Start-stop technique

This method involves stimulating the penis until just before orgasm and then stopping until the urge to ejaculate goes away. This is repeated several times so the man can learn to recognize the phase of sexual arousal that occurs before orgasm. During that phase the level of arousal can still be controlled and ejaculation can still be delayed for a certain time.

Squeeze technique

In the squeeze technique, the penis is also stimulated until just before orgasm. Then you put a little bit of pressure on the head of the penis to decrease the level of arousal. This can be done by putting your index finger on the back side of the penis (where the head joins the shaft) and placing your thumb on the other side of the penis, and then gently squeezing. After that you wait for about 30 seconds and then repeat the steps several times in a row.

Pelvic floor exercises

Another option is to do pelvic floor exercises regularly. The pelvic floor is the layer of muscles that supports things like the sphincter muscle of the urethra (pee tube). The exercises are done to learn how to voluntarily move the pelvic floor muscles and then strengthen them through training.

How effective are these techniques?

There is no good-quality research on how well these techniques help to reduce premature ejaculation. There are only individual studies, each involving fewer than 40 couples or men.

In one small study the start-stop method and the squeeze method increased the time it took until ejaculation was reached by a few minutes after twelve weeks of training. In these studies, the methods were used as part of sex therapy, though. In sex therapy the possible psychological causes of premature ejaculation are treated – as well as problems like self-doubt or relationship conflicts. So it’s not clear what benefits these techniques have when a man uses them on his own.

Another small study looked at pelvic floor exercises. In that study, the exercises were able to increase the time until ejaculation from half a minute to two minutes on average.

What else men can try

Sometimes men are advised to think about something else during sex to distract themselves and delay ejaculation. Some find that helpful. But others say that that causes their erection to get weaker or go away completely. Some men think it's dishonest to their partner to think about something else during sex.

Another option is to use a condom if you don't already. This makes the penis less sensitive. Some men find it helpful to masturbate before sex. When they are then aroused for a second time and have sex, ejaculation will be delayed. But that only works if the man can achieve a second erection. You can also try slowing things down during foreplay or taking breaks.

If you're in a long-term relationship, it’s a good idea to talk openly about the problem to help find solutions together – even though it's such a sensitive issue.

Sources

• Cooper K, Martyn-St James M, Kaltenthaler E, Dickinson K, Cantrell A. Interventions to treat premature ejaculation: a systematic review short report. Health Technol Assess 2015; 19(21): 1-180, v-vi. [PMC free article: PMC4781071] [PubMed: 25768099]
• Cooper K, Martyn-St James M, Kaltenthaler E, Dickinson K, Cantrell A, Wylie K et al. Behavioral Therapies for Management of Premature Ejaculation: A Systematic Review. Sex Med 2015; 3(3): 174-188. [PMC free article: PMC4599555] [PubMed: 26468381]
• Giuri S, Caselli G, Manfredi C, Rebecchi D, Granata A, Ruggiero GM et al. Cognitive Attentional Syndrome and Metacognitive Beliefs in Male Sexual Dysfunction: An Exploratory Study. Am J Mens Health 2017; 11(3): 592-599. [PMC free article: PMC5675226] [PubMed: 27283433]
• Revicki D, Howard K, Hanlon J, Mannix S, Greene A, Rothman M. Characterizing the burden of premature ejaculation from a patient and partner perspective: a multi-country qualitative analysis. Health Qual Life Outcomes 2008; 6: 33. [PMC free article: PMC2390524] [PubMed: 18474090]

• IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. We do not offer individual consultations.

  Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.