of bupropion in DE among non-depressed men. Modell et al. Side effects such as insomnia, anxiety, irritability and headache were generally mild and transient occurred with greater frequency on the higher dose and in no case necessitated drug discontinuation.

Abdel-Hamid and Saleh 34 reported on bupropion therapy in a series of 19 lifelong DE men. There was also a significant improvement in the intercourse satisfaction and the orgasmic domains of IIEF and depression score from baseline.

The authors concluded that bupropion-SR in a daily dosage of mg seemed to be of limited benefit in about of 1 fourth of lifelong DE patients. Bidaki et al. Although laboratory tests showed primary hypogonadism high level of LH and low T level , T undecanoate 25 mg weekly IM treatment did not result in improved DE. The authors reported that the sexual dysfunction had resolved three days after stopping bupropion. Although preliminary clinical data seem to suggest that bupropion has beneficial clinical effects in certain DE patients, there is not sufficient scientific evidence to suggest that it could stand alone as a drug therapy for all patients with DE.

Further studies are needed. It is also used for treating Parkinsonism, extrapyramidal symptoms and many other disorders It possesses DA enhancing activity by facilitating presynaptic DA release and inhibiting DA reuptake post-synaptically.

Based on the principle that increasing DA neurotransmission may enhance sexual function, amantadine-treated male rats showed a higher sexual response and decreased ejaculation latency time than vehicle-treated rats 40 - The primary site of action of this drug is possibly supraspinal because amantadine-induced seminal emissions were impaired by spinal cord transection On the other hand, Devaangam et al.

The effects of amantadine on the human ejaculatory or orgasmic functions are conflicting. Reported effective doses have ranged between — mg taken either on a daily or as-needed basis. Shrivastava et al.

Amantadine was given in divided doses of mg twice daily and mg daily. There were no other side effects or drug interactions reported. Fifty three percent of these patients were originally complaining of orgasmic delay or anorgasmia. In this study, one patient on amantadine discontinued it secondary to depression, which resolved within 48 hr of discontinuation. There is insufficient evidence to recommend amantadine for treatment of DE.

Cyproheptadine is a piperidine derivative first-generation antihistamine. Cyproheptadine also has mild anticholinergic and antiserotonergic properties possibly through blocking 5-HT 1A and 5-HT 2A receptors Animal data suggested that cyproheptadine potentiates the prejunctional inhibitory effect of 5-HT and attenuates its stimulatory effect in the rat and guinea-pig vas deferens 49 , 50 suggesting peripheral effects.

Additionally, it facilitates sexual behavior of the male rat possibly through antiserotonergic effects The mechanism of antidepressants-induced DE and delayed orgasm is thought to involve stimulation of post synaptic 5-HT 2A and 5-HT 2C receptors by the increased synaptic levels of serotonin The prosexual effects of cyproheptadine are likely due to the antiserotonergic properties of the drug, rather than its antihistaminic effects, because diphenhydramine an antihistaminic is ineffective in treating sexual dysfunction 46 , Several case reports and case series showed efficacy of cyproheptadine in reversal of DE or anorgasmia supposed to be caused by antidepressants 57 - 63 , monoamine oxidase inhibitors 64 or imipramine Effective doses range from 2—16 mg.

The drug is effective when taken either on an as-needed basis 1—2 hours before planned intercourse or on a daily basis nightly before bed time. The mean duration of treatment with cyproheptadine was 2. Sedation and weight gain were associated with cyproheptadine.

However, its sedative effects are likely to diminish its overall efficacy. However; imipramine is significantly inferior to midodrine. Midodrine is usually given in flexible doses, starting with 7. A study with a robust design and sample of 20 men with anejaculation associated with SCI evaluated the effects of midodrine In this small sample study, treatment with midodrine and PVS did not result in a better rate of antegrade ejaculation in ten men than in ten men treated with a placebo and PVS.

The drug was well-tolerated. However, these later findings are questionable because the author of this primary study had six retracted clinical studies in the past three years The idea is intriguing and still awaits prospective testing in a large sample size enrolling different grades of DE. Animal studies have demonstrated that yohimbine has pro- ejaculatory effects 84 - Concerning the 5-HT 1A agonist effect of yohimbine, it has been demonstrated that stimulation of 5-HT 1A is associated with reduced number of pre-ejaculatory intromissions and thereby the ejaculation latency In a retrospective study of 21 patients complaining of antidepressant-induced sexual dysfunction, yohimbine was found to be superior to both cyproheptadine and amantadine in improving the sexual function Seventeen patients The average dose for yohimbine was Another study 94 on 29 men with orgasmic dysfunction of different etiology that were provided yohimbine at 20 mg and were allowed to increase the dose at home up to 50 mg.

