Premature Ejaculation & Sexual Dysfunction
Comprehensive integrative medicine approach for lasting healing and complete recovery
Understanding Premature Ejaculation & Sexual Dysfunction
Premature ejaculation (PE) is a common sexual dysfunction characterized by persistent or recurrent ejaculation occurring within approximately one minute of vaginal penetration (lifelong PE) or a clinically significant reduction in latency time (acquired PE), accompanied by an inability to delay ejaculation and associated with negative personal consequences such as distress, frustration, or avoidance of sexual intimacy. It involves complex interactions between neurobiological, psychological, and hormonal factors, where heightened penile sensitivity, altered serotonin neurotransmission, and autonomic nervous system dysregulation contribute to reduced ejaculatory control.
Recognizing Premature Ejaculation & Sexual Dysfunction
Common symptoms and warning signs to look for
Ejaculating within 1-2 minutes of penetration, often before you or your partner are satisfied
Feeling unable to control or delay ejaculation despite trying various techniques
Experiencing anxiety or dread about sexual performance before intimacy begins
Avoiding sexual encounters or relationships due to fear of disappointing your partner
Feeling frustrated, embarrassed, or inadequate after sexual encounters
Noticing ejaculation occurs with minimal stimulation or even before penetration
What a Healthy System Looks Like
Healthy ejaculatory function involves a precisely coordinated neurophysiological cascade. Sexual stimulation activates sensory nerve endings in the penis, transmitting signals via the pudendal nerve to the spinal cord and brain. The ejaculatory reflex is regulated by the central nervous system, particularly the medial preoptic area and paraventricular nucleus, with serotonin (5-HT) acting as the primary inhibitory neurotransmitter that delays ejaculation. Normal ejaculatory latency time (ELT) ranges from 4-10 minutes during vaginal intercourse, though significant variation exists. The process involves three phases: emission (seminal fluid accumulation in the posterior urethra), expulsion (rhythmic contractions of pelvic muscles), and orgasm. Healthy function requires balanced autonomic nervous system activity (sympathetic control of emission, somatic control of expulsion), adequate serotonin neurotransmission, normal penile sensitivity thresholds, psychological relaxation, and harmonious communication between partners.
How the Condition Develops
Understanding the biological mechanisms
Premature ejaculation develops through multiple interconnected mechanisms: (1) Neurobiological factors - Reduced serotonin (5-HT) neurotransmission, particularly involving 5-HT1A receptor hypersensitivity and 5-HT2C receptor hyposensitivity, decreases inhibitory control over the ejaculatory reflex. Genetic polymorphisms in the 5-HT transporter gene may predispose to PE. (2) Penile hypersensitivity - Lower threshold for penile sensory stimulation triggers the ejaculatory reflex prematurely; this may involve heightened nerve fiber density or increased receptor sensitivity in the glans and frenulum. (3) Autonomic nervous system dysregulation - Excessive sympathetic tone or reduced parasympathetic activity impairs ejaculatory control; some men exhibit hyperarousal patterns with rapid progression through the sexual response cycle. (4) Hormonal influences - Low progesterone (which has inhibitory effects on ejaculation), altered testosterone-to-estrogen ratios, and thyroid dysfunction can affect ejaculatory latency. (5) Inflammatory factors - Chronic prostatitis and pelvic floor dysfunction can cause hypersensitivity and reduced control. (6) Psychological factors - Performance anxiety creates a vicious cycle where fear of premature ejaculation triggers sympathetic arousal, which actually accelerates ejaculation; depression and relationship stress further impair control. (7) Genetic predisposition - Twin studies suggest 30-40% heritability, with variations in genes controlling serotonin and dopamine pathways.
