Präejakulation ist die häufigste sexuelle Beschwerde, die Männer äußern, und sie gehört zu den am besten behandelbaren. Ärzte legen die Grenze bei etwa einer Minute an. „Lebenslang“ bedeutet, dass die Ejakulation immer innerhalb von etwa einer Minute nach dem Eindringen erfolgt; „erworben“ bezeichnet einen Mann, der früher länger durchhielt, nun aber schnell zum Höhepunkt kommt. Mehrere Maßnahmen verlängern die Zeit. Beckenbodentraining ist durch eine Studie belegt und kostet nichts, sobald man es erlernt hat, und die Start-Stopp- sowie die Klemmtechnik ergänzen dies.
Ein betäubendes Spray oder eine Creme, die wenige Minuten vor dem Sex aufgetragen wird, wirkt schnell und zuverlässig. Dapoxetin bei Bedarf und täglich eingenommene SSRI außerhalb der Zulassung (off-label), wie Paroxetin, verlängern die Zeit am stärksten, jeweils mit ihren eigenen Nebenwirkungen; Tramadol bei Bedarf wirkt ebenfalls, kann aber abhängig machen. Wenn ein Nachlassen der Erektionsfestigkeit den Drang auslöst, muss zuerst die Erektion behandelt werden.
Practice Ranking
Every practice we track for Premature Ejaculation: what lengthens the time, and how well, ranked by how well the evidence supports it for this condition. Strength describes the evidence, not our endorsement.
2 practices · 1 to start with
| # | Practice | Evidence | Type | Cost | Effort | Results In | Add to plan |
|---|---|---|---|---|---|---|---|
| 1 | Pelvic Floor Muscle Training: What It Does, Why Technique Makes It Work, and How to Start Pelvic-floor training lengthened time to ejaculation to about 146 seconds in most men who did it; the empower-first place to begin. | Emerging | Self-Directed | Free to $$ | Easy to Moderate | Weeks to Months | |
| 2 | Acupuncture: What the Evidence Shows, Where It Helps Most, and How to Start Preliminary evidence for delay. | Preliminary | Self-Directed | Free to $$$ | Easy to Moderate | Weeks to Months | |
Default order puts the best-supported practices first, with self-directed care ahead of clinical options. Click any row to open the practice.
What It Is
Premature ejaculation is ejaculation that arrives sooner than a man wants it to, most often within about a minute of penetration. An international expert committee drew two clinical lines. Lifelong premature ejaculation has come within roughly a minute from the very first sexual experiences, together with an inability to delay it and real distress. Acquired premature ejaculation is a clear drop in a man who used to have normal control, often to about three minutes or less. The measured figure has a name, the intravaginal ejaculatory latency, or IELT, and it is the number these studies track.
Four types point to different first moves:
- Lifelong. Fast from a man's earliest sexual experiences onward, usually within about a minute, nearly every time. It appears to run in part on serotonin biology, which is why the antidepressant-type drugs work. Behavioral work, a numbing agent, or an SSRI all help.
- Acquired. A clear change from how a man used to be, and the type most likely to have a specific cause underneath. That cause might be a new erection problem, thyroid trouble, prostate inflammation, anxiety, a new medication, or relationship strain. Finding and treating it is the first move.
- Variable or subjective. Timing that is actually normal but feels too quick, or that varies with the situation and how aroused he is. Many men here have no medical problem at all. Accurate information and open talk with a partner do most of the work.
- With an erection problem. Rushing to finish before firmness fades, so the fast finish follows a fading erection. Aiming only at the timing misses the cause.
What Works, And Where To Start
Pelvic-floor training, the start-stop and squeeze techniques, and a numbing spray each lengthen the time, and none needs a prescription. In a trial of 40 men, the training alone more than doubled the average time. The prescription drugs (on-demand dapoxetine, daily SSRIs, and tramadol) lengthen it the most and come after these self-directed steps.
The Research & Studies
Everything here is based on the research we have collected and checked, sorted into groups and ordered with the strongest evidence first. Click any claim to open the studies behind it.
Sexual Function
Numbing creams, gels and sprays beat placebo at lengthening time to ejaculation
Numbing creams and sprays put on the penis before sex reliably lengthen the time to ejaculation.