A further 3 men Side effects included dartos contraction, a rise in the pulse and blood pressure, tremor, pleasurable tingling, palpitations, malaise, nausea and headache. Yohimbine may be useful in the treatment of DE, however final conclusions still awaits large sample size as well as prospective double blind placebo controlled testing. The drug is originally an azapirone that was approved by the US FDA for the treatment of generalized anxiety disorder.

In other words, the mechanism of action of buspirone in treating DE may be through reduced serotonergic tone via stimulation of presynaptic 5-HT 1A receptor. It appears that the effects of on sexual behavior may be possible at different parts of the central nervous system This area of research is in need of further effort. A retrospective study was undertaken of 16 patients treated with adjunctive buspirone in the context of sexual dysfunction associated with the use of SSRls Treatment was generally very well tolerated.

However, several patients that had become less irritable after treatment with an SSRI, reported increased irritability. Among a total of patents 82 women, 37 men , 12 men Given the small numbers of studies, the small sample size, no conclusions could be drawn at this time regarding the role of buspirone in DE.

Further studies are warranted. It is involved in a wide variety of physiological and pathological functions including sexual activity, penile erection and ejaculation In contrast to the findings of pro-ejaculatory effect in male rats, in the male prairie vole, OT causes an immediate cessation of all sexual activity which continues to remain so for at least 24 hr In a prospective randomized controlled study at a private assisted reproduction technology center included consecutive healthy men, OT 16 IU were administered intranasally to 49 subjects study group before masturbation to ejaculation In the OT group, no major side effects were registered.

Minor side effects such as feeling flushed, slight transient headache, or a strange peculiar taste disappeared in all subjects within 10 min after application of the hormone. In another double-blind, placebo-controlled, cross-over trial, Burri et al.

All subjects reported having achieved an orgasm in the min sequence of sexual activity in the experimental sessions with significant shorter ejaculation time after placebo 5. In contrast, Ishak el al. OT improved the sexual function in this man with satisfied with orgasm changed on the Arizona Sexual Experience Scale, from 3 somewhat satisfying to 2 very satisfying. It appears that very little of the huge amounts applied intranasally reach the cerebrospinal fluid and peripheral concentrations are increased to supraphysiologic levels, with likely effects on diverse targets including and the genital tract It has been demonstrated that whereas OT plasma concentrations peaked at 15 min after intranasal administration and decreased after 75 min, CSF concentrations took up to 75 min to reach a significant level.

Bethanechol is muscarinic receptor agonists that are fairly selective for muscarinic receptors possibly for M3 receptors with little effect on nicotinic receptors. It is supposed to have mixed central and peripheral cholinergic and adrenergic effects The drug is used to treat urinary retention and other disorders. Additionally, it has been suggested that an imbalance between cholinergic and adrenergic function may be responsible for the tricyclic antidepressant-induced orgasmic dysfunction Case reports - and one randomized, double-blind, placebo-controlled, two-period crossover study 12 patients have shown the benefit of bethanechol in treating DE associated with antidepressants.

The doses of the drug in DE are 10—20 mg as needed or 30— mg daily in a divided dose. Its potential side effects of bethanechol might include diarrhea, cramps, and diaphoresis.

Although there is only one randomized, double-blind, placebo-controlled trial that reported efficacy of bethanechol in treating antidepressants -associated DE evidence level 1 , the sample size was small. Definitely, it is difficult to draw solid conclusion waiting for further randomized clinical trials. Other drugs that may be of value in the treatment of DE include, apomorphine, pramipexole, ropinirole, quinelorane, anandamide AEA , and reboxetine. Apomorphine, a non-selective DA receptor agonist, has been shown to facilitate the ejaculatory response possibly through the activation of D 2 -like and 5-HT 2C receptors, respectively - This proejaculatory effect is likely mediated at supraspinal, spinal or peripheral levels - To the best of our knowledge, no clinical study has ever been published to test this hypothesis to date.

Case series and retrospective patient surveys have shown strong association between these drugs and the occurrence of hypersexuality, one of the severe impulse control disorders, suggesting a pro-sexual effect Additionally, DA receptor is known to facilitate ejaculation in laboratory animals , Anandamide N-arachidonoylethanolamine, AEA is an essential fatty acid neurotransmitter derived from the non-oxidative metabolism of arachidonic acid and is considered as a cannabinoid receptor CB1 agonist.