Key Laboratory Markers
Important values for diagnosis and monitoring
| Test | Normal Range | Optimal | Significance |
|---|---|---|---|
| Total Testosterone | 300-1000 ng/dL | 500-700 ng/dL | Low testosterone may contribute to sexual dysfunction; optimal levels support healthy sexual function |
| Free Testosterone | 65-210 pg/mL | 100-150 pg/mL | Bioavailable testosterone; more accurate indicator of tissue availability |
| Progesterone | 0.1-1.0 ng/mL (males) | 0.3-0.8 ng/mL | Progesterone has inhibitory effects on ejaculation; low levels may reduce ejaculatory control |
| Prolactin | 2-18 ng/mL | 4-12 ng/mL | Elevated prolactin can cause sexual dysfunction; very low may also impair function |
| Thyroid Stimulating Hormone (TSH) | 0.45-4.5 mIU/L | 1.0-2.0 mIU/L | Thyroid dysfunction can affect sexual function and ejaculatory control |
| Free T3 (Triiodothyronine) | 2.3-4.2 pg/mL | 3.0-3.8 pg/mL | Active thyroid hormone; low levels associated with sexual dysfunction |
| Free T4 (Thyroxine) | 0.8-1.8 ng/dL | 1.0-1.5 ng/dL | Thyroid function marker; imbalances affect metabolism and sexual health |
| Estradiol (E2) | 10-50 pg/mL | 20-30 pg/mL | Elevated estrogen relative to testosterone can affect sexual function |
| DHEA-S (Dehydroepiandrosterone Sulfate) | Male: 252-634 mcg/dL | 300-450 mcg/dL | Adrenal androgen; supports overall hormonal balance and sexual function |
| Cortisol (Morning) | 5-25 mcg/dL | 12-20 mcg/dL | Chronic stress elevates cortisol, which can impair sexual function |
| Serotonin Metabolites (5-HIAA) | 2-12 mg/24hr (urine) | 6-10 mg/24hr | Low serotonin associated with reduced ejaculatory control |
| Dopamine | 0-30 pg/mL | 10-25 pg/mL | Neurotransmitter balance affects sexual response and control |
| Vitamin D (25-OH) | 30-100 ng/mL | 60-80 ng/mL | Deficiency associated with sexual dysfunction and hormonal imbalance |
| Zinc | 70-120 mcg/dL (serum) | 90-120 mcg/dL | Essential for testosterone production and prostate health |
| Magnesium (RBC) | 4.2-6.8 mg/dL | 5.5-6.5 mg/dL | Supports nervous system function and muscle control |
| Homocysteine | 5-15 micromol/L | <8 micromol/L | Elevated levels indicate methylation issues affecting neurotransmitters |
| hs-CRP (High-Sensitivity C-Reactive Protein) | <3 mg/L | <1 mg/L | Inflammation marker; chronic inflammation affects sexual function |
Root Causes We Address
The underlying factors contributing to your condition
{"cause":"Neurobiological Factors - Serotonin Dysregulation","contribution":"40-50%","assessmentApproach":"Evaluation of neurotransmitter metabolites (5-HIAA), genetic testing for 5-HT transporter polymorphisms, assessment of medication history, response to SSRIs as diagnostic trial"}
{"cause":"Psychological Factors - Performance Anxiety","contribution":"25-35%","assessmentApproach":"Comprehensive psychosexual history, anxiety screening (GAD-7), assessment of sexual beliefs and expectations, evaluation of early sexual experiences, relationship dynamics assessment"}
{"cause":"Penile Hypersensitivity","contribution":"15-25%","assessmentApproach":"Penile sensitivity testing (biothesiometry), evaluation of response to topical anesthetics, assessment of frenulum and glans sensitivity, nerve conduction studies if indicated"}
{"cause":"Hormonal Imbalances","contribution":"10-20%","assessmentApproach":"Comprehensive hormone panel (testosterone, progesterone, prolactin, thyroid), assessment of symptoms of hormonal dysfunction, correlation with other hormonal symptoms"}
{"cause":"Pelvic Floor Dysfunction","contribution":"10-15%","assessmentApproach":"Pelvic floor physical therapy evaluation, assessment of muscle tone and coordination, identification of trigger points, evaluation of urinary symptoms"}
{"cause":"Prostatitis and Inflammation","contribution":"5-15%","assessmentApproach":"Prostate examination, assessment for pelvic pain, urinalysis and culture, evaluation of urinary symptoms, response to anti-inflammatory treatment"}
{"cause":"Genetic Predisposition","contribution":"30-40% heritability in lifelong PE","assessmentApproach":"Family history evaluation, genetic testing for serotonin-related polymorphisms, assessment of onset (lifelong vs acquired), response patterns"}
{"cause":"Thyroid Dysfunction","contribution":"5-10%","assessmentApproach":"Thyroid function testing (TSH, Free T4, Free T3), assessment of other thyroid symptoms, correlation between thyroid status and PE severity"}
{"cause":"Substance Use and Medications","contribution":"5-10%","assessmentApproach":"Comprehensive medication and substance use history, assessment of temporal relationship between substance use/withdrawal and PE onset, evaluation of drug interactions"}
