Penile squeeze therapy, stop-start therapy, and medication for premature ejaculation

What is penile squeeze therapy?

The squeeze technique, also known as tolerance training, was proposed by Masters and Johnson in 1970, based on the previous belief that premature ejaculation was primarily caused by high sensitivity of the glans penis. The squeeze technique involves manually squeezing the glans or base of the penis to raise the stimulation threshold, relieve the urgency of ejaculation, and thus delay ejaculation and treat premature ejaculation. The specific procedure is as follows.

The man lies naked on his back with his legs apart. The woman sits between his legs, facing his head, making it easy to operate with her right hand. The woman then applies continuous stimulation to the penis with her hand. When the man feels an urge to ejaculate, the woman quickly places her right thumb on the frenulum of the penis, and her index and middle fingers on the other side of the penis, positioned above and below the coronal sulcus respectively. She squeezes and presses for about 5 seconds, then suddenly releases, causing the penis to gradually weaken. After the penis becomes flaccid, sexual stimulation is repeated. This technique can increase the man's ejaculation threshold, thus relieving the urge to ejaculate. With consistent use of 15-30 times, it can significantly strengthen the ability to inhibit ejaculation and prolong ejaculation time.

After several days of squeezing training, the man's confidence increased, and his symptoms improved. For men, the sensation of the penis inside the vagina is very different from that of non-sexual activity; therefore, this method should be applied to woman-on-top intercourse. Before penetration, the woman should use the squeezing technique 3-8 times in the woman-on-top position. After penetration, remain still, both partners focusing on bodily sensations; the man should not actively rub at this time. After a short period of retention inside the vagina, the woman should withdraw the penis and squeeze again before re-inserting, beginning slow rubbing. If the man feels he is about to ejaculate, he should give the woman a signal, and she should then remove herself and continue squeezing. If retention inside the vagina continues for 4-5 minutes, the rubbing speed can be increased to induce ejaculation.

Although this training method is simple, the following points should be noted: ① The direction of pressure applied during penile squeezing is back-to-back, not side-to-side. ② The woman should use her fingertips, not her nails, to pinch or scratch the penis. ③ The squeezing pressure should be controlled so that the man does not feel pain. The squeezing force should be proportional to the degree of erection; the harder the erection, the greater the pressure. If the erection is weak or flaccid, the pressure should be lighter. ④ The man's attention should be focused on the sensations produced by penile stimulation, rather than worrying excessively about when he will ejaculate. Once ejaculation occurs, there should be no anxiety or guilt, but rather the focus should be on the orgasmic sensation. The woman providing the stimulation is most effective; if the man does it himself, the effect is much less.

What is stop-motion therapy?

The stop-start technique was first proposed by Helen Singer Kaplan. It primarily involves continuously stimulating the penis to reduce its sensitivity, thereby increasing the ejaculation threshold. The specific method is as follows.

The man lies on his back, focusing entirely on the sensations produced by the woman stimulating his penis. The woman sits beside him or between his legs, gently stroking his penis until it becomes erect. When the man indicates he is about to reach orgasm, she stops stroking and allows his arousal to subside. After a few minutes, the woman resumes stroking, re-exciting the man. This process is repeated, gradually increasing the patient's tolerance for high levels of stimulation without ejaculation. The number of breaks gradually decreases until eventually, he can withstand prolonged, continuous stimulation without premature ejaculation, without needing to rest.

This training can also be done by the man himself through masturbation, experiencing the intensity and method of stimulation. Similar training can also be performed during intercourse, such as reducing the amplitude and speed of penile thrusting or pausing thrusting to reduce sexual arousal, and then thrusting again just before the penis becomes flaccid. Repeating this process can prolong intercourse, allowing ejaculation to occur only after the woman reaches orgasm.

Can topical medications treat premature ejaculation?