It is the first endogenous ligand of central CB1, was isolated from porcine brain in It showed pro-ejaculatory effects in laboratory animals possibly through the activation of CB1 receptors - Reboxetine is a selective noradrenaline reuptake inhibitor with little effects on other neurotransmitter systems A variety of herbal preparations have been consumed along thousands of years across numerous cultures for stimulation of sexual activity.

These herbs may include Ferula hermonis , Chinese herbal extract , Ginkgo biloba extract , Mucuna pruriens Linn. Seed , Eurycoma longifolia , Pedalium murex Linn. Fruits , Maca root , and many others.

The common action for all of these preparations is shortening in ejaculation latency in male rats whereas its place of these herbs in the therapeutic armamentarium of DE is not yet known.

For many pharmacological treatment options the evidence is still limited for small trials, case series or case reports. Given the variety of drugs available for managing DE Table 1 , which one to choose might be a complicated issue in the clinical setting. For a patient who had suffered antidepressant-related DE, shifting to another antidepressant such as bupropion or adding cabergoline if there is hyperprolactinemia may be the prudent option.

Hence, the selection of drug would be best tailored to the needs of individual patient and the specific circumstances of the case. To conclude, successful drug treatment of DE is still in its infancy. The clinicians need to be aware of the pathogenesis of DE and the pharmacological basis underlying the use of different drugs to extend better care to the patients.

Various drugs are available to address such problem, however the evidence of their efficacy is still limited and the choice of drugs needs to be individualized to each specific case. Conflicts of Interest: The authors have no conflicts of interest to declare. National Center for Biotechnology Information , U. Journal List Transl Androl Urol v. Transl Androl Urol. Ibrahim A. Abdel-Hamid , 1 Moustafa A. Moustafa A. Author information Article notes Copyright and License information Disclaimer.

Corresponding author. Correspondence to: Ibrahim A. Abdel-Hamid, MD. Email: moc. Received Feb 6; Accepted Mar Copyright Translational Andrology and Urology. All rights reserved. This article has been cited by other articles in PMC. Abstract Delayed ejaculation DE is an uncommon and a challenging disorder to treat. Keywords: Ejaculation, delayed ejaculation DE , inhibited ejaculation, drugs, treatment. Cabergoline Rationale The rationale for a pharmacological approach to treating DE by cabergoline [a dopamine DA agonist on D2 receptors] came from the following observations: I DA has been recognized as a pro-sexual neurotransmitter 13 , 14 ; II DA agonists have been demonstrated to facilitate both animal 15 and human sexual behavior 16 ; III acute changes in the normal physiological levels of prolactin may also modify sexual motivation and function 17 ; IV increased prolactin concentrations by protirelin anterior pituitary gland stimulator administration produced significantly longer ejaculation latency during the first sequence of sexual activity in healthy men, whereas, cabergoline-induced hypoprolactinemia significantly enhanced all parameters of sexual drive and function, including ejaculation latency 17 ; and V cabergoline has been shown to activate the 5-HT 2B agonists receptors Findings Research on cabergoline for treatment of DE is hard to find.

Conclusions There is weak scientific evidence to suggest that cabergoline could be beneficial for some cases of delayed orgasm. Bupropion Rationale Bupropion is an atypical antidepressant belonging to the chemical class of aminoketones. Findings There have been few reports 34 - 36 on the use of bupropion in DE among non-depressed men.

Conclusions Although preliminary clinical data seem to suggest that bupropion has beneficial clinical effects in certain DE patients, there is not sufficient scientific evidence to suggest that it could stand alone as a drug therapy for all patients with DE. Findings The effects of amantadine on the human ejaculatory or orgasmic functions are conflicting. Conclusions There is insufficient evidence to recommend amantadine for treatment of DE. Cyproheptadine Rationale Cyproheptadine is a piperidine derivative first-generation antihistamine.

Findings Several case reports and case series showed efficacy of cyproheptadine in reversal of DE or anorgasmia supposed to be caused by antidepressants 57 - 63 , monoamine oxidase inhibitors 64 or imipramine Findings In a retrospective study of 21 patients complaining of antidepressant-induced sexual dysfunction, yohimbine was found to be superior to both cyproheptadine and amantadine in improving the sexual function Conclusions Yohimbine may be useful in the treatment of DE, however final conclusions still awaits large sample size as well as prospective double blind placebo controlled testing.