{"cause":"Relationship and Sexual Factors","contribution":"10-20%","assessmentApproach":"Relationship satisfaction assessment, sexual communication evaluation, assessment of sexual techniques and patterns, partner interview if possible"}
Risks of Inaction
What happens if left untreated
{"complication":"Progressive Relationship Deterioration","timeline":"6-24 months","impact":"Unaddressed PE leads to increasing sexual avoidance, emotional distance, partner resentment, and relationship breakdown. Sexual dissatisfaction is a major predictor of relationship dissolution. Many relationships end due to untreated sexual dysfunction."}
{"complication":"Severe Psychological Distress","timeline":"Progressive","impact":"Chronic PE leads to major depression, generalized anxiety disorder, social withdrawal, and significant reduction in quality of life. Men may develop sexual aversion, social anxiety, and avoid intimate relationships entirely."}
{"complication":"Sexual Avoidance and Celibacy","timeline":"1-5 years","impact":"Men may completely avoid sexual relationships, leading to isolation, loneliness, and missed life experiences including marriage and family formation. This pattern becomes increasingly difficult to reverse with time."}
{"complication":"Development of Secondary Erectile Dysfunction","timeline":"1-3 years","impact":"Anxiety about PE can lead to ED as the nervous system becomes conditioned to associate sexual activity with failure and stress. Combined PE and ED are more difficult to treat than either condition alone."}
{"complication":"Fertility Challenges","timeline":"When attempting conception","impact":"Severe PE may interfere with conception if ejaculation occurs before vaginal penetration or if sexual frequency decreases due to avoidance. This adds fertility stress to existing sexual dysfunction."}
{"complication":"Substance Abuse","timeline":"Variable","impact":"Men may develop problematic alcohol or drug use attempting to self-medicate anxiety or delay ejaculation. This creates additional health problems and dependency issues."}
{"complication":"Professional and Social Impact","timeline":"Ongoing","impact":"Depression and anxiety from untreated PE affect work performance, social relationships, and overall life satisfaction. Reduced confidence may impact career advancement and social opportunities."}
{"complication":"Chronic Cycle Reinforcement","timeline":"Progressive","impact":"Each failed sexual encounter reinforces anxiety and the conditioned response of rapid ejaculation. The neural pathways become more entrenched, making treatment more challenging over time."}
How We Diagnose
Comprehensive assessment methods we use
{"test":"Comprehensive Hormonal Panel","purpose":"Identify hormonal contributors to PE","whatItShows":"Testosterone, free testosterone, progesterone, prolactin, estradiol, DHEA-S, thyroid function; hormonal imbalances affecting sexual function"}
{"test":"Neurotransmitter Metabolite Testing","purpose":"Assess serotonin and dopamine metabolism","whatItShows":"5-HIAA (serotonin metabolite), dopamine metabolites; low serotonin associated with reduced ejaculatory control; guides treatment approach"}
{"test":"Penile Biothesiometry","purpose":"Evaluate penile sensitivity","whatItShows":"Vibratory perception thresholds; heightened sensitivity correlates with PE; helps determine if topical treatments may be beneficial"}
{"test":"Pelvic Floor Physical Therapy Assessment","purpose":"Evaluate pelvic floor muscle function","whatItShows":"Muscle tone, trigger points, coordination; hypertonic pelvic floor can contribute to PE; guides physical therapy interventions"}
{"test":"Prostate and Genitourinary Examination","purpose":"Rule out prostatitis and anatomical issues","whatItShows":"Prostate inflammation, pelvic floor dysfunction, anatomical abnormalities; chronic prostatitis commonly associated with acquired PE"}
{"test":"Psychosexual Evaluation","purpose":"Assess psychological and relational factors","whatItShows":"Performance anxiety, sexual beliefs, relationship dynamics, early sexual experiences; essential for comprehensive treatment planning"}
{"test":"Intravaginal Ejaculatory Latency Time (IELT) Assessment","purpose":"Objective measurement of ejaculatory latency","whatItShows":"Baseline IELT for diagnosis and treatment monitoring; stopwatch-measured time from penetration to ejaculation"}
{"test":"Premature Ejaculation Diagnostic Tool (PEDT)","purpose":"Standardized questionnaire for PE assessment","whatItShows":"Validated 5-item questionnaire assessing control, frequency, distress, and difficulty delaying; scores >8 suggest PE"}