A systematic review and meta-analysis of nine randomized trials found that topical anesthetics, mainly lidocaine and prilocaine formulations (EMLA cream, lidocaine gel, and a metered lidocaine and prilocaine spray), significantly increased intravaginal ejaculatory latency and improved control and satisfaction compared with placebo, and lidocaine gel was more effective than sildenafil or paroxetine, though most of the included trials were of unclear methodological quality. Measured in: Men with premature ejaculation across randomized controlled trials of topical lidocaine and prilocaine preparations pooled in the review.. Local numbness and reduced sensation are common, and the anesthetic can transfer to a partner and dull their sensation or, rarely, cause reactions if it is not wiped off before penetration.
Who this may not transfer to:Male-specific outcome. The anaesthetic can transfer to and numb a partner of either sex if not wiped off, which is a use caution, not a measured effect in them.
The study · 1
Martyn-St James et al., topical anaesthetics for premature ejaculation: a systematic review and meta-analysis · Sex Health 2016;13(2):114-123
A numbing spray raised time to ejaculation about six-fold, to nearly four minutes
A measured spray of numbing medicine used a few minutes before sex increased the time to ejaculation about six times over in a large trial.
In two phase 3 randomized, double-blind, placebo-controlled trials, a metered-dose aerosol delivering lidocaine and prilocaine (PSD502), applied to the head of the penis about five minutes before intercourse, raised the geometric-mean intravaginal ejaculatory latency from about half a minute to about 2.6 minutes in the North American trial (256 men, roughly a 4.6-fold increase) and to about 3.8 minutes in the European trial (300 men, a 6.3-fold adjusted increase), against little change on placebo, and improved patient-reported ejaculatory control and sexual satisfaction. Measured in: Men with lifelong premature ejaculation and their female partners enrolled in multicenter phase 3 randomized controlled trials in Europe and North America.. The trials ran for a few months, so long-term durability is less certain, and mild local numbness in the man or, without wiping, in the partner was the main side effect.
Who this may not transfer to:Male-specific outcome. Partners were assessed for satisfaction, but the latency effect is measured in men; the spray can transfer numbness to a partner if not wiped off.
The studies · 2
Carson & Wyllie, improved ejaculatory latency, control and sexual satisfaction when PSD502 is applied topically in men with premature ejaculation: results of a phase III, double-blind, placebo-controlled study · J Sex Med 2010;7(9):3179-3189
Dinsmore & Wyllie, PSD502 improves ejaculatory latency, control and sexual satisfaction when applied topically 5 min before intercourse in men with premature ejaculation: results of a phase III, multicentre, double-blind, placebo-controlled study · BJU Int 2009;103(7):940-949
On-demand dapoxetine raised time to ejaculation about two-and-a-half to three-fold
Dapoxetine, a fast-acting antidepressant taken a couple of hours before sex, roughly tripled the average time to ejaculation, though nausea and dizziness led some men to stop.
An integrated analysis of large randomized, double-blind, placebo-controlled trials found that on-demand dapoxetine at 30 mg and 60 mg, taken one to three hours before intercourse, increased average intravaginal ejaculatory latency roughly two-and-a-half to three-fold and improved control, satisfaction and distress scores compared with placebo, in a dose-related way; nausea, dizziness, headache and diarrhea were the common adverse effects and the leading reasons for discontinuation. Measured in: Several thousand men with premature ejaculation pooled from multinational phase 3 randomized controlled trials of dapoxetine.. Benefit lasts only while the drug is taken, discontinuation rates were high largely because of nausea and dizziness, and dapoxetine is approved in many countries but not in the United States.
Who this may not transfer to:Male-specific outcome; not transferable to women. Trial populations spanned multiple countries and were mostly men in stable relationships.
The study · 1
McMahon et al., efficacy and safety of dapoxetine for the treatment of premature ejaculation: integrated analysis of results from five phase 3 trials · J Sex Med 2011;8(2):524-539
Daily paroxetine gave the strongest ejaculatory delay of the SSRIs
Taken every day, standard antidepressants delay ejaculation as a side effect, and paroxetine delayed it the most, but they take a week or two to work and can lower desire.