Findings A retrospective study was undertaken of 16 patients treated with adjunctive buspirone in the context of sexual dysfunction associated with the use of SSRls Conclusions Given the small numbers of studies, the small sample size, no conclusions could be drawn at this time regarding the role of buspirone in DE.

Bethanechol Rationale Bethanechol is muscarinic receptor agonists that are fairly selective for muscarinic receptors possibly for M3 receptors with little effect on nicotinic receptors. Findings Case reports - and one randomized, double-blind, placebo-controlled, two-period crossover study 12 patients have shown the benefit of bethanechol in treating DE associated with antidepressants. Conclusions Although there is only one randomized, double-blind, placebo-controlled trial that reported efficacy of bethanechol in treating antidepressants -associated DE evidence level 1 , the sample size was small.

Other drugs Other drugs that may be of value in the treatment of DE include, apomorphine, pramipexole, ropinirole, quinelorane, anandamide AEA , and reboxetine. Herbal preparations A variety of herbal preparations have been consumed along thousands of years across numerous cultures for stimulation of sexual activity. Which drug to choose For many pharmacological treatment options the evidence is still limited for small trials, case series or case reports.

Table 1 Drug treatment for delayed ejaculation. Open in a separate window. Acknowledgements None. Footnotes Conflicts of Interest: The authors have no conflicts of interest to declare.

References 1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Althof SE. Int J Impot Res ; 24 Psychobiological correlates of delayed ejaculation in male patients with sexual dysfunctions.

J Androl ; 27 Standard operating procedures in the disorders of orgasm and ejaculation. J Sex Med ; 10 How is delayed ejaculation defined and treated in North America? Andrology ; 3 Effect of androgens on penile tissue.

Endocrine ; 23 Keast JR. Effects of testosterone on pelvic autonomic pathways: progress and pitfalls.

J Auton Nerv Syst ; 79 Bulbocavernosus muscle area measurement: a novel method to assess androgenic activity. Asian J Androl ; 16 Dopamine, the medial preoptic area, and male sexual behavior. Physiol Behav ; 86 Facilitation of male sexual behavior in Syrian hamsters by the combined action of dihydrotestosterone and testosterone.

PLoS One ; 5 :e Different testosterone levels are associated with ejaculatory dysfunction. J Sex Med ; 5 J Clin Endocrinol Metab ; Prolactinergic and dopaminergic mechanisms underlying sexual arousal and orgasm in humans. World J Urol ; 23 Normal male sexual function: emphasis on orgasm and ejaculation. Fertil Steril ; Sexual behavior in male rodents. Horm Behav ; 52 Apomorphine-induced brain modulation during sexual stimulation: a new look at central phenomena related to erectile dysfunction.

Int J Impot Res ; 15 Effects of acute prolactin manipulation on sexual drive and function in males. J Endocrinol ; Mol Pharmacol ; 63 Pharmacol Biochem Behav ; 88 Cabergoline for the treatment of male anorgasmia. J Urol ; :e Abstract Salvage pharmacotherapy for delayed orgasm after treatment for testosterone deficiency.

Perelman MA. Patient highlights. Delayed ejaculation. CNS Drugs ; 29 Effects of bupropion on the ejaculatory response of male rats. Int J Impot Res ; 26 Cardiovascular stimulant actions of bupropion in comparison to cocaine in the rat.

Eur J Pharmacol ; Bupropion treatment increases epididymal contractility and impairs sperm quality with no effects on the epididymal sperm transit time of male rats. J Appl Toxicol ; 35 Kravos M. Bupropion associated premature ejaculation. Pharmacopsychiatry ; 43 Evrensel A, Ceylan ME. Turk Psikiyatri Derg ; 25 Comparative sexual side effects of bupropion, fluoxetine, paroxetine, and sertraline. Clin Pharmacol Ther ; 61 Bupropion in the depression-related sexual dysfunction: a systematic review.

Bupropion treatment of serotonin reuptake antidepressant-associated sexual dysfunction. Ann Clin Psychiatry ; 9 Waldinger MD. The neurobiological approach to premature ejaculation. J Urol ; Effect of bupropion-SR on orgasmic dysfunction in nondepressed subjects: a pilot study. J Sex Marital Ther ; 26 Primary lifelong delayed ejaculation: characteristics and response to bupropion.

J Sex Med ; 8 Generalized Acquired Retarded ejaculation in a young man with opium dependency: A rare case report. Health Med ; 6 Anorgasmia in a patient treated with bupropion SR for smoking cessation.

