Treatment Options

Back to Premature Ejaculation

Behavioral Treatments

Behavioral therapies can help many men gain control and reduce anxiety related to PE. Our providers coach patients on techniques that are realistic, effective, and non-disruptive to intimacy.

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Common Strategies Include:

  • Masturbation before intercourse to lengthen refractory time
  • Adjusting sexual positions to reduce stimulation
  • Resensitization tools such as masturbation sleeves to reduce hypersensitivity
  • The “Sandwich Technique” (ejaculating first, then resuming intimacy once arousal resets)

While older methods like the “start-stop” and “squeeze” techniques exist, Maze focuses on modern, evidence-backed strategies that prioritize enjoyment and connection.

Medical Treatments

Medical therapy can dramatically improve PE outcomes, often in combination with behavioral work.

Topical Therapies

  • EMLA cream (lidocaine + prilocaine) and Promescent spray are numbing agents that reduce penile sensitivity and increase duration.
  • Applied before intercourse, then wiped off to avoid partner transfer.

Oral Medications

  • SSRIs such as sertraline (Zoloft), paroxetine (Paxil), and fluoxetine (Prozac) are the most effective long-term pharmacologic treatment for PE.
  • These drugs delay climax by boosting serotonin, the neurotransmitter that helps control ejaculation reflexes.
  • Dapoxetine, a short-acting SSRI used worldwide, is not yet FDA-approved in the US.

PDE5 Inhibitors (Viagra, Cialis, Levitra, Stendra)

These do not delay ejaculation directly, but they improve erection quality, reduce anxiety, and help men maintain rigidity even after climax — all of which aid PE management.

Intracavernosal Injections

For select patients, injections that produce firm erections can allow continued intercourse after ejaculation, helping retrain the body’s timing and satisfaction response.
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Combination Therapy

Most men see the best results when behavioral and medical treatments are used together.

Example:

  • Masturbate two hours before sex
  • Take Cialis 1–2 hours prior
  • Apply Promescent before intercourse

This structured approach increases stamina and confidence — balancing planning with spontaneity.

Understanding Ejaculation:
The Science Behind It

Ejaculation involves three linked events:
  1. Emission: Seminal fluid enters the urethra.
  2. Ejaculation: Muscles contract rhythmically to expel semen.
  3. Orgasm: The brain’s pleasure response that usually occurs simultaneously.

Premature ejaculation begins when this sequence activates earlier than intended.

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Factors That Influence Ejaculation

A complete evaluation looks at the systems that regulate ejaculation:

  • Central Nervous System: Neurotransmitters like serotonin (delays ejaculation) and dopamine (speeds it up)
  • Hormones: Thyroid hormone and testosterone levels affect libido and timing
  • Prostate Health: Inflammation or prostatitis can increase PE risk
  • Erectile Function: Anxiety or weak erections can trigger early climax
  • Genetics: PE may run in families due to inherited serotonin receptor differences

Evaluation and Diagnosis

During your first appointment (45–60 minutes), your provider will:

  • Take a detailed medical and sexual history
  • Assess erection quality, rigidity, and timing
  • Ask about relationship factors, prior treatments, and frequency of ejaculation
  • Perform a focused physical exam (penis, testes, and sometimes prostate)
  • Conduct biothesiometry testing to measure penile sensitivity

This comprehensive evaluation helps identify lifelong vs. acquired PE and informs your personalized treatment plan.

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