A meta-analysis of 43 SSRI and clomipramine studies (1,514 men) found that daily selective serotonin reuptake inhibitors substantially prolonged intravaginal ejaculatory latency once the drug had built up over one to two weeks of daily use. Overall efficacy across paroxetine, clomipramine, sertraline and fluoxetine was broadly comparable, but paroxetine produced the strongest ejaculatory delay, and the larger effect sizes came from the better-designed stopwatch-measured trials. Measured in: Men with premature ejaculation across drug-treatment trials, with the analysis weighting studies by whether they used real-time stopwatch measurement and a prospective controlled design.. The larger effect sizes came from the better-designed stopwatch studies while many trials were methodologically weaker, the drugs are used off-label for this purpose, and daily SSRIs can lower desire, cause sweating, or make orgasm difficult.
Who this may not transfer to:Male-specific outcome; not transferable to women. Delayed orgasm from SSRIs occurs in both sexes, but the ejaculatory-latency measure is male-specific.
The study · 1
Waldinger et al., relevance of methodological design for the interpretation of efficacy of drug treatment of premature ejaculation: a systematic review and meta-analysis · Int J Impot Res 2004;16(4):369-381
On-demand tramadol beat placebo at lengthening time to ejaculation, with a dependence risk
Tramadol, a painkiller that also delays ejaculation, worked better than placebo but can be habit-forming, so it is kept as a later option.
A systematic review and meta-analysis of randomized controlled trials found that on-demand tramadol significantly increased intravaginal ejaculatory latency compared with placebo (four trials, 721 men, P=0.0007), with a dose-related effect but high between-trial heterogeneity, while causing more nausea, dizziness, drowsiness and headache than placebo; single trials also placed it ahead of on-demand paroxetine, sildenafil and lidocaine gel. Measured in: Men with premature ejaculation across randomized controlled trials of on-demand tramadol at various doses.. Tramadol is an opioid that carries a risk of dependence and of serotonin-related interactions, the trials were mostly short, and its long-term safety in this use is not established, which is why guidelines reserve it for when other options have failed.
Who this may not transfer to:Male-specific outcome; not transferable to women.
The study · 1
Martyn-St James et al., tramadol for premature ejaculation: a systematic review and meta-analysis · BMC Urol 2015;15:6
Erection tablets help ejaculation timing mainly when an erection problem is also present
The erection tablets help premature ejaculation mostly in men who also have an erection problem, and are less convincing in men whose erections are fine.
A systematic review and meta-analysis found that phosphodiesterase type 5 inhibitors were more effective than placebo at increasing intravaginal ejaculatory latency, no more effective than SSRIs on their own, and more effective than an SSRI alone when the two were combined. In a separate randomized trial in men who had both premature ejaculation and erectile dysfunction, adding dapoxetine to a PDE5 inhibitor raised the average time to ejaculation to 5.2 minutes against 3.4 on placebo. The clearest role for these tablets is in men who also have an erection problem, where relieving the fading firmness addresses the rushing that follows from it; the benefit in men with normal erections is weaker and less consistent. Measured in: Men with premature ejaculation, including subgroups with and without co-existing erectile dysfunction, across the randomized controlled trials pooled in the review.. Many trials were small and combined a PDE5 inhibitor with other treatment, making the drug's independent effect hard to isolate, and the benefit in men with normal erections is uncertain, so this is not a first-line PE treatment on its own.
Who this may not transfer to:Male-specific outcome; not transferable to women.
The studies · 2
Martyn-St James et al., phosphodiesterase type 5 inhibitors for premature ejaculation: a systematic review and meta-analysis · Eur Urol Focus 2017;3(1):119-129
McMahon et al., efficacy and safety of dapoxetine in men with premature ejaculation and concomitant erectile dysfunction treated with a phosphodiesterase type 5 inhibitor · J Sex Med 2013;10(9):2312-2325
Pelvic-floor training raised time to ejaculation to about 146 seconds in 33 of 40 men
Training the pelvic-floor muscles raised the average time to ejaculation several times over in men with lifelong premature ejaculation, and it costs nothing once learned.