Nowadays, advertisements for various drugs for premature ejaculation are popping up all over the internet and in the media, especially topical medications that claim to be "the nemesis of premature ejaculation," "guaranteed to work with one use," and "effective with just one spray." Are they really that magical?

In reality, no matter how enticing the advertisements are, whether it's a spray or an ointment, topical medications for the genitals are primarily local anesthetics. For example, the heavily advertised SS cream is a topical ointment made from nine kinds of traditional Chinese herbs used to treat premature ejaculation, and it has a local anesthetic effect. When using topical medications, they should be applied or sprayed onto sensitive areas such as the glans penis, coronal sulcus, and frenulum before intercourse. The local anesthetic effect reduces the input of sexual stimulation, lowers the sensitivity of the glans penis, and can prolong ejaculation time. It is generally believed that the medication can penetrate the glans penis within 5-20 minutes after application, and its effects are noticeable in a short time.

It is important to note that after using local anesthetic, if a condom is not used, it is best to wash off any residual medication from the penis before intercourse. Otherwise, the residue can cause vaginal numbness in the woman, reducing sexual pleasure. This treatment method is contraindicated if the patient or sexual partner is allergic to the local anesthetic.

While local anesthetics can be effective, there is a lack of formal clinical trial results to confirm this. Some people, in pursuit of maximum effect, often use excessively high concentrations, causing penile numbness in a significant number of individuals, leading to a lack of sexual pleasure and erectile dysfunction. In more severe cases, it can even result in delayed ejaculation or anejaculation.

What are some commonly used oral medications for treating premature ejaculation?

Because behavioral therapy requires long-term cooperation from the female partner and guidance from a professional doctor, the long-term efficacy of this treatment is often unsatisfactory due to the inability of most patients to adhere to the regimen. Topical medications often lead to decreased sensitivity to sexual stimulation, and many patients are unwilling to use medication before each sexual encounter. Therefore, oral medications have become the preferred treatment for premature ejaculation.

Currently, the most commonly used medications for treating premature ejaculation are antidepressants. Yes, you read that right, antidepressants. Why is that? Because these drugs can increase the level of a neurotransmitter in the brain called serotonin, which can enhance the brain's ability to control ejaculation. This discovery stemmed from reports of delayed ejaculation as a side effect when patients were treated for depression. Urologists believed these drugs had the potential to treat premature ejaculation, so they became very interested in this side effect and used it to treat premature ejaculation, achieving relatively ideal results. Now, these drugs have become the first-line treatment for premature ejaculation.

In recent years, selective serotonin reuptake inhibitors (SSRIs) have been widely used antidepressants due to their fewer side effects and higher safety profile, making them popular with both doctors and patients. Commonly used medications include paroxetine, sertraline, and fluoxetine, which require daily administration. The advantage of long-term use is that patients have more freedom in choosing when to ejaculate. The medication typically takes effect within a few days, causing delayed ejaculation, with the effect becoming more pronounced after 1-2 weeks and reaching its peak effect after 1-2 months. Due to economic reasons and concerns about adverse drug reactions, on-demand treatment remains attractive to some patients. In such cases, the new drug dapoxetine can be taken orally. It is currently the only approved medication for treating premature ejaculation, a fast-acting and effective serotonin reuptake inhibitor that can be taken orally as needed. This drug is rapidly absorbed and quickly eliminated, preventing accumulation.

While serotonin reuptake inhibitors (SRIs) are often effective, they are not always. Because antidepressants primarily act on the brain, they often affect multiple neurotransmitter systems, resulting in a wide variety of side effects. Common adverse reactions include dizziness, headache, fatigue, drowsiness, yawning, nausea, vomiting, dry mouth, mild nasal congestion, diarrhea, and sweating; these are usually mild and gradually subside after 2-3 weeks. Other side effects reported include decreased libido, loss of sexual pleasure, ejaculatory dysfunction, and erectile dysfunction. It is important to note that long-term users should not abruptly discontinue their medication to prevent withdrawal syndrome.