J Clin Psychopharmacol ; 24 Hosenbocus S, Chahal R. Amantadine: a review of use in child and adolescent psychiatry. J Neural Transm Suppl ; 43 Brain Res ; Baraldi M, Bertolini A. Penile erections induced by amantadine in male rats. Life Sci ; 14 Ferraz MR, Santos R.

Amantadine stimulates sexual behavior in male rats. Pharmacol Biochem Behav ; 51 Chronic amantadine treatment enhances the sexual behavior of male rats.

Pharmacol Biochem Behav ; 86 The effect of amantadine on clomipramine induced sexual dysfunction in male rats. Oman Med J ; 26 Treatment of fluoxetine-induced anorgasmia with amantadine. J Clin Psychiatry ; 53 Amantadine in the treatment of sexual dysfunction associated with SSRIs. J Clin Psychopharmacol ; 15 For this article, we are mainly discussing the lack or delay of orgasm.

Some men who complain of DE have no identifiable causes or factors. While it can be helpful to distinguish between physical and psychosocial causes, both often coexist.

Due to the heavy influence of the nervous system on ejaculation, it makes sense that any condition that affects the brain, spinal cord, or peripheral nerves may interfere with this function. Examples of conditions known to cause DE include stroke, multiple sclerosis, spinal cord injuries, and diabetes.

Diabetes is an exceptional example because it is so common and can affect all aspects of sexual function including the ability to achieve and sustain an erection through the entirety of sexual activity. As previously stated, problems with ejaculation can occur secondary to erectile dysfunction. In these cases, it is generally accepted that correction of the ED can help improve DE.

The same is true for premature ejaculation. Testosterone also plays a role in ejaculation and orgasm. However, research studies have not shown testosterone replacement therapy to be a very effective treatment for DE.

Recreational and prescription substances are common causes of DE. Examples include alcohol, narcotic pain medication, thiazide diuretics, and selective serotonin reuptake inhibitors SSRIs. SSRIs are commonly prescribed for problems such as depression and anxiety, but are also used to help patients with premature ejaculation. Occasionally, we hear complaints of delayed orgasm from men on intracavernosal injection ICI therapy for ED. There is no proven correlation between ICI therapy and DE, however extreme rigidity may inhibit sensitivity causing delayed orgasm.

Therefore, it is thought that a small reduction in medication strength or dose may help resolve the DE problem. Social, psychological, and cultural influences all can be involved in a patient with DE. Sometimes treatment for DE may actually be as simple as adjusting the medication causing it. For example, if a patient is taking an SSRI, a conversation with the prescribing physician can help determine if a reduced dose or a different medication is less likely to cause DE.

Some patients may benefit from consultation with a therapist or mental health professional that specializes in sexual disorders.

Delayed ejaculation - Diagnosis and treatment - Mayo Clinic

In addition to asking about your sex life, your doctor will ask about your health history and might do a physical exam. If you have both premature ejaculation and trouble getting or maintaining an erection, your doctor might order blood tests to check your male hormone testosterone levels or other tests. In some cases, your doctor might suggest that you go to a urologist or a mental health professional who specializes in sexual dysfunction.

Common treatment options for premature ejaculation include behavioral techniques, topical anesthetics, medications and counseling. Keep in mind that it might take time to find the treatment or combination of treatments that will work for you. In some cases, therapy for premature ejaculation might involve taking simple steps, such as masturbating an hour or two before intercourse so that you're able to delay ejaculation during sex.

Your doctor also might recommend avoiding intercourse for a period of time and focusing on other types of sexual play so that pressure is removed from your sexual encounters. The male pelvic floor muscles support the bladder and bowel and affect sexual function.

Kegel exercises can help strengthen these muscles. Weak pelvic floor muscles might impair your ability to delay ejaculation. Pelvic floor exercises Kegel exercises can help strengthen these muscles. Your doctor might instruct you and your partner in the use of a method called the pause-squeeze technique. This method works as follows:. By repeating as many times as necessary, you can reach the point of entering your partner without ejaculating.

After some practice sessions, the feeling of knowing how to delay ejaculation might become a habit that no longer requires the pause-squeeze technique. If the pause-squeeze technique causes pain or discomfort, another technique is to stop sexual stimulation just prior to ejaculation, wait until the level of arousal has diminished and then start again.

This approach is known as the stop-start technique. Condoms might decrease penis sensitivity, which can help delay ejaculation. These condoms contain numbing agents such as benzocaine or lidocaine or are made of thicker latex to delay ejaculation. Anesthetic creams and sprays that contain a numbing agent, such as benzocaine, lidocaine or prilocaine, are sometimes used to treat premature ejaculation. These products are applied to the penis 10 to 15 minutes before sex to reduce sensation and help delay ejaculation.