In a prospective study of 40 men with lifelong premature ejaculation, all with a baseline intravaginal ejaculatory latency of one minute or less, twelve weeks of guided pelvic-floor muscle rehabilitation raised the mean latency to about 146.2 seconds, and 33 of the 40 men (82.5%) regained control of the ejaculatory reflex; a separate prospective randomized comparison found pelvic-floor rehabilitation reached a mean latency of about 126.6 seconds, holding up reasonably against on-demand dapoxetine, which reached about 178 to 203 seconds. Measured in: Men with lifelong premature ejaculation in single-center Italian studies, one a single-arm prospective cohort and one a randomized comparison against dapoxetine.. The studies were single-center, modest in size, and depended on men learning and keeping up the technique correctly, and the single-arm design of the larger study cannot separate the training from attention and practice effects.
Who this may not transfer to:Male-specific outcome. Pelvic-floor training helps women with other pelvic conditions, but this ejaculatory finding does not transfer.
The studies · 2
Pastore et al., pelvic floor muscle rehabilitation for patients with lifelong premature ejaculation: a novel therapeutic approach · Ther Adv Urol 2014;6(3):83-88
Pastore et al., a prospective randomized study to compare pelvic floor rehabilitation and dapoxetine for treatment of lifelong premature ejaculation · Int J Androl 2012;35(4):528-533
Start-stop and squeeze added about 7 to 9 minutes over waitlist in two of four small trials
The start-stop and squeeze techniques can help a man last longer, but the evidence is thin and they work best combined with another treatment.
A systematic review of 10 randomized trials (521 men) found limited, low-quality evidence for behavioral techniques. In two of four trials comparing them against a waitlist, physical techniques such as start-stop and the squeeze increased intravaginal ejaculatory latency by about 7 to 9 minutes, while the other two found no change; three trials found that adding a behavioral technique to drug treatment gave a small extra gain of about half a minute to a minute over the drug alone, with better control and satisfaction. Measured in: Men with premature ejaculation across a small number of controlled and comparative trials of behavioral, psychotherapeutic and combined interventions.. The included trials were few, small and methodologically weak, several lacked a true control group, and the gains tended to fade once the practice stopped, so the effect size is uncertain.
Who this may not transfer to:Male-specific outcome; not transferable to women. The techniques were studied mostly in men in stable heterosexual relationships.
The study · 1
Cooper et al., behavioral therapies for management of premature ejaculation: a systematic review · Sex Med 2015;3(3):174-188
Acupuncture added about half a minute, and Chinese herbs plus an SSRI beat the SSRI alone
Some Chinese herbal formulas and acupuncture lengthened the time to ejaculation in trials, but the studies were weak, so this is promising, not settled.
A systematic review of 10 randomized trials of complementary and alternative treatments found small increases in intravaginal ejaculatory latency: acupuncture raised it about 0.55 minute over placebo in one trial, Ayurvedic herbal medicine about 0.80 minute, and Chinese herbal medicine added to an SSRI beat the SSRI alone by about 1.92 minutes, though direct comparisons favored SSRIs over Chinese herbal medicine on its own. The review concluded the overall evidence was of low quality and at high risk of bias. Measured in: Men with premature ejaculation across trials of Chinese herbal medicine, topical herbal preparations, acupuncture and other complementary treatments.. The trials were small, mostly conducted in single centers, poorly blinded and at high risk of bias, and some tested herbal products with undisclosed contents, so the size and reliability of any effect are uncertain.
Who this may not transfer to:Male-specific outcome; not transferable to women.
The study · 1
Cooper et al., complementary and alternative medicine for management of premature ejaculation: a systematic review · Sex Med 2017;5(1):e1-e18
Measurement And Diagnosis
Lifelong PE is within about one minute, acquired about three minutes or less
Ärzte sprechen von vorzeitiger Ejakulation, wenn ein Mann fast immer innerhalb von etwa einer Minute nach der Penetration zum Höhepunkt kommt und dies nicht verzögern kann, und es ihn oder eine Partnerin bzw. einen Partner belastet.