{"test":"Index of Premature Ejaculation (IPE)","purpose":"Comprehensive PE severity assessment","whatItShows":"Evaluates control, sexual satisfaction, and distress; useful for monitoring treatment response"}
{"test":"Nutritional and Micronutrient Testing","purpose":"Identify deficiencies affecting sexual function","whatItShows":"Zinc, magnesium, vitamin D, B-vitamins; nutritional support for nervous system and hormonal function"}
{"test":"Inflammatory Markers","purpose":"Assess systemic inflammation","whatItShows":"hs-CRP, IL-6; chronic inflammation may contribute to prostatitis and pelvic dysfunction"}
{"test":"Genetic Testing (if indicated)","purpose":"Identify genetic predispositions","whatItShows":"5-HT transporter gene polymorphisms (5-HTTLPR); may guide SSRI selection and predict response"}
Our Treatment Approach
How we help you overcome Premature Ejaculation & Sexual Dysfunction
Phase 1: Assessment and Immediate Symptom Management (Weeks 1-4)
{"phase":"Phase 1: Assessment and Immediate Symptom Management (Weeks 1-4)","focus":"Comprehensive evaluation, establish baseline, and begin behavioral interventions","interventions":["Complete diagnostic workup: hormonal panel, neurotransmitter assessment, penile sensitivity testing, pelvic floor evaluation","Psychosexual counseling to address performance anxiety and establish realistic expectations","Begin behavioral techniques: stop-start method, squeeze technique, sensate focus exercises","Introduce topical treatments if indicated: lidocaine-prilocaine cream or spray to reduce penile sensitivity","Pelvic floor physical therapy assessment and initial exercises","Address modifiable factors: sleep optimization, stress management, substance use reduction","Partner education and involvement in treatment plan","Establish baseline IELT measurement for monitoring progress","Begin foundational supplements: magnesium, zinc, vitamin D, B-complex","Address any identified prostatitis or pelvic inflammation"]}
Phase 2: Targeted Intervention and Skill Building (Weeks 4-12)
{"phase":"Phase 2: Targeted Intervention and Skill Building (Weeks 4-12)","focus":"Implement specific treatments based on identified causes and build ejaculatory control skills","interventions":["Pharmacological intervention if indicated: SSRI therapy (dapoxetine, paroxetine, sertraline) or PDE5 inhibitors for combined PE/ED","Advanced behavioral therapy: cognitive-behavioral techniques, mindfulness-based sex therapy","Progressive pelvic floor rehabilitation: biofeedback, muscle relaxation techniques, coordination exercises","Continue topical treatments with optimization of application timing and technique","Hormonal optimization if deficiencies identified: testosterone replacement, progesterone support","Thyroid treatment if dysfunction present","Couples therapy to improve sexual communication and reduce performance pressure","Masturbation retraining exercises to build awareness and control","Introduction of thicker condoms or multiple condoms to reduce stimulation","Acupuncture for nervous system regulation and pelvic floor relaxation","Regular monitoring of IELT and PEDT scores to track progress"]}
Phase 3: Consolidation and Confidence Building (Months 3-6)
{"phase":"Phase 3: Consolidation and Confidence Building (Months 3-6)","focus":"Solidify gains, reduce reliance on aids, and build sexual confidence","interventions":["Gradual reduction of topical anesthetics as control improves","Maintenance SSRI therapy or transition to on-demand dosing if appropriate","Advanced sexual techniques: edging, pacing, communication skills with partner","Continued pelvic floor maintenance exercises","Address any remaining psychological barriers through ongoing counseling","Optimization of hormonal status with regular monitoring","Integration of successful strategies into regular sexual routine","Building sexual spontaneity and reducing performance focus","Maintenance supplementation and lifestyle practices","Regular follow-up to prevent relapse and address setbacks"]}
Phase 4: Maintenance and Long-Term Optimization (Month 6+)
{"phase":"Phase 4: Maintenance and Long-Term Optimization (Month 6+)","focus":"Sustain improvements, prevent relapse, and optimize sexual wellbeing","interventions":["Personalized maintenance protocol based on individual response","Ongoing sexual communication skills with partner","Periodic reassessment of hormonal status (every 6-12 months)","Maintenance pelvic floor exercises and stress management practices","Continued attention to sleep, nutrition, and lifestyle factors","Early intervention protocols if symptoms recur","Relationship maintenance and ongoing intimacy building","Long-term psychological wellbeing and confidence","Annual comprehensive sexual health assessment","Lifestyle optimization for overall sexual health and vitality"]}