A lidocaine-prilocaine cream for premature ejaculation EMLA is available by prescription. Lidocaine sprays for premature ejaculation are available over-the-counter. Although topical anesthetic agents are effective and well-tolerated, they have potential side effects. For example, some men report temporary loss of sensitivity and decreased sexual pleasure. Sometimes, female partners also have reported these effects.

Many medications might delay orgasm. Although none of these drugs are specifically approved by the Food and Drug Administration to treat premature ejaculation, some are used for this purpose, including antidepressants, analgesics and phosphodiesterase-5 inhibitors. These medications might be prescribed for either on-demand or daily use, and might be prescribed alone or in combination with other treatments.

A side effect of certain antidepressants is delayed orgasm. For this reason, selective serotonin reuptake inhibitors SSRIs , such as escitalopram Lexapro , sertraline Zoloft , paroxetine Paxil or fluoxetine Prozac, Sarafem , are used to help delay ejaculation.

These medications usually take five to 10 days to begin working. But it might take two to three weeks of treatment before you'll see the full effect. If SSRIs don't improve the timing of your ejaculation, your doctor might prescribe the tricyclic antidepressant clomipramine Anafranil.

Unwanted side effects of antidepressants might include nausea, perspiration, drowsiness and decreased libido. Tramadol Ultram is a medication commonly used to treat pain. It also has side effects that delay ejaculation. Unwanted side effects might include nausea, headache, sleepiness and dizziness.

It might be prescribed when SSRIs haven't been effective. Tramadol can't be used in combination with an SSRI. Research suggests that several drugs that might be helpful in treating premature ejaculation, but further study is needed. These drugs include:. This approach involves talking with a mental health provider about your relationships and experiences. Sessions can help you reduce performance anxiety and find better ways of coping with stress. With premature ejaculation, you might feel you lose some of the closeness shared with a sexual partner.

You might feel angry, ashamed and upset, and turn away from your partner. Your partner also might be upset with the change in sexual intimacy. Premature ejaculation can cause partners to feel less connected or hurt. Talking about the problem is an important step, and relationship counseling or sex therapy might be helpful. Several alternative medicine treatments have been studied, including yoga, meditation and acupuncture. It's normal to feel embarrassed when talking about sexual problems, but you can trust that your doctor has had similar conversations with many other men.

Premature ejaculation is a very common — and treatable — condition. Being ready to talk about premature ejaculation will help you get the treatment you need to put your sex life back on track. The list below suggests questions to ask your doctor about premature ejaculation.

Your doctor might ask very personal questions and might also want to talk to your partner. To help your doctor determine the cause of your problem and the best course of treatment, be ready to answer questions such as:.

Deciding to talk with your doctor is an important step. In the meantime, consider exploring other ways in which you and your partner can connect with one another.

Although premature ejaculation can cause strain and anxiety in a relationship, it is a treatable condition. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. This content does not have an English version. This content does not have an Arabic version. Diagnosis In addition to asking about your sex life, your doctor will ask about your health history and might do a physical exam.

Male pelvic floor muscles The male pelvic floor muscles support the bladder and bowel and affect sexual function. Request an Appointment at Mayo Clinic. Share on: Facebook Twitter.

References Ferri FF. Ejaculation and orgasm disorders. In: Ferri's Clinical Advisor Philadelphia, Pa. Accessed Sept. Saitz TR, et al. Advances in understanding and treating premature ejaculation.

Nature Reviews Urology. Gur S, et al. Current therapies for premature ejaculation. Drug Discovery Today. Wein AJ, et al. Disorders of male orgasm and ejaculation. In: Campbell-Walsh Urology. Althof SE, et al. An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation PE.

The Journal of Sexual Medicine. Cooper K, et al. Behavioral therapies for management of premature ejaculation: A systematic review. Sexual Medicine. Serefpglu EC, et al. Premature ejaculation: Do we have effective therapy?

Translational Andrology and Urology. Siegel AL. Pelvic floor muscle training in males: Practical applications. Kegel exercise tips. Hill BJ, et al. The effect of condoms on penile vibrotactile sensitivity thresholds in young, heterosexual men. Contemporary management of disorders of male orgasm and ejaculation.

Castiglione F, et al. Current pharmacological management of premature ejaculation: A systematic review and meta-analysis. European Urology.

Delay ejaculation medication

Delay ejaculation medication