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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 31334
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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Hi, I am a 25 year old male who suffers HORRIBLY from premature

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Hi, I am a 25 year old male who suffers HORRIBLY from premature ejaculation. I first tried extended pleasure condoms and they didnt work at all. Then coincidentally I was diagnosed with depression. I was prescribed 40mg of celexa once a day. I read online that it is also starting to be prescribed off label for premature ejaculation so I was excited that the SSRI would have a positive affect on my sex life. But still after being on it for 3 years have I ever had it delay an orgasm. So to sum it up, benzocaine on my penis does not work nor do SSRI medications work. Do I have any other options? I am desperate enough that I'd even have an operation at this point. Its ruining my self esteem and self confidence and makes me want to only have sex with hookers because they wont judge my performance. Thanks in advance doc.



The causes of premature ejaculation are mostly complex and sometimes difficult to ascertain as they can be collectively due to various factors like;


1) Hormonal

2) 5 HT dysfunction

3) Hyperexcitable ejaculation or hyperarousability

4) Penis hypersensitivity

5) Poor ejaculatory control

6) Infrequent sex

7) Anxiety

8) Performance stress


One or many factors can play role simultaneously. Urologist's assessment would be able to give the clue and then are dealt appropriately.


Following measures are helpful for premature ejaculation;


1) Application of lidocaine / benzocaine on glans about 20-30 minutes before the intercourse (which you have already tried).

2) Learning of squeeze technique; your physician or urologist can give counsel about this (you learn to squeeze the erect penile shaft before the ejaculatory reflex is stimulated; see the resource also)

3) Medical therapy;

a) clomipramine, phenoxybenzamine are the medication which can be helpful to you.

b) Numerous studies have shown that selective serotonin reuptake inhibitors (SSRIs) and drugs with SSRI-like side effects are safe and effective to treat premature ejaculation. So following medications can help (if one is not helpful, other should be tried);


1) Sertraline

2) Fluoxetine

3) Clomipramine

4) Paroxetine

5) Citalopram


The other way suggested is the masturbate 3-4 hours before the sex. The ejaculation is significantly delayed than with the sexual act, if you get an erection in 3-4 hours.

4) Female up position; this delays the ejaculation

5) Avoidance of stress: performance stress, again increases the premature ejaculation and aggravate the situation.

6) Talk to your physician about the problem in the presence of your partner and together this can be easily handled.

7) Sex therapy sessions.


Read this resource;


So a combination of treatment together would help.


Please feel free for your follow up questions.


I would be happy to assist you further, if you need any more information.


Dr. Arun
Customer: replied 4 years ago.
Ok, that sounds great and I am totally satisfied with the suggestions you gave me. Another quick question on an unrelated note if you dont mind. I have horrible pain in my right knee due to a high school football injury. I have been to numerous Drs and not 1 of them will prescribe me an opioid medication due to the possibility of addiction. I am suffering in pain with no history of addiction or addictive behavior and they are denying my medication such as hydrocodon/apap or oxycodone/apap. I have tried every NSAID under the sun as well as physical therapy. I feel they are being inhumane by making me suffer through this pain. Any advice?
Customer: replied 4 years ago.
Could you answer that last one for me doc?

Sorry for the delay. I was on another question.

An MRI would be required to assess the injury. If it is meniscus or ligament injury; an arthroscopic surgery would help. Opioid in a young person is not an answer. This need a definite fixation by a proper assessment.

It is privilege assisting you.

Dr. Arun
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