An international expert committee set an evidence-based unified definition: lifelong premature ejaculation is ejaculation that always or nearly always occurs within about one minute of vaginal penetration from the first sexual experiences, and acquired premature ejaculation is a clinically significant reduction in latency, often to about three minutes or less, in a man who previously had normal control, in both cases with an inability to delay ejaculation and with negative personal consequences such as distress or avoidance of intimacy. Measured in: Adult men, as defined by the International Society for Sexual Medicine committee reviewing the evidence on ejaculatory latency and its consequences.. The one-minute and three-minute thresholds are drawn largely from studies of vaginal intercourse and stopwatch-measured latency, so they map imperfectly onto other kinds of sex and onto how quick a man feels he is.
Who this may not transfer to:Premature ejaculation is male-specific, so the definition does not transfer to women. The latency thresholds derive mainly from studies of vaginal intercourse.
The study · 1
Serefoglu et al., an evidence-based unified definition of lifelong and acquired premature ejaculation: report of the ISSM ad hoc committee · J Sex Med 2014;11(6):1423-1441
Pelvic-Floor Training
The muscles that control the ejaculatory reflex can be trained, squeezed and released in daily sets.
In 40 men with lifelong premature ejaculation, all starting at a minute or less, twelve weeks of guided training raised the average time to about 146 seconds. Thirty-three of the 40 regained control of the reflex.
A separate small randomized trial from the same group found the training worked about as well as on-demand dapoxetine. It stacks on top of the other steps.
The Start-Stop And Squeeze Techniques
Two behavioral drills interrupt the build-up before the point of no return: stopping until the urge passes, and pinching the glans to bring arousal down. In two of four small trials, these added about seven to nine minutes compared with men who got no treatment. The other two found no change, and the gains fade if practice stops. Stacked on a drug, a behavioral technique beat the drug alone by about half a minute to a minute.
Numbing Sprays And Creams
A lidocaine and prilocaine spray or cream dulls the head of the penis. Pooled trials found the cream, gel, and metered spray reliably beat placebo, and lidocaine gel beat both sildenafil and paroxetine at lengthening the time. In two phase 3 trials, the metered spray took the average time from about half a minute to 2.6 minutes in one trial and 3.8 minutes in the other. That is a five- to six-fold increase, against little change on placebo.
The SSRIs, And Tramadol Behind Them
On-demand dapoxetine, a short-acting SSRI made for this, lengthens the time about two-and-a-half to three-fold across large pooled trials, and improves control and satisfaction. Side effects are the main reason men stop it.
Daily off-label SSRIs are a standing dose, and the delay builds over one to two weeks. In a meta-analysis, paroxetine gave the strongest delay, with clomipramine, sertraline and fluoxetine broadly comparable. Because the effect works over weeks, a daily SSRI does nothing for a man who wants help on one particular night.
On-demand tramadol, a painkiller with a serotonin action, beat placebo at lengthening the time in pooled trials. It is an opioid and can be habit-forming, so it carries more risk than the SSRI options.
When An Erection Problem Is The Root
When a man rushes because firmness is fading, the erection is the root. Treating it, often with a PDE5 inhibitor tablet, can settle the rushing on its own. Erection tablets do little for men whose erections are already firm. That is why the erection is checked and treated first, and why a new erectile problem is worth taking seriously.
Where The Evidence Runs Thin
Many over-the-counter delay products are untested, and some contain the same lidocaine or prilocaine as the tested sprays. The trials on thicker climax-control condoms are small and show a modest delay. Some Chinese herbal formulas and acupuncture lengthened the time in trials. Acupuncture added about half a minute over placebo in one study, and Chinese herbs on top of an SSRI beat the SSRI alone in others. The trials were small and at high risk of bias, so the effect is unconfirmed.
What To Do First
None of the first steps needs a prescription, and the order matters less than doing a few of them steadily. The self-directed work is yours to start today; the sprays and any prescription options are a conversation with whoever prescribes for you.
Squeeze the muscle you would use to stop your urine mid-flow, hold a few seconds, then release. Build up to daily sets over about twelve weeks, the schedule used in the trial.
Pause at the point of no return until the urge passes, or squeeze the head of the penis to let arousal drop, and build the habit over weeks. These help most stacked with pelvic-floor work, a numbing spray, or an SSRI; alone they do less.
Apply a metered numbing spray or cream a few minutes before sex, then wipe it off. It reliably lengthens the time.