Diet & Lifestyle
Recommendations for optimal recovery
Lifestyle Modifications
Regular aerobic exercise: 150 minutes weekly - reduces anxiety, improves cardiovascular health, Resistance training: 2-3x weekly - supports testosterone production, Pelvic floor exercises: regular practice of relaxation and coordination (not just strengthening), Stress management: daily meditation, breathwork, or yoga - reduces sympathetic overactivity, Sleep optimization: 7-9 hours nightly - supports hormonal balance and recovery, Limit pornography use: can create unrealistic expectations and desensitization, Practice mindful masturbation: build awareness of arousal levels and control, Communicate openly with partner: reduce performance pressure through honest dialogue, Schedule sexual encounters: reduce anxiety by planning rather than spontaneous pressure, Focus on pleasure rather than performance: shift mindset from achievement to enjoyment, Use lubrication: reduces friction and can help delay ejaculation, Try different sexual positions: some positions provide less stimulation and more control, Take breaks during sexual activity: pause when approaching high arousal, Practice relaxation techniques before intimacy: deep breathing, progressive muscle relaxation, Avoid rushing: create adequate time for sexual encounters without time pressure, Maintain healthy weight: obesity affects hormones and cardiovascular function, Quit smoking: smoking impairs vascular function and sexual health
Recovery Timeline
What to expect on your healing journey
Phase 1 (Weeks 1-4): Assessment and Initial Intervention - Comprehensive evaluation completed; behavioral techniques introduced; topical treatments initiated if indicated; initial improvements in some men using topical anesthetics; psychosexual counseling begins addressing anxiety.
Phase 2 (Weeks 4-12): Active Treatment - SSRIs or other medications reach therapeutic effect (1-2 weeks for daily SSRIs); behavioral techniques become more effective with practice; pelvic floor therapy progresses; IELT typically increases by 2-4 minutes; confidence begins improving.
Phase 3 (Months 3-6): Consolidation - Significant improvement in ejaculatory control for most men; ability to engage in satisfying sexual activity; reduction in performance anxiety; many men achieve IELT of 4-8 minutes; sexual satisfaction improves for both partners.
Phase 4 (Month 6+): Maintenance - Sustained improvement with continued practice; some men may reduce or discontinue medications while maintaining gains; behavioral techniques become natural; ongoing attention to relationship and sexual health.
Note: Individual timelines vary significantly. Lifelong PE may require ongoing management, while acquired PE may resolve completely. Consistency with treatment and partner involvement significantly impact outcomes.
How We Measure Success
Outcomes that matter
Intravaginal ejaculatory latency time (IELT) increased to 4+ minutes or satisfactory duration
Improved sense of control over ejaculation (self-rated 7+/10)
Reduction in distress related to PE (PEDT score <8)
Increased sexual satisfaction for both partners
Reduced performance anxiety and anticipatory worry
Ability to delay ejaculation using learned techniques
Improved sexual confidence and self-esteem
Reduced avoidance of sexual intimacy
Improved relationship satisfaction and communication
Normalization of penile sensitivity if previously elevated
Hormonal optimization if deficiencies were present
Resolution of prostatitis or pelvic floor dysfunction if contributing
Ability to engage in spontaneous sexual activity without excessive preparation
Maintenance of gains at 6 and 12-month follow-up
Reduced or eliminated need for topical anesthetics
Successful medication tapering if appropriate (for some cases)
Overall improvement in quality of life and wellbeing
Frequently Asked Questions
Common questions from patients
Is premature ejaculation a permanent condition?
No, premature ejaculation is highly treatable. Lifelong PE may require ongoing management, but significant improvement is achievable for most men. Acquired PE often resolves completely when underlying causes are addressed. With proper treatment combining behavioral techniques, possible medication, and addressing root causes, most men achieve substantial improvement in ejaculatory control and sexual satisfaction.
What is considered a 'normal' time to ejaculation?
