Managing premature ejaculation

Q. I am in a new sexual relationship and surprised that at age 63 I have premature ejaculation. My partner is understanding, but it bothers me. What might help?

A. Premature ejaculation is common in older men, especially when beginning a new relationship. Even men with erectile dysfunction (ED), who have difficulty getting and holding an erection, can experience premature ejaculation. It's great that your partner is so understanding, and it benefits you both to be open about the issue and discuss your options together.

The official definition of premature ejaculation is uncontrolled and unwanted ejaculation within a minute or less of penetration. Personally, I think this definition is too limiting. Of course, men need to be realistic about their expectations for staying power. But if a man is consistently ejaculating before he wants to, and it causes him distress, then he should speak with his doctor.

However, there are two techniques you and your partner can try right away that may help. They are the "stop-start" and "stop-squeeze" methods.

With stop-start, you begin sexual intercourse and keep going until you are close to the point of orgasm. You stop all sexual stimulation until the feeling passes and then resume intercourse.

Stop-squeeze is somewhat similar. When you approach orgasm, you pause, and you (or your partner) use the thumb and two fingers to gently apply pressure just below the head of the penis for about 20 seconds. Then release the squeeze, and resume sexual activity. Both techniques can be repeated as often as needed.

Another option is to apply a topical numbing agent to the head of the penis. The most convenient types are sprays that contain lidocaine or a similar anesthetic product. You will need to test this out to see if your partner finds it causes irritation. (Using condoms also might help by reducing sensation.)

Antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs), can counter premature ejaculation because delayed orgasm is a common side effect. Some studies suggest that paroxetine (Paxil) may be the most helpful, but any of the other SSRIs also should work, such as fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa), and escitalopram (Lexapro). However, they need to be taken daily, since they don't work on an as-needed basis.

Men who have both ED and premature ejaculation should first address their ED. That usually entails taking medication like sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), or avanafil (Stendra). After this, they can add an SSRI.

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