If firmness is fading, treat the erection first with a prescriber. A new erection problem can also flag a circulation issue, so have it checked.
Performance anxiety worsens the problem, and open talk with a partner, plus accurate information about what is normal, does as much as any tablet for many men. This is often the whole answer for the variable, situational type.
If you want more control than the steps above give, on-demand dapoxetine works for a specific occasion and a daily SSRI works over weeks. Both are a shared decision with a prescriber who can weigh the side effects and your other medicines.
Go Deeper
- Erectile dysfunction: the erection problem that often drives the fast finish; treat it first.
- Pelvic-floor training: the reflex-control work behind the biggest self-directed gain, taught step by step.
- Nitric oxide and the endothelium: the artery-lining signal behind an erection, worth understanding when firmness fades.
- Anxiety: performance pressure worsens the timing, and open talk with a partner eases it.
Cautions For This Practice
Extra restraintEverything to be aware of is here, in one place. This practice suits most healthy people; a few situations call for real care.
Numbing agents can transfer to a partner
Lidocaine and prilocaine can pass to a partner and dull their sensation, or rarely cause a local reaction, if they are not wiped off before penetration. Applying it a few minutes before, then wiping the penis clean, or using a condom over it, keeps the effect where it is wanted.
The SSRIs, on demand and daily
Dapoxetine, paroxetine and the other SSRIs can bring nausea, dizziness, headache, sweating, lower desire, or difficulty reaching orgasm. Do not combine them with another serotonergic drug (tramadol, other antidepressants, or St John's wort) without a prescriber's guidance. The combination can push serotonin too high. A daily SSRI is tapered gradually.
Tramadol can be habit-forming
Tramadol, an opioid, carries a clear risk of dependence when taken regularly to manage timing, along with serotonin interactions with the SSRIs. If you are relying on it to last longer, raise that with your prescriber.
Start slow, be smart, read the research, and consult a professional if you have any concerns. This is here to inform your choice, not make it for you.
When to See Someone
A sudden change can have a cause worth finding. These are the signs worth acting on:
- Pain on ejaculation, blood in the semen or urine, or fever with pelvic or groin pain, which can point to a prostate or other infection that needs treating(seek urgent care)
- A new erection problem alongside the change, often the root of the rushing, and an early sign of a circulation problem(seek urgent care)
- Thoughts of low mood or self-harm that come with the distress, which are a reason to reach out for support promptly(seek urgent care)
- A sudden change from long-standing normal control, especially with a drop in sex drive, fatigue or low mood, can point to a thyroid or hormonal cause worth measuring
- A testosterone, thyroid and general blood panel is something you can arrange yourself through direct-to-consumer testing
- Premature ejaculation that began soon after starting a new medication: worth reviewing with the prescriber before you stop it
- Marked distress, avoidance of sex, or relationship strain, where talking with a partner or a therapist trained in sexual health helps
- Taking tramadol regularly to manage timing, a dependence risk worth raising with your prescriber
Most of these signs point to something treatable once it is found. If the change was sudden, see a clinician to rule out an erection, thyroid, or prostate cause before settling on a fix.
Common Questions
Is there a pill for it approved in the United States?
Not one made for it. On-demand dapoxetine, taken one to three hours before sex, is approved across much of Europe and Asia but not in the United States. American prescribers use a daily SSRI such as paroxetine off-label instead.
What if I have both premature ejaculation and erection trouble?
In men who have both, treat the erection first. Adding dapoxetine on top of erection treatment raised the average time to ejaculation to 5.2 minutes, against 3.4 minutes on placebo. An erection tablet alone often settles the timing.
Explore Related
Other pages this one connects to, by the evidence they share, the outcomes they touch, and the ground they cover.
All 13 sources on this page independently checked and cross-referenced.
Thomas Dehli, Founder & Editor, Sacred Lotus
Sacred Lotus has published Chinese medicine reference material since 2001. Integrative pages are held to the same standard as the herb and formula library: cite the source, grade the claim at its real strength, and say where the research has not looked. This page is educational and it is not medical advice. Last reviewed and updated August 9, 2026.
Evidence strength
How confidently the research supports a claim. Strength describes the evidence, not our endorsement.