The average time from penetration to ejaculation (IELT) is approximately 5.4 minutes, though there is wide variation. Medically, PE is defined as ejaculation within approximately 1 minute of penetration for lifelong PE, or a significant reduction in latency time for acquired PE. However, what matters most is whether ejaculation occurs before the man or his partner wishes it, and whether it causes distress. Some men with 3-4 minute latency may still experience PE if it causes dissatisfaction.
Can anxiety really cause premature ejaculation?
Yes, anxiety is a major contributor to PE. Performance anxiety activates the sympathetic nervous system (fight-or-flight), which paradoxically accelerates ejaculation. This creates a vicious cycle: anxiety about PE leads to PE, which increases anxiety. The nervous system becomes conditioned to associate sexual activity with stress and rapid ejaculation. Addressing anxiety through therapy, relaxation techniques, and sometimes medication is often essential for treatment success.
Do SSRIs (antidepressants) help with premature ejaculation?
Yes, SSRIs are the most effective pharmacological treatment for PE. They increase serotonin levels, which inhibits the ejaculatory reflex and delays ejaculation. Dapoxetine is specifically approved for on-demand PE treatment. Other SSRIs like paroxetine, sertraline, and fluoxetine are used off-label with daily dosing. Side effects may include decreased libido, erectile dysfunction, and nausea. Benefits typically begin within 1-2 weeks of daily use.
Can pelvic floor exercises help with premature ejaculation?
Yes, pelvic floor physical therapy can be very effective, especially for acquired PE. Many men with PE have hypertonic (overly tight) pelvic floor muscles or poor muscle coordination. Learning to relax these muscles and coordinate contractions can significantly improve ejaculatory control. A specialized pelvic floor physical therapist can assess muscle function and teach appropriate exercises, which differ from standard Kegel exercises.
Is premature ejaculation related to low testosterone?
While PE is not directly caused by low testosterone, hormonal imbalances can contribute to sexual dysfunction. Low testosterone may reduce sexual confidence and affect overall sexual function. Some studies suggest progesterone (which has inhibitory effects on ejaculation) may be more relevant than testosterone. Comprehensive hormone testing helps identify if hormonal factors are contributing to PE in individual cases.
Medical References
- 1.1. Althof SE, et al. (2014). An Update of the International Society of Sexual Medicine's Guidelines for the Diagnosis and Treatment of Premature Ejaculation (PE). Sex Med. 2(2):60-90. doi:10.1002/sm2.28
- 2.2. Serefoglu EC, et al. (2011). Prevalence of the complaint of ejaculating prematurely and the four premature ejaculation syndromes: results from the Turkish Society of Andrology Sexual Health Survey. J Sex Med. 8(2):540-548. doi:10.1111/j.1743-6109.2010.02127.x
- 3.3. Waldinger MD, et al. (1998). Familial occurrence of primary premature ejaculation. Psychiatr Genet. 8(1):37-40. doi:10.1097/00041444-199803000-00006
- 4.4. Jern P, et al. (2009). Premature and delayed ejaculation: genetic and environmental effects in a population-based sample of Finnish twins. J Sex Med. 6(11):2991-2999. doi:10.1111/j.1743-6109.2009.01427.x
- 5.5. Giuliano F, et al. (2008). Premature ejaculation: results from a five-country European observational study. Eur Urol. 53(5):1048-1057. doi:10.1016/j.eururo.2007.10.015
- 6.6. McMahon CG, et al. (2012). Standard operating procedures in the disorders of orgasm and ejaculation. J Sex Med. 9(1):204-229. doi:10.1111/j.1743-6109.2011.02583.x
- 7.7. Porst H, et al. (2007). The Premature Ejaculation Prevalence and Attitudes (PEPA) survey: prevalence, comorbidities, and professional help-seeking. Eur Urol. 51(3):816-823. doi:10.1016/j.eururo.2006.07.004
- 8.8. Symonds T, et al. (2003). Development and validation of a premature ejaculation diagnostic tool. Eur Urol. 44(6):587-594. doi:10.1016/s0302-2838(03)00399-6
- 9.9. Waldinger MD. (2002). The neurobiological approach to premature ejaculation. J Urol. 168(6):2359-2367. doi:10.1097/01.ju.0000033418.70676.0f
- 10.10. Andersson KE, et al. (2013). Pharmacology of phosphodiesterase-5 inhibitors and their use in premature ejaculation. Int J Impot Res. 25(6):206-211. doi:10.1038/ijir.2